Thursday, April 22, 2010

OMM: Touching the Picture and the Frame

Mick Jagger of the Rolling Stones NYC show, ta...
The Placebo Effect gets a bum rap. When you're rushing to the emergency room, as I was one night with what felt like a Bowie knife sticking in my back, you don't care about the ambiance, you just want morphine. Although I didn't know it at the time, I'd blown a spinal disk while helping deal with a psychotic patient a couple of days previously, and for all the good they didn't do, my pain medications may as well have been candy. It was the kind of pain that is so pervasive, you can't get away from it no matter what you do. Relief, to borrow from Mick Jagger, would have to be "a shot away."

It turned out, the ER I practically crawled into on my belly like a soldier ducking fire, was brand new. Between answering the intake nurse's questions with gritted teeth and wishing he'd cut to the chase and just hit me over the head, I got the impression the architect definitely knew something about the placebo effect. The decor made it clear, I'd come to the right place.

And that's what the placebo effect does: it reinforces the sense that we're in good hands. Usually, when the term "placebo" is mentioned, people assume we're talking about sugar pills. In fact, it goes far beyond that and includes such things as the physician's white coat, an efficient and empathetic nursing staff, a well-lit and organized examining room, and above all, the doctor's ability to convey confidence that s/he knows what they're doing. In other words, it promotes trust.

Think about those times when you may have walked into a doctor's office and felt like you needed a shower as soon as you walked out. Magazines in the waiting room were out of date and the receptionist scarcely looked up when she pushed a clip board toward you and said, "Fill this out." The carpets looked as though they hadn't been vacuumed in a month and not a single person smiled. You're feeling anxious before you even see the doctor and it's all because nobody paid attention to the placebo effect.

I've been talking about rites of passage the past few days, while thinking about what my soon-to-graduate classmates and I have experienced together the past four years. Some, like me, came here with backgrounds in liberal arts, and others having been immersed in the hard sciences. In both cases, we've had to undergo an alteration in thinking that enables us to view patients as an integrated persons. We've had to learn that OMM addresses physical as well as psychological dysfunction, because we can't touch the frame without touching the picture at the same time. We've had to learn to take the placebo effect seriously and use it to a patient's advantage. We've had to learn that doing so not only makes good sense, it makes for good medical practice.


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