Inappropriate use of nocebic language in prehospital care: a cautionary tale

Background: Nocebic communication can impair patient outcomes and increase their risk of post-traumatic stress disorder. It could therefore be legitimately regarded as a patient safety issue. Aims: This study aimed to determine whether nocebic effects (negative outcomes) induced by potentially harmful word and language choices commonly occur in clinical practice involving paramedics and other emergency responders. Methods: Five publicly available televised excerpts of prehospital care encounters were reviewed. Cases typically involved the treatment of patients who had sustained serious traumatic injuries. The incidence of words and language patterns commonly associated with nocebo effects were collected using a template to enable relevant dialogue to be tracked and recorded. Results: Emergency responders, typically paramedics and doctors in these examples, frequently employed nocebic words and poor language pattern choices even though less harmful forms of communication were available and more clinically appropriate. Conclusions: Inappropriate nocebic effect-inducing language is frequently used by emergency response personnel, potentially inflicting avoidable pain and anxiety.