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December 26, 2017

The Iatrogenic Potential of the Physician’s Words

Author Affiliations
  • 1Department of Psychiatry, Brigham & Women's Hospital, Boston, Massachusetts
JAMA. 2017;318(24):2425-2426. doi:10.1001/jama.2017.16216

Some of the information that physicians convey to their patients can inadvertently amplify patients’ symptoms and become a source of heightened somatic distress, an effect that must be understood by physicians to ensure optimal management of patient care. This effect illustrates the iatrogenic potential of information, as opposed to the iatrogenic potential of drugs and procedures.

Somatic symptoms and underlying disease do not have a fixed, invariable, one-to-one equivalence. Symptoms can occur in the absence of demonstrable disease, “silent” disease occurs without symptoms, and there is substantial interindividual variability in the symptoms resulting from the same pathology or pathophysiology. One mediator of this variability between symptoms and disease is the patient’s thoughts, beliefs, and ideas. These cognitions can amplify symptoms and bodily distress. Although cognitions may not cause symptoms, they can amplify, perpetuate, and exacerbate them, making symptoms more salient, noxious, intrusive, and bothersome.