Therapeutic communication: avoidance of negative influences and application of beneficial suggestions in anesthesia and intensive care, emergency, and pain medicine

In anesthesia, and in emergency and intensive care medicine a “therapeutic communication” with the patient is needed that exceeds mere information exchange and that supports patient and treatment. First, ever-present nocebo effects and negative suggestions must be avoided or neutralized. For any medical intervention to be optimally effective, their explicit announcing it and its significance is essential to induce placebo effects. To avoid sources of stress, significant themes derived from the basic psychological needs should be addressed. The patient's own contribution to homeostasis and healing should be appreciated to get him out of prescribed passivity. In an acute existential threat during an emergency, surgery or intensive care, patients tend to enter a naturally occurring trance state as an emergency program and are less rational and particularly susceptible to suggestions. Accordingly, in emergency care “painful” words should be avoided, non-verbal signals of companionship be given, and images of healing induced. Hypnotic language directed at the unconscious, where programs for physiological and mental functions are located and modulable, seems especially appropriate. Induction of nocebo effects during risk information to obtain informed consent can be counteracted by simultaneous offer of positive aspects, such as ways to prevent, detect early, or treat side effects. For support during surgery under regional anesthesia, the patient can be encouraged and guided to dissociation to an inner safe place of well-being and to reframing of sensory impressions. Given recent evidence of perception during unconsciousness, like under anesthesia, during resuscitation, or in coma, communication should not be limited to conscious patients. Positive suggestions during general anesthesia have reduced pain, analgesic and antiemetic use, and PONV. Communication with the unconscious patient during emergencies, resuscitation, surgery or intensive care might prevent generation of PTSD exactly at that critical moment. In chronic pain or disease, the patient's experience of “being-ill” needs consideration on a level equal to the doctor's understanding of the “illness”, and such intersubjective resonance is a prerequisite for optimal therapeutic results. Therefore, resonance-based treatment should supplement evidence-based medicine. The same approach in communication that is effective with the patients can reduce stress in the medical staff and improve their intervention.