Provider as Placebo

A few weeks ago my nurse came to me to give report about my patient: “she looks terrible, vomiting non-stop for 3 hours, horrible abdominal pain and she’s allergic to the medication that we usually give for vomiting”, she said, “could you go see her before the other patients please?”.  I walked in and immediately recognized her face “You again? What happened? I just saw you last week.”  I had just seen her for the same symptoms. That time she was writhing on the exam table and I immediately called 911 to have EMS transport her to the hospital as we could do little there at the acute care clinic. This time she was sitting down, pale, shaking her head, bent over arms crossed over her belly in obvious discomfort. I sat down next to her and talked to her about what had transpired after our last visit. Her diagnosis was not horrible, but no ulcers. She had been diagnosed with gastritis, an inflammation of the gut. As we talked, her discomfort softened as she told me about her pending appointment to the gastroenterologist (GI) the following week. “They say the GI doctor will be able to fix me and they told me to change my diet”. I prodded her about the diet and got to hear some of what I had hoped. “It’s hard to follow a diet doctor, I ate ice cream last night”. Then a few hours later she woke up with her symptoms. We talked about how it’s not the doctors role to ‘fix her’ if she isn’t willing to make the changes that are necessary to help herself. I let her tell her story about the past weeks and what she had experienced.

When she was done, I felt a slight calm come over her. We talked a little bit more about her diet and I encouraged her to make the food changes that would heal her gut, with time, instead of allowing us to prescribe bandaids. “You’ve been eating this way for three decades, your health isn’t going to change over night, but with slow, steady steps towards transformation, you’ll get there and we’ll help you”.

Continuing to talk, her posture improved, her arms moved from across her belly onto the shared desk in front of us and she laughed a few times. We discussed her almost lifelong journey with these symptoms and how no one has ever told how to eat or what the cause could be or that she could actually live a life without pain. Twenty minutes later, she was smiling, her color was improved and she said her pain was gone. I had her move to the exam table, examined her thoroughly and found nothing that would require further workup or evaluation in the ER again. We developed a plan together, I refilled her ‘bandaids’ and made sure she had a primary care doctor to follow-up with after she saw the specialist.

After she left, the nurse came to me and said “what did you give her, you didn’t order anything for me to give her?”. I said I gave her a dose of love, compassion and real, easy to understand steps towards getting better and we collaborated towards a working plan. She looked at me like I was crazy and then said “she was a different person leaving from here, I thought for sure we were going to send her to the ER again”. I didn’t think anything of her statement, I was just excited that my patient had some hope of getting better.

When I was up at a meditation as medicine conference at Harvard Medical School a few weeks ago, they talked about the medical providers words and energy as placebo towards the benefit or detriment of the patient. Then later in the week at another conference, Dr. Aviva Romm mentioned it in her talk in relation to how we punish our patients for being ‘non-compliant’ when we should be praising them for being ‘engaged’ and the power of our thoughts surrounding our patients and their success.

The New England Journal of Medicine published a study in 2013 where 146 adults with chronic knee pain caused by a torn meniscus underwent arthroscopy of the affected knee followed either by removal of portions of the damaged meniscus or by simulated surgery in which no tissue was actually removed. None  of the patients knew whether or not they’d actually undergone surgery, and all received similar post-operative care and follow up. Remarkably, the patients in both groups reported significant improvement in their symptoms irrespective of whether or not any meniscal tissue had been removed.

Another study by Benedetti talked about how doctor’s words affect the neural processing of the patients brain. There is scientific evidence that show dopamine and endorphins (natural pain killers) are released from the brain when saying that a patient is getting a pain pill, even if its placebo. In Love, Medicine and Miracles, Dr. Bernie Siegal, talks about a cancer treatment called OPEH that was being used in multiple locations that was getting same results through all the different centers except for one. They questioned this particular center and found that the doctor rearranged the letters of the chemotherapy and told his patients they were getting HOPE, hence increased numbers of success. So simple and yet so amazing!

There is countless anecdotal evidence of this happening as well, but we usually just chalk it up to coincidence.We have to recognize there is major magic in our words and that thoughts become things, so choose your words and your thoughts and even your demeanor carefully when interacting with people. This is absolutely imperative when it comes to us as medical providers, have faith in your patient and engage them and you’ll see miracles happen sometimes faster than any pill could ever produce.

‘There are only two ways to live your life. One is though nothing is a miracle. The other is as though everything is a miracle.’ – Einstein

Thank you for reading.

Image courtesy of naypong at FreeDigitalPhotos.net

2 replies
  1. Lynn
    Lynn says:

    Way To Go Erica!!!!! So true! One patient engagement at a time. Keep it simple, keep it real,and Listen. Keep up your courageous efforts!!

    Reply

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