In your message dated Friday 12, July 1996 Paul Bates wrote :
[snip]
It is arrogant to believe that our scientific based
> medical care is the only one that works.How many patients do we fail
to heal?
> (healing being defined as making whole)As GPs we underestimate
ourselves  -
>  we dabble in healing a great deal and generally pretty successfully
> considerng the constraints of a 5-10 minute consultation.Healing
does not
> have to have religious overtones -  but it is to do more with the
''spitit''
> than the physical.I think most of us have some concept ot the spirit
or
> ''energy''  of  the human animal.Is it unreasonable that a healer
might be
> able to influence this more than a Western trained medic?Could such
treatment
> be cost-effective  rather than adding to the ''thick file''? We
will only
> know the answer to this if an attempt to research and quantify is
made.

Hm...I've just returned from a week long workshop on evidence-based
medicine (there - I've made my agenda explicit!) and I'm impressed by
the potential to improve our management of individual patients who are
suffering from illness or to decide on best prophylaxis, give
accurate advice on risk factors (one way to avoid Risk is to avoid
gp-uk - sorry for inane interjection) or decide when it is best not to
treat. In fact any clinical problem can be more accurately diagnosed
and more effectively treated if we use EBM skills.

But (and this is a huge BUT) this takes time and effort, and I am also
now sure that all clinical members of the team should be involved,
such as nurses, midwives etc. If I want to practice EBM properly and
raise my clinical effectiveness, there is enough illness out there to
keep me going. In fact my main problem is going to be making sure that
I get enough freedom from non-clinical problems to have the time to do
it. And that's the most important point of my job - to treat clinical
problems as effectively as possible.
I don't deny the importance of social, psychological and spiritual
aspects of patients' problems and, in order to be helpful to my
patients, need to acknowledge them explicitly and take them into
account in approaching the patient as a person (thus there may be
personal circumstances which make the theoretically optimal treatment
of anticoagulation in a particular patient with atrial fibrillation
impractical or unwise, for instance). On the other hand, I do not
think that unscientific, spiritual or other complementary "healing"
therapies have any place in clinical medicine beyond the normal
supportive and traditional role of the "drug doctor" as Balint put it.

Another way of putting this is to say that if a patient keeps
presenting to a doctor with vague complaints, the doctor's duty is to
take all reasonable steps to satisfy himself that there is not a
serious underlying illness, to do his best to explain this to the
patient and to avoid doing harm by unnecessary investigations and
treatment. He should make it clear that this is the limit of his
expertise and responsibility. If the patient then wants to go to a
faith healer, homeopathist or whatever, that's fine; it's his choice -
but let us not be seduced into believing that such activities should
be provided by GPs - they should not.

Toby
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| Dr Toby Lipman    EMail [log in to unmask]
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