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The Bedside Manner of Physician Healers
Communicating Certainty Rather Than Doubt
Someone once told me about their physicians bedside manner: he could give you a candy and you’d feel better.
I’ve also met some healers in my time, but none of them were doctors.
I didn’t really understand the difference between a run of the mill clinician and a healer until I saw it with my own eyes.
Like other physicians I was educated on how to give a proper informed consent, detailing all the risks and benefits of proposed therapies, discussing the side effects and what to watch out for, when to be worried, when to alert a physician and when to stop the treatment.
At risk of pointing out the obvious: this does not inspire confidence.
After this kind of interaction it is no wonder that 20-30% of prescriptions are never filled, 57% of patients miss doses, 22% take lower doses and 14% stop taking their prescribed medications against doctors advice.
Overall at least half of chronic medications are not taken as prescribed.
And the real adherence rates may be even lower than reported.
The ancient injunction to first do no harm, has become an impossible standard for modern medicine to achieve.
There is always a good chance of harm, and some people will always be harmed.
Physicians themselves have little faith in their own science, if they know anything about it.
Marcia Engell, former editor of the New England Journal of Medicine, one of the most prestigious journals in the world, writes:
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”
She wrote this in 2009 and if anything it has gotten much worse since then.
Other famous former journal editors at the Lancet and British Medical Journal have concurred with her assessment in their own exposes of the underbelly of the medical establishment.
There is a replication crisis in modern medicine. Much of what is published cannot be replicated. Much of what is published may in fact be faked.
I wrote about this in an earlier post where I noted that:
“The Cochrane Review concluded after an exhaustive study of published medical research that only about 10% is based on high quality evidence and another 37%
on moderate quality evidence, meaning just over 50% of modern medical practice is based on low or very low quality evidence.”
Later in that post, after providing numerous real world examples of how weak the efficacy is for the most common medical therapies like insulin for diabetes, statins for high cholesterol, antihypertensives, cancer chemotherapy, antidepressants, antibiotics, and painkillers, I also wrote about the groundbreaking work of John Ioannidis that finally provided a theoretical framework for making sense of what is going on in medicine:
“In 2005 John Ioaniddis, MD, professor of Neurology at Stanford, published his seminal paper “Why Most Published Research Findings are False”, which rocked the foundations of the scientific community and formed the basis for the entire field of meta-research.
“It quickly became the most downloaded technical paper from the journal PLoS Medicine and far from being controversial made Ioannidis something of a celebrity in research circles, and a highly sought after speaker at conferences, as he had formally clarified an embarrassing, publically unspoken fact that had been bothering many research scientists for decades – the lack of reproducibility of most research studies in the modern sciences.
“Ioannidis, in the introduction to his paper, wrote: “There is increasing concern that most current published research findings are false … (s)imulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.”
“In a separate 2005 paper, Ioannidis went on to analyze “49 of the most highly regarded research findings in medicine over the previous 13 years”. His paper compared 45 landmark studies that claimed to have found effective interventions with subsequent studies conducted with larger sample sizes: 16% of the initial studies were later completely contradicted, 16% had effects that were significantly larger in the first study than the second confirmatory one, only 44% of studies were actually replicated, and 24% remained mostly unchallenged (neither confirmed nor denied) by any further research.”
So that’s the sorry state of modern medicine.
It’s not surprising that most patients don’t take drugs as prescribed when their own doctors, if they know what they are doing, have little faith in many of them.
However I tend to doubt most physicians really do know the actual efficacy of what they are prescribing.
Many simple follow guidelines.
And many others are true believers, fervently trying to convince their patients their health and lives will be better for taking their pills.
Surprisingly those doctors may actually be on to something, despite having the science all wrong.
The first time I met a healer was during med school and it was a traditional healer trained in herbalism.
I went with a moderate case of psoriasis that I had suffered with for 15 years or so.
He checked my pulse, wrote a long herbal prescription, and matter of factly told me that he had treated 5000 cases just like it, and that it would be gone in 3 months time.
It wasn’t just what he said, but the certainty with which he said it that really floored me.
The prescription was not as simple as popping a few pills once a day.
It was inconvenient because it took some time to prepare.
I had to soak and boil things every 3 days and drink down disgusting smelling and tasting teas multiple times a day.
If he had not spoken to me the way he did I would never have stuck to such treatment.
And the psoriasis cleared up in a few months as promised.
Years later I met another healer in the Ayurvedic tradition who explained to me that he would never reveal uncertainty to a patient, and might even tell a white lie to ensure their complete belief in a positive healing outcome and commitment to their recovery plan.
These healers know the power of the mind and our own beliefs to determine outcomes for our bodies and health.
She said about the mind body connection:
“Examples include trials demonstrating that hypnotherapy is a highly effective treatment for patients with irritable bowel syndrome (IBS), and studies showing that perceived stress correlates with telomere length in cells. But what I personally found most convincing were studies suggesting an evolutionary rationale for the mind’s influence on health.
“There are now several lines of research suggesting that our mental perception of the world constantly informs and guides our immune system in a way that makes us better able to respond to future threats.”
And went on to explain the many forms the “placebo effect” can take, beyond simply relieving symptoms:
“Placebo painkillers can trigger the release of natural pain-relieving chemicals called endorphins. Patients with Parkinson’s disease respond to placebos with a flood of dopamine. Fake oxygen, given to someone at altitude, has been shown to cut levels of neurotransmitters called prostaglandins (which dilate blood vessels, among other things, and are responsible for many of the symptoms of altitude sickness).
“None of these biological effects are caused by placebos themselves, which are by definition inert. They are triggered by our psychological response to those fake treatments. The active ingredients are complex and not fully understood but include our expectation that we will feel better (which in turn is affected by all sorts of factors such as our previous experience with treatment, how impressive or invasive a treatment is, and whether we’re an optimistic person) and feeling listened to and cared for.
“Another element is conditioning, where if we learn to associate a particular treatment — taking a pill, say — with a certain biological response, we experience that response when we take a similar pill in the future, even if it’s a placebo. This influences physiological functions such as hormone levels and immune responses, and works regardless of our conscious beliefs.”
What we see in the research she cites, is the mind body connection can literally create the effects of medications without the medications themselves.
This begs the question: are the treatments, with all their real risks, actually even necessary if they can be mirrored by a harmless placebo?
Can we have pure benefit without the risk of harm?
What I take from all this is the tremendous power of our systems of belief.
Some systems of belief trap us in ill health with only one way out.
For example the “bone on bone” story that is retold every day in thousands of exam rooms to arthritis patients, despite research showing that sham knee surgery outcomes are equivalent to real knee surgery outcomes.
Despite the fact many of those same arthritis patients have good days without pain and bad days with it - how can that be if it’s all just a matter of “bone on bone”?
I’ve seen end stage arthritis patients recover within weeks to walking pain free without pain killers when they replaced their story with another story about eliminating the inflammatory foods causing knee pain - is that really true, or is it just a better story, one more amenable to a relatively easy to achieve positive outcome?
I don’t know, but it may be that the only limit to the capacity of brain and body to heal are the limits of our own belief and belief is a tricky thing - you can’t fake it - but you can go in search of it.
For example there is a healing method for people suffering chronic pain syndromes that relies heavily on reeducation through reading and viewing videos of real life examples, followed by guided journaling.
The more people expose themselves to the idea that their pain, or other symptoms, aren’t primarily physical phenomenon, the more they start to believe a new story or paradigm and the easier it becomes to overcome it.
So regardless of which medical system you may subscribe to I recommend you find a doctor or healer who inspires confidence that you will get better when you follow their advice.
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