The briefing of patients is part of the daily routine of clinical anaesthesiologists and a central element for justification of medical treatment. It is increasingly apparent that such conversations can significantly affect the success of treatment by eliciting placebo and nocebo effects. Placebo effects are psychosocially caused clinical improvements, mediated by neurobiological mechanisms, which would be omitted in the case of hidden application. Nocebo effects are deteriorations, caused by the same mechanism. Anesthesiologists can make use of the knowledge about placebo and nocebo effects to increase positive impact on the outcome of treatment and to reduce negative effects at the same time. To do so legitimately, physicians have to balance the respect for patients' autonomy, the benevolence, and the non-maleficence for their patients. Patient's autonomy remains the supreme principle of the briefing about treatment and is institutionalized by the informed consent paradigm. Positive and negative expectations are to be handled by patient-oriented communication, but hard paternalistic deceptions and omissions are ethically unjustifiable. We will examine the practical strategies that could be used to deal with the imminent conflict between profound information and optimising placebo and nocebo responses. One key stone of these strategies is the pilot model. It helps to shape briefings as individually required and to promote the wellbeing and autonomy of our patients at the very same time.
Die Patientenaufklärung ist „täglich Brot“ des klinisch tätigen Anästhesisten und gleichzeitig ein zentrales Rechtfertigungselement medizinischer Behandlungsmaßnahmen. Durch Auslösen von Placebo- und Noceboeffekten kann sie den Behandlungserfolg aber auch selbst maßgeblich beeinflussen. Einem daraus drohenden Konflikt verschiedener medizinethischer Prinzipien kann mit entsprechenden praktischen Strategien wirksam begegnet werden.
Georg Thieme Verlag KG Stuttgart · New York.