Confessions of a GP

Now I would be wrong to criticise a profession for healing via the placebo effect as I use placebos all the time for my patients. The important thing to remember is that placebos do work. As I said, I am fairly sure that anti-inflammatory gel is of no more benefit for chronic back pain than rubbing on a placebo gel. This would suggest that it is the process of rubbing the gel on and thinking that it is reducing the pain rather than any pharmacological properties of the gel itself that are working. However, whether you use a placebo gel or the real painkilling gel, the patient feels better than if they have no gel at all. This is how most alternative medicines work. The mind is an immensely powerful tool for healing and is used by conventional doctors and alternative practitioners alike. If we can convince our patients to have belief and faith in our treatments, the results can be astonishing.

My most dramatic witnessing of the healing power of the mind occurred during my time working in Mozambique. A middle-aged woman presented herself to the ward in absolute hysterics. She owed her village witch doctor money that she couldn’t afford to pay and he had put a curse on her. The woman was convinced that she would die shortly and was screaming and throwing herself onto the floor and beating the ground. We managed to keep her still for a few minutes to do some basic observations and I have never known someone to have a pulse and blood pressure so high. It was quite possible that she could die from a heart attack simply because of the immense stress her body was under.

The head of medicine was a German professor who was always particularly impatient with the local people’s spiritual beliefs and superstitions. ‘There is no such thing as witchcraft!’ he shouted at the woman as she writhed and screamed on the ground. The woman took no notice and carried on wailing as her blood pressure and heart rate continued to rise to increasingly dangerous levels. One of the local doctors took a very different approach. ‘I can break the spell,’ he told her authoritatively. He took some magical stones from his pocket (some gravel from the hospital courtyard) and started chanting and throwing his arms around. After several minutes, he dramatically threw the gravel to the feet of the hysterical woman and announced in a booming voice that she was cured. The woman collapsed into an exhausted heap and started to whimper. Her blood pressure and heart rate were normal within a few minutes and she happily headed home to her village. ‘If you look convincing enough, these people will believe anything,’ the doctor remarked to me after I had looked on in astonishment. He then calmly asked one of the nurses to sweep up the gravel and we carried on with the ward round.

A patient once told me that she had turned to homoeopathy as she didn’t feel that she was treated holistically by modern medicine. I felt a little offended by this. The different ways in which health and illness are perceived by different classes, cultures and ages are perhaps more evident to GPs than to anyone else. A good GP should, by definition, recognise the delicate balance between mind, body and spirit in the treatment of his or her patients. It’s not always easy to take all these multiple factors into consideration with our limited time and resources but most of us do try. We appreciate the importance of emotional factors in physical symptoms and that illness can affect patients, their families and their environments in a myriad of different ways. This patient who had turned her back on conventional medicine clearly felt let down by modern doctors. I personally won’t be prescribing any alternative treatments, but I do think that I could learn a lot from the techniques and holistic approaches of many complementary practitioners.

Thai bride

As I mentioned in ‘Who am I?’ I love being an observer and sometimes playing a part in the soap operas that are people’s lives. In real soap operas, the watcher can only shout at the telly when a character is clearly heading for a fall. As a GP, sometimes I have the opportunity to step in, but the problem is knowing whether it is the right thing to do. This was the problem I faced with John.