The Conversation “Placebo”

We came across an interesting opinion piece in the New York Times discussing the benefits of a conversation “placebo” –  the evidence supports that substantial portion of “healing” comes from the communication and connection with the patient.

Under the Midwifery Model of Care, the conversation between provider and client is an essential component of partnership care.  We agree that conversation is crucial, but would not characterize it as a “placebo” – still, the discussion in the context of the medical model to address this important relationship of trust between provider and client is a positive and worthwhile read.

Before we had treatments that could actually counteract the pathology of disease — antibiotics, chemotherapy, stents, organ transplants, transfusions — placebo was the mainstay of medical care, and in many cases it was remarkably effective.

A good example is patients suffering from vague diffuse pains with no discernible cause. Frequently my patients ask if a multivitamin will give them more energy. In the past I would say no, because there are no significant scientific studies to demonstrate this, and also because in the absence of a vitamin deficiency there’s not much for a basic multivitamin pill to do. Now I take a different approach. I say something along the lines of “Many of my patients find that they have more energy when they take a multivitamin.” I’m not lying, because many have indeed said so. Without fail, there are always a few patients who come back at the next visit and swear they feel much better.

There are some who argue that it is unethical to promote placebos to patients. But increasingly, many say it would be unethical not to give placebos a try in situations where patients are not getting relief from traditional means (and where it would not cause harm or replace a necessary treatment).

It’s clear that how doctors and nurses communicate their treatment can have profound effects on how patients experience the results of that treatment. Yet the conversation between doctors and patients is one of the least valued aspects of medical care. Insurance reimbursements for tests and medical procedures dwarf reimbursements for talking to patients or spending time thinking about what ails them. And the pharmaceutical industry, with its direct-to-consumer advertising, has promulgated the fallacy that every ailment must be met with a pill — brand name, of course.

As health care faces its latest overhaul, it’s crucial for the medical profession, as well as insurance companies and decision makers in government, to recognize the power of the doctor-patient conversation. It’s the most valuable diagnostic tool we have and can be remarkably effective as a treatment tool as well. Training for doctors and other medical professionals should emphasize communication skills with the same rigor that it does for other clinical skills.

Call conversation a placebo if you like, but if it helps without causing harm, then it’s legitimate medicine. Relieving suffering, after all, is what the Hippocratic oath is all about.

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