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Nocebo effects from clinical notes: reason for action, not opposition for clinicians of patients with medically unexplained symptoms
  1. Anna Kharko1,2,
  2. Maria Hägglund1
  1. 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  2. 2 Faculty of Health, University of Plymouth, Plymouth, UK
  1. Correspondence to Anna Kharko, Department of Women's and Children's Health, Uppsala University, 751 05 Uppsala, Sweden; anna.kharko{at}

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In her paper, ‘Sharing online clinical notes with patients: implications for nocebo effects and health equity’, Blease bridges findings from two research fields to describe possible unintended consequences of providing patients access to clinical notes.1 She explains how nocebo effects, genuine psychological and physiological reactions following negative expectations, may arise after patients read such notes. Blease emphasises that the likelihood of nocebo may be greater for those patient groups who experience stigmatisation in healthcare. We argue that this is the case for patients with so-called medically unexplained symptoms (MUSs) and that clinicians who work with them should consider nocebo but not for the reasons they may think.

MUS is a term used to refer to persistent physical symptoms which cannot be fully or reliably attributed to a structural pathology. They include common symptoms such as chronic or recurrent pain in joints and muscles, fatigue, paresthesia or digestive issues. MUS may persist indefinitely and vary in severity, often accompanied by chronic psychological distress such as anxiety and depression. It is estimated that as many as half of the patients in general practice have at least one MUS.2 Sometimes, MUSs are appraised jointly and receive a formal diagnosis. Depending on …

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  • Funding This work was partly supported by NordForsk through the funding to Nordic eHealth for Patients: Benchmarking and Developing for the Future (NORDeHEALTH), project number 100477 and by FORTE through the funding to Beyond Implementation of eHealth (2020-01229).

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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