Guest post: A small hardcore of patients who are quite well but think they’re not

Originally a comment by Steamshovelmama on An extended discussion with their homeopath.

This is one of the appealing things about most “alternative therapies”. You’re paying through the nose for the “therapist”‘s time so you get a nice comfy sit down with a cup of tea and have a long chat with someone who is basically there to listen to you talk about your problems. There’s no rush, there’s time to talk about all those neurotic little issues – which we all have but which medical doctors don’t want to hear about because theres’s nothing they can do about them. Then you go home with (or having had) the equivalent of a sugar pill which, yes, probably does do you some good because you’ve performed all the necessary steps to activate the placebo effect. You’ve been spoken to by someone you consider to be in a position of authority, you’ve sacrificed (paid a shitload of money), you’ve undergone/will carry out some ritually prescribed actions (been physically manipulated/massaged/had needles stuck in you, been given magic pills to take a set time every day etc) so it’s no wonder some people swear by them. Between the placebo effect – actually very strong – and regression to the mean (most things get better on their own in a few weeks) people do perceive they are getting an effect.

This has led to suggestions it should be offered on the NHS. Not because it does anything more than placebo but because it’s basically harmless. You see, every GP’s surgery has a small hardcore of patients who are quite well but think they’re not. They have a plethora of physical symptoms, all of which are either self-evidently neurotic or have been investigated in every way possible. They aren’t actually mentally ill as such so referral to the psych services (which are very overstretched) is just bouncing the problem elsewhere. Back in the 1940s and 50s it wasn’t uncommon for this group to be appeased by being prescribed something innocuous – a sugar pill. These days we aren’t allowed to lie to patients (and all medication can be easily looked up on line) so this small coterie of patients often ends up having their symptoms treated because the GP is left with no choice. The suggestion was to employ a homoeopathist or an acupuncturist to deal with these people’s problems. They get their sit down and chat about their issues. They get their sugar pills (or magic water), they go home happy and free up a shit-load of appointments at their GP’s surgery. The GP keeps a weather eye on them to make sure the symptoms that have been interpreted as innocuous don’t transform into something treatable. Everyone is happy – except for the folks who make the argument that the NHS should never, under any circumstances, pay for anything that doesn’t work.

I can see both sides. The problem with the current system is that, in order not to lie to this group of patients, we have to poison them, which also costs the NHS money. Overall, a local complementary therapist might well be cheaper – especially if he/she negotiates a lower rate to ensure regular NHS business. It’s not much different to the “exercise prescriptions” that GPs can give out which may include access to local authority gyms.

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