Starting a medicine? Accentuate the positive

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He Ako Hiringa
26 November 2021
Bulletin #9

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Starting a medicine? Accentuate the positive

A new medicine is available that may benefit your patient, and together you must consider its appropriateness – your patient needs to be well informed. How you discuss the medicine is pivotally important. It is central to whether your patient takes the medicine and how long they remain on it, and may influence treatment benefit and the severity of any adverse events. Reduced efficacy, symptom worsening and new side effects are all possible, too, simply as a result of your discussion!

Discussion between patient and prescriber should include an emphasis on the positive attributes of a medicine and reasons for its initiation rather than focusing only on the likelihood of adverse events – which need to be placed in context of treatment benefit.1 Accentuating the benefits optimises the powerful placebo effect, a major part of treatment success, and minimises the nocebo effect (adverse effects induced independently of active treatment).1,2

Prescribers are instrumental in framing a medicine positively or negatively, setting patient expectations. Optimising these expectations during a short consult can enhance and sustain benefits.3 Conversely, highlighting negative information may lead to increased experience, and reporting, of adverse events, and to poor adherence.1

Prescribers influential

Prescriber’s own beliefs significantly influence how a patient feels about a medicine. A prescriber who is hesitant, diffident or uncertain about a medicine can transfer these feelings during the consult, affecting how the patient experiences and accepts the medicine.

Your patient may have already conducted research via the internet or social groups and hold pre-conceived beliefs about medicines. Encourage positive conversations by creating environments where patients feel comfortable introducing their concerns/beliefs. Using the Ask, Build, Check health literacy framework may help to identify specific patient concerns prohibitive to taking a medicine – target your conversation to these.

Nocebo effect

Expectations and perceptions of harm from a medicine can cause a patient to actually experience adverse events: the so-called nocebo effect. Reasons patients may experience this phenomenon include, among others, perceived sensitivity to medicines’ effects, personal beliefs about medicines, and interactions with healthcare professionals.1

Therefore, how medicines information is communicated is crucial: focus on treatment goals and expected benefits; balance adverse event risk with treatment benefit; use positive framing (eg, 90 per cent of patients will not experience headache); state facts about adverse events; and avoid use of emotive language.1


1. BPACnz. The nocebo effect: What is it, why is it. August 2019.

2. Petrie KJ, Rief W. Psychobiological mechanisms of placebo and nocebo effects: Pathways to improve treatments and reduce side effects. Annu Rev Psychol 2019;70:599–625.

3. Akroyd A, Gunn KN, Rankin S, et al. Optimizing patient expectations to improve therapeutic response to medical treatment: A randomized controlled trial of iron infusion therapy. Br J Health Psychol 2020;25(3):639–51.