Artikel
The context and the doctor as a drug
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Veröffentlicht: | 10. September 2018 |
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Gliederung
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Background: For years we have talked about the importance of the doctor patient relationship and the doctor drug, and in their daily work all GPs have seen how the context may modulate the patient experienced symptoms, and we have all learned about and seen placebo effects.
Modern research – which will be presented – about the effect of context on the experienced severity of many symptoms has shed new light on the effect of the doctor patient relationship as a therapeutic ‘drug’.
It is now time to realize in clinical practice that placebo, or context, in the modern and broad definition of the concept, may influences processes in the brain – and thereby also the experienced symptoms – just as much, or possibly even more, than symptom-alleviating drugs. It is also time to realize that doctors may actively modulate the total context around experienced symptoms and thus their severity. The next step is to realize that ‘nocebo’, the opposite of placebo, understood as anxiousness, mistrust and lack of relation or contact, may aggravate symptoms and thus outperform, in part or in total, the effect of e.g. analgesic drugs. The core message is that we now have a scientific understanding that can explain the observations experienced by doctors since Hippocrates; the power of the encounter between doctor and patient should not be ignored. This new knowledge has also important implications for our understanding and treatment of medically unexplained symptoms and many minor psychiatric illnesses.
These practical implications are the focus for this presentation.