Patients’ Expectations

Valuing Patients’ Expectations | Avoid Being a Nocebo

Healthcare institutions have a lot to deal with. Some of the challenges they face include recruitment and staff training, management of costs, improving quality, and technological advancements, and with everything, they also need to manage patient’s expectations.

Patient expectations involve what patients contemplate may happen, will happen, and what they expect from treatment. Interestingly, patients’ expectations can change based on their interactions with the healthcare institution’s staff. The information they believe and how they perceive other patients being treated all contribute to patients’ expectations.

Healthcare organizations need to consider patients’ expectations significantly because they are influential. Patients’ expectations can trigger a Nocebo effect, where patients’ negative expectations lead to negative outcomes. Nocebo effects are typically triggered by healthcare staff when they neglect and fail to meet patients’ expectations.

The Nocebo effect can worsen a patient’s case and make them dissatisfied. It can spiral out of control from here in that patients can drop out of treatment or refuse to follow the recommended therapy plan, leading to frustration with the efforts of the medical staff. This ultimately leads to the demotivation of the staff, and the cycle begins again.

This article summarizes how healthcare organization members can cause nocebo effects and provides ways to reduce this phenomenon.1


Patients’ Expectations

Scenarios of Nocebo Effects Within the Healthcare Organization

A healthcare institution should verify patient expectations across all levels. It should be clear and consistent. Below are three examples of situations where an organization contributes to the Nocebo effect because of a discrepancy between what it says and does.

Many healthcare organizations highlight patient-centred care as one of their leading qualities. However, it can be challenging to deliver on what the organization says and its promise to the patient when many people make appointments on short notice. There are many cases that medical staff must deal with, contributing to the Nocebo effect.

Discord between clinicians and managers can contribute to the nocebo effect. Clinicians assess the quality of care from a subjective perspective. In Docotor-patient interaction, the patient divulges information on how they feel. They also evaluate it objectively by how much symptoms have reduced.

Conversely, managers assess the quality of care from an overarching perspective through surveys and questionnaires. In cases where surveys show that patients are satisfied with their level of care, managers may misinterpret this to mean that the resources put into providing that level of care are sufficient. This may eventually lead to Patient expectations being unmet when, in reality, the quality of care was never enough.

Although often overlooked, front-desk workers at health facilities can significantly contribute to the nocebo effect. These workers are typically saddled with essential tasks, like triaging patients, which they may not prepared for. This may lead to poor patient outcomes and experiences of healthcare.

In the UK, for example, the NHS is under pressure to reduce wait times for musculoskeletal cases. One solution they’ve implemented is “First Contact Physiotherapy,” wherein specialized physiotherapists treat patients typically seen by general practitioners (GPs). Although this strategy has some possible advantages, such as faster access to treatment, there are also worries regarding shorter appointment times. This may lead to a scenario where nocebo effects are likely since patients and physiotherapists may become unsatisfied.

Implications for Healthcare Organizations

There isn’t a singular solution to the Nocebo effect, but significant steps can be taken to reduce its frequency in healthcare organizations.

One key recommendation is to tailor patient expectations to the quality evaluation process. Below are a few ways to do so:

  • Patient Engagement: Organizations should gain valuable insight into patients’ expectations, including those on the board and in key decision-making roles.
  • Performance Indicators: A person-centered approach may be promoted at all organizational levels by creating particular performance measures linked to patient expectations. Organizations may ensure they are held responsible for fulfilling patient expectations by measuring and tracking these metrics.
  • Bridging the Gap Between Clinicians and Managers: Organizations may foster better understanding and communication between management and physicians by figuring out how to convey information about patient expectations being met in various contexts. Furthermore, placing people with clinical backgrounds in leadership positions might help them develop empathy for the difficulties frontline employees encounter.

This article discusses creating an uplifting environment for effective patient care throughout every stage of the care process. Organizations must map out the patient journey, fully comprehend the various touchpoints, and equip staff members with the knowledge and tools to manage patient expectations. This will help improve outcomes, increase satisfaction, and reduce the probability of the nocebo effect.

Lastly, this article emphasizes the critical importance of having trained front-desk staff. As they frequently serve as patients’ initial point of contact, ensuring they are prepared to manage interactions skillfully to match patient expectations with care better is crucial.


Healthcare organizations can foster a more compelling experience for all parties involved by recognizing the possibility of nocebo effects within their organization and implementing measures to moderate them. Healthcare delivery is complex. Beyond clinician-patient interaction, health institutions must pay attention to patient expectations.

This article emphasizes the SIPS (Society for Interdisciplinary Placebo Studies) endeavour to foster education and enlightenment for healthcare providers.


Dynamic Disc Designs offers realistic models to help with accurate patient education and keep communication lines open about probable sources and solutions for low back pain.