We think of a “placebo” as an inert substance that acts therapeutically because the patient believes it will. Up to forty percent of post-treatment improvement, as a matter of fact, is due to placebo effect.
Placebos aren’t just pills. Doctors are also placebos.
Imagine that you, sick and vulnerable, have come to your doctor. Knowing this person is intelligent, well-trained, dedicated and experienced, you put yourself in his or her hands and expect salutary results. Even though the doctor hasn’t yet done a thing, you feel a little better already: placebo.
Unfortunately, my medical classmates and I were absent the day they taught Placebo 101. Had we been there, we’d know better how to use placebo power skillfully. Indigenous shamans, on the other hand, receive intense placebo training. They have time for it because they’re not required to take microbiology and biochemistry. Like much else in life, it’s a tradeoff: they wind up lacking scientific background, and we lack healing magic.
Of course, nothing prevents us docs from learning how to play our placebo role effectively. For example, we could decide to see our examining room as a sacred space. That means getting quiet and centered before we enter it, and then, once inside, treating its intimacy and potential power with serious respect. It means converting its atmosphere from mundane to transcendent, from despair to hope, with ritual.
The traditional medical ritual is the physical exam, with its four major components, observation, auscultation, palpation, and percussion. The amount of diagnostic information this can reveal is staggering. All this staring and listening, feeling and tapping can also be mystifying to the patient; in the benign disorientation the ritual engenders, it begins to create a wider reality, one richer in possibility.
Despite its medical and spiritual value, though, the physical exam is dying. As often as not, the doc relies more on a quick history and abundant testing to reach the grail of diagnosis. Just as today’s psychiatrists are taught psychopharmacology but very little psychotherapy, too many young docs learn to practice without the sublime contact skills that both reveal and comfort.
A century ago, Dr. Edward Livingston Trudeau opened America’s first tuberculosis sanitarium. The disease was considered medically incurable then, but Dr. Trudeau achieved great success simply by offering his patients rest, fresh air, good food, and abundant attention. His motto, preserved on a plaque near the shore of Lake Saranac, New York, was,
In those days, diagnosis wasn’t everything. Relief and comfort were and remain our most profound goals. One of today’s proponents of reviving the physical exam is physician-author Dr. Abraham Verghese. In a recent NY Times interview, he said that performing the exam tells the patient, “‘I will never leave you. I will not let you die in pain or alone.’ There’s not a test you can offer that does that.”