I agree. Informed consent is not optional, and the possibility of a nocebo effect does not give a clinician permission to leave out meaningful risks. My point is about how those risks are communicated, not whether they are communicated. There is a difference between saying, “This medication can cause nausea, dizziness, insomnia, sexual dysfunction, weight gain…” as a frightening inventory of everything that might go wrong, and putting those same risks into context: how common they are, how serious they are, what we would do if they occurred, and why I still think the potential benefit makes the treatment worth considering. The patient needs the information before deciding. But informed consent does not require us to deliver that information in a way that inadvertently primes the patient to expect harm. If anything, the nocebo literature makes the consent conversation more important, not less.
You end the nocebo passage wider than the inert-pill research, on expectation itself. The consent conversation before a drug gets started falls under that sentence too. Relevant risks have to be said out loud before the patient decides, whatever the saying does to what comes next. Which is the part of the explaining nobody gets to leave out.
When the essay reaches your own visits, what you describe explaining is why the drug is being prescribed and why you think it's worth trying.
Same in surgical consent. The risk gets named before the decision.
I agree. Informed consent is not optional, and the possibility of a nocebo effect does not give a clinician permission to leave out meaningful risks. My point is about how those risks are communicated, not whether they are communicated. There is a difference between saying, “This medication can cause nausea, dizziness, insomnia, sexual dysfunction, weight gain…” as a frightening inventory of everything that might go wrong, and putting those same risks into context: how common they are, how serious they are, what we would do if they occurred, and why I still think the potential benefit makes the treatment worth considering. The patient needs the information before deciding. But informed consent does not require us to deliver that information in a way that inadvertently primes the patient to expect harm. If anything, the nocebo literature makes the consent conversation more important, not less.
You end the nocebo passage wider than the inert-pill research, on expectation itself. The consent conversation before a drug gets started falls under that sentence too. Relevant risks have to be said out loud before the patient decides, whatever the saying does to what comes next. Which is the part of the explaining nobody gets to leave out.
When the essay reaches your own visits, what you describe explaining is why the drug is being prescribed and why you think it's worth trying.
Same in surgical consent. The risk gets named before the decision.