Episode 12: Our Words Have the Power to Heal and Harm

In this episode, we focus on the power of language in clinical practice. We’ve all seen patients who are hypervigilant or scared of movement because they’ve heard their pelvis is unstable, their pelvic floor muscles are too weak, they have disc degeneration, etc. 

These biomechanical and kinesiopathological explanations of pain paint an image that their body is broken and they must rely on our help to fix it. So we have to consider every statement that we're making and have an intent behind it. 

How does this sound to someone who doesn’t know much about anatomy and treatment? Are we empowering or creating dependency? What are we conveying to people with our marketing? Let’s change our words to reflect our message of empowerment, from “common not normal” to “common and treatable.” 

Expectations are the key to unlocking the power of language because we're constantly setting people up for something. Our words shape patient expectations which produce chemical changes within their brain that may affect outcomes. When positive, we call this the placebo effect, and when negative it’s the nocebo effect. There are specific strategies that emphasize the negative which we may not even realize we're using. We dive into each of these and offer suggestions for reframing how we speak to people. 

Highlights from our conversation in Episode 12

• Introduction and patient examples (0:40)
• Placebo definition and effects (5:13)
• Nocebo definition and effects (7:11)
• How patients may hear our “explanations” of their pain (11:26)
• Pelvic floor marketing using nocebo language (16:59)
• Strategies to improve your communication with patients (22:33)
• #1 Reduce uncertainty / Build confidence (23:36)
• #2 Limit jargon / use layman’s terms (27:50)
• #3 Avoid ambiguity / Be clear (29:16)
• #4 De-emphasize the negative / Embrace the positive (31:47)
• #5 Focus attention on / outside of pain (32:51) 
• #6 Stop trivializing / start empathizing (37:33)
• Practice with a PT friend before you see the patient (41:25)

Thank you for listening to The Conscious Clinician. If you enjoyed this episode, please subscribe and write a review for the podcast to grow our community. Keep the conversation going by following The Conscious Clinician on Instagram and Facebook. 

Resources from Episode 12

• Episode 11: Authentic Evidence-Based Practice with Annemarie Everett, DPT, WCS (3:16)
• Placebo effect research Bendetti et al 2007 (5:41)
• Nocebo effect research from Bendetti et al 2007 (7:30)
• Quote from Bendetti et al 2007 “expecting a painful stimulus…” (8:11) 
• Nocebo effect on erectile function (9:15)
• Epidural pain based on provider language from Häuser et al 2012 (9:54)
• Unintended negative suggestion in everyday clinical practice from Häuser et al 2012 (22:50; 23:36; 27:50; 29:16; 31:47; 32:51; 37:33)
• Risk factors for pelvic girdle pain development and persistence from Clinton et al 2017 (26:05) 

Let's connect! 

• Find us on Facebook
• Stay up to date on Instagram @TheConsciousClinician
• Connect professionally over LinkedIn with Sammy & Monika