Sunday, December 31, 2006

The Placebo Effect

In his private and personal life, Dr Dork is...a dork. A dweeb, a dolt, a dummkopf.

Yet in his interactions with his patients, he exudes confidence, charm and reassurance.

This is a conscious decision. This is an aspect of the mask.

This is, in essence, utilizing the Placebo Effect to help his patients.

Dr Dork does not think he is being misleading or deceptive. He gives bad news truthfully, but with some dorky aplomb, he hopes. He ensures his patients are aware of potential pitfalls of treatment options. If he thinks a particular medication might help a particular patient, for example, he uses words such as "could" and "might" as opposed to "will". He gives probability outcomes where there is good evidence for such.

But Dr Dork knows that his subtle, subvocal clues, his body's unspoken language, his demeanour and so forth...have themselves a potentially significant contribution to the healing process. Especially in regards to symptoms of pain, depression, nausea and other scenarios where there can sometimes be a large psychological element contributing.

As strange as it may feel in the hands of a any tool at his disposal to help his patients, it is sharpened, oiled, and used to best effect.


Anonymous said...

It's Liz from I Speak of Dreams. Synchronicity in the blogosphere.

Autism Diva just wrote a post on placebo, at Placebos, Nocebos, and Quasi-bos?.

Worth reading.

Godwhacker said...

I know it hinders the persona of "Dr. Dork", but I can only picture you as eloquent, graceful, and poised... maybe in a dorky kind of way ;)

Happy New Year DD!

NeoNurseChic said...

Nice bit there. :) I find that the demeanor of the doctor and his words, mannerisms, etc are extremely helpful in the contexts of areas like pain, headaches, etc. These things are all real maladies, but so often, those of us who have them are treated as if its "all in our heads" and so on. So what is the effect of a doctor who actually believes what we are saying?

At the headache center where I am treated (and also worked for a very brief time), I have personally gone through this concept. When I first went there, 11 months to the day into having a constant headache, I was a bit skeptical that this would be helpful. My neurologist there was phenomenal - no matter what, he never gave up on me. He used to introduce me to visiting doctors as a premed student. If I sent him an email while I was away at university, he'd phone me back to ask what was going on. When I went in, I feared that he was going to say we'd run out of things to try, but he never did that. I had gone to the ER 8 days into the chronic headache, but then I didn't go the entire time I was being treated by my first neuro at the headache center.

Then my neuro moved back to Singapore, and I felt left high and dry in a sense. Becuase I had spent time working in the center, they gave me a choice of going with the new fellow or going to a doctor who had years of experience. I chose experience, but our personalities clashed from day one. I went to the ER for severe headache the day after my 1st appointment with him. Perhaps that was my head's way of giving him a vote of no confidence. I couldn't stand him - I used to leave my appointments in tears, calling my mom with angry words full of how badly my appointments had gone. I ended up in the ER for clusters and severe migraine a few times, whereas I had never gone when I had my former neuro. I called for steroid tapers repeatedly.

Then, over time, we started to get along. I don't think we get along as well as my first neuro and I did, but we do get along a bit better. I am also working with a nurse practitioner who I like a lot. So I haven't gone to the ER for migraine or clusters in some time now. I don't know if that's because our relationship has also settled or if I just haven't needed it. And I'm not saying my headaches aren't real, but having a good relationship with my doctor is EXTREMELY important...

A psychiatrist friend of mine and I talked about a conference she went to one time where the topic was on the placebo effect. She said that the topic was wonderful because it focused on the body's amazing ability to heal itself - the mind's amazing ability to heal the body. She came out with the question, "So what's wrong with the placebo effect?" Nothing - it does get a bad rap though. Because then it means we've been tricked. I used to wonder if my meds were real or if they were just sugar pills. It really stressed me out. Nowadays, I know that doesn't happen, unless I sign myself up for a study. But still, it was a worry!

Happy New Year!
Carrie :)

Bo... said...

I can relate to this issue. In home health, the patients and their families tend to look to the nurse for their source of hope and confidence. But I struggle with the fact that I usually present an extremely "strong" and "confident" countenance, even in the face of terrible circumstances. Because although I definitely want them to take heart and have courage in their physical battles---I feel somewhat guilty sometimes because I also don't want to mislead or lie to them either, you know what I mean? It's difficult, sometimes...

Dr Dork said...

Bohemian RN,
It doesn't hurt to be optimistic, yet truthful.
And a happy new year as well.
Thanks, I'll check it out.
That's exactly how I picture me...until a reflective surface intervenes.

Best wishes for the new year

Anonymous said...

Dr. Dork,

You rock.

We all wear masks from time to time, but even beneath yours is a gentle soul.

Hope 2007 is a good year for you and yours.

Deb at

Robin said...

That's really good. You're simply using the tools that you have to help give patients something they need, which is the feeling that you are someone who knows what he's talking about and someone they can trust.

(I'm working on the assumption that you actually *are* that kind of person! Otherwise it might not be so good! ;)

Moof said...

Dr. Dork .. that "mask" is really a part of your reality, of who you really are. You're not giving them a placebo, you're giving them the right medicine.

Just be ... because who you are is just fine.

My absolute best wishes for a peaceful and light New Year!

Dr Dork said...

Hi Deb,
Thanks and welcome back.

I know how little I know, which makes me knowledgeable.

And many happy returns.


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