Wednesday, October 20, 2010

…AND DOCTORS CAN ALSO BE NOCEBOS

A reader commented yesterday, “But the problem is, my doctor is NOT much of a placebo for me...this is hard to explain to my mother, for whom doctors ARE placebos…”

There is that difference between generations, isn’t there? Our parents, believing doctors commuted from Mount Olympus, put themselves into medical hands with nary a question or qualm. If my parents’ doctor had offered to sew their elbows together, they would’ve eagerly assented. I remember one doctor treating my teenage face with radiation, and another doing oral surgery on my sister for what I recognized later was no problem at all.

Now, thank goodness, we’re more sophisticated, more likely to demand evidence that the doc’s a genuine healer and not a nocebo. When I wrote about doctors as placebos I forgot to mention its opposite. A nocebo is something that’s chemically inert but makes you feel worse. Just as docs can be placebos, they can be nocebos, too.

I’m not sure which your own doctor is to you, but his professional atmosphere is evidently a turn-off. You wrote, “…in that dreadful office with the blaring fluorescent lights in a high rise building I don't connect with anyway.”

Whatever a doc’s values, they’re inevitably expressed in the office ambiance. When I arrived for a medical appointment several years ago, the receptionist sourly questioned me as though I’d come to burgle the place. Like you, I was irritated by the harsh fluorescents, and even more by the nurses’ clinical detachment and the half-hour wait in the examining room. I left that doctor and found another who operated his office as though people mattered.

Legislation can dictate who pays for healthcare, but it can’t command its humanity to bloom. That can come about only by patients voting; every appointment, every transaction, is a vote for or against a style of practice.

3 comments:

  1. Fully agreed, that every appointment is a vote for or against a style of practice....yet, again, the medical hierarchy determines our options before we get to vote...meaning, that sub-specialties like neurosurgery, plastic surgery, cardiology, etc, are the coveted positions in the medical profession, and afford the highest respect and top dollar to its practitioners....thus, being an internist is almost the dregs of the profession, what is left over for docs who, for whatever reason, couldn't make it in the hot specialty of their dreams....that, sadly, seems to be the starting point for many family practice docs (I am consistently dismayed, for the rare time I meet a resident on our unit who really has a terrific bedside manner, who is sharp and sweet and can translate reams of medical knowledge to make it fresh and pertinent to the patient at hand---whenever I ask these men or women if they would ever consider going into family practice, they all screw up their faces and tell me point blank there's no respect in that....and I can only surmise they feel the same way about nursing, and would never demean themselves by choosing such a lowly profession...)

    Add the pre-existing medical hierarchy to the layout and values of the town you are in, and you may not have the palette you wish to vote from...Let me tell you, after just now briefly perusing the Nevada City, CA Chamber of Commerce website, this suburb of Washington, D.C. is a far cry from the quaintness and serenity oozing from every pore there. And in 2 weeks we may be electing a Republican who will demolish the last miniscule grove of woods we have left, to make an on-ramp for this ridiculous re-structuring of all the military bases after 9/11, away from a centralized spot presumed more likely to be a target. The park, Winkler Preserve, was set up in the 1970s for generations of Alexandria's school children, but it, too, has to be another casualty of our ludicrous paranoia, despite community outcry.

    So, most of our landscape is simply eyesore high rise buildings, or sprawling strip malls...all wastefully traversed by individuals in honking huge SUVs. As if it wasn't bad enough 20 years ago, the last year alone seemed to have added the same number of cars and gobbled up more land all the way to the Shenandoah mountains....the lack of sustainability intensifies and accelerates exponentially, and we seem increasingly unwilling to do anything about it. I am the only living girl in northern VA who still walks or bikes anywhere, it feels many a day...(echo Simon and Garfunkel, "Only Living Boy in New York...")

    So in an atmosphere where the town is ruled by the military or its private contractors, where the natural consequence of an extolling of hierarchy is a flagrant violation of nature or any recognition of the land's beauty...what kind of MD options are you going to have here? Let me tell you, there ain't many hippie docs in this town, and they're all clustered together for their lives in Takoma Park...

    This is the cost of overdevelopment...there are zillions and zillions of us teeming in every crevice of the planet, but the cost of industrialization so often seems to be our humanity. So many doctors, so many people, and yet so few who really care to notice things, who have the wherewithal to fight an uphill battle against expediency, as defined by the existing infrastructure of a car dependent landscape of canyons of high rises sprawling over hill and vale as far as the eye can see....

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  2. I don't dislike nurses, but I hate, hate, hate being interrogated by a nurse when I've come to see the doctor. If I wanted to talk about my body with a nurse I'd have made an appointment with a nurse.

    My doctor held out for a really long time but our local for-profit-masquerading-as-a-nonprofit hospital eventually bought him out, as they have every PCP in a 30-mile radius. Resistance, I've seen, is futile when money's at stake.

    There's nothing I can do to change the medical system so my sweetie and I have lost a lot of weight, walk daily now (or nearly so) and try to eat as much locally produced food bought from farmers we KNOW as possible. In short, our approach is to do our best to not need doctors because being caught in the clutches of the US medical system is a fearsome thing.

    My Irish grandmother had a horror of hospitals. In her day they were where you died. Today, with the cutting back on housekeeping and the rise of hospital-acquired infections, we've come full circle. The big difference is that nowadays the death isn't the result of ignorance, it's the result of corporate greed.

    The CEO at our local hospital pulls down $750,000, before perks, in a rural area in a small New England state.

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  3. PS: Nice blog. Thanks.

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