Doctors and the Nocebo Effect

The biopsy result was negative – huge relief that that possible path is closed. No surgery or radiation, though I imagine the 5% future cancer risk still applies and we will have to go on watching the nodules.

What I have to ask is why doctors so often tell one the worst before they really know the situation. In this case, all she actually knew was that my ultrasound had changed, there was a 5% chance of cancer and if it were malignant, then a further 1% of those malignancies are really aggressive. However, she talked matter-of-factly about cancer, saying if the biopsy were inconclusive, she would recommend removing the thyroid anyway.

All I needed and wanted to know was that a biopsy would be advisable just to be sure. All further info I could be told if necessary. The fact that she was so up front about cancer when I knew of the 5% risk already made it sound as if some other factor had put me into another risk bracket.

This seems a common stance from doctors. Some years back, following an MRI, my husband was told he didn’t have a brain tumor but he did have something very nasty behind his nose.

“I’m sorry,” said the doctor almost with gusto, “but I tell it like it is.”

In the days it took to get to the specialist, we lived through possible death and bereavement. Almost shaking with fear, we sat in the specialist’s office.

He laughed, “it’s a polyp!”

Does medicine never take account of the damage to patients from fear and stress? A nocebo (opposite of placebo) effect – shades of witch doctors! I remember reading of a cancer patient who was given a new drug and made great progress, until he read in the newspaper that it was ineffective. He promptly went downhill, till his doctors, while continuing the same drug, told him it was a new, better version. He improved again, until he overheard someone saying the drug was no good. He relapsed and died.

There are also studies showing that patients taking identical drugs have better outcomes when the doctor believes they will work. So if you take the nocebo effect and compound it with the physical effects of stress, Western medicine must often be counterproductive to healing.

Thought much more about being above the space of pain. Rather like being in a plane above the clouds. I remember flying transatlantic to my mother’s death, beside a man flying to his brother’s. We talked spasmodically and comfortingly. As we circled in soaring sunlight, we could see England gray and rain-shadowed beneath.

“We must remember this in the days ahead,” I said to my companion. And in the grim days that followed, the metaphor of sunlit space, cloud-softened, stayed with me as something I could one day reach again. An affirmation that life is good.

Georges Duhamel asked whether it is worse to be unhappy on a fine day, which mocks your grief, or a wet gloomy one that mirrors it. I have often pondered that, particularly when driving through budding hedgerows and warm brick villages to my mother’s funeral. Definitely sunlight – it promises a resurrection of the spirit. I remember when very ill at 20 deciding that I would like one day to die in the spring when there is hope.

About UntraveledRoads

Fascinated by life, looking for answers to chronic pain and finding unexpected gifts. Interested in people, ideas, healing and humour. I am very happily married with three children and a kitten. As English born immigrants to Canada, we have family spread overseas, a daughter in South Africa and one in England. We also run a charity in South Africa to educate black, rural South African Women. Our first girl from a rural township has just graduated as an accountant from Johannesburg University and got a good job in a bank.
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