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“This may hurt”: predictions in procedural disclosure may do harm

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h649 (Published 06 February 2015) Cite this as: BMJ 2015;350:h649
  1. Baruch S Krauss, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  1. Baruch.Krauss{at}childrens.harvard.edu

Open ended statements such as “You may feel something now” allow for patients’ widely varying responses to stimuli and are less likely to invoke a nocebo reaction, says Baruch S Krauss

The practice of “procedural disclosure” involves clinicians providing a description of the sensations that they assume patients are likely to experience during a procedure. The presumed rationale is threefold: as a corollary of the principle of informed consent; as part of truth telling in the clinician-patient relationship that fosters trust; and to help patients cope with procedures. But this seemingly intuitive rationale has not been critically assessed.

Subjective descriptions of sensations

Procedural disclosure includes statements that warn the patient that something is about to happen, along with subjective descriptions of sensations that the patient may experience. Statements are either declarative (“I am going to give you some numbing medicine now”), descriptive (“You will feel some cold soap on your back”), or a combination (“I am going to do X, and you will feel Y”), and they can be expressed as either definite (“This will feel cold”) or qualified (“You may feel some burning”). The content depends on the age of the patient, the type of procedure, and the expected response from the patient. Disclosures are based on the model that …

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