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Rapid Responses: Rapid Responses published:
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Human touch in healing process
- Keshav J Kulkarni (8 June 2004)
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Truth or hope?
- Giuseppe Vetrugno, Fidelia Cascini, Francesco Ausania, and Ernesto D'Aloja (14 June 2004)
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The Lack of a Precise Bodily Location
- Erik R Johnson (19 July 2004)
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A Crisis in Confidence - The Fall of Evidence Based Medicine
- Erik R Johnson (21 July 2004)
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Keshav J Kulkarni, observer in gastroenterology stoke-mandeville hospital, HP21 8AL
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Modern medicine, in the den of labarotory, is full of micromolecular and pharmaceutical questions with very few answers. The exponential growth of supr-subspecialities in the diagnosis and the management of the genetic disorders and cancers has resulted in broader multi-disciplinary approach. In this regard, the patient loses the human touch, which is most essential in these sort of disorders. In India, the common illnesses are not investigated thoroughly before treated, because of financial constraints. However, majority of the patients get cured of thier common ailments, because of the immense faith they are having in the doctor that the doctor is going to heal their illness. In rural India, it is common practice to put all the faith in one particular doctor, who is known to have to 'healing touch' and in many cases it works. No stidies, so far, as far as I know, have been done in this regard to check the human-side of treating the illness. The therapeutic effect of faith or trust in the treating doctor (who is human) needs further studies to confirm or rule out what is happening in countries like India, where more trust is on treating doctor than the information or investigation. Competing interests: None declared |
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Giuseppe Vetrugno, Medical Directorate Policlinico, Fidelia Cascini, Francesco Ausania, and Ernesto D'Aloja
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Dear editor, we can’t but agree with your analysis (1) on the need to using extreme care in providing information on fatal prognosis to terminally ill patients, adopting appropriate terminology, so as not to induce further suffering, avoiding to rule out residual hopes. “To be honest but be able to keep hope alive are two fundamental attributes of a good doctor”: however, in some areas of Medicine, and in particular in the palliative treatment of terminally ill, it is very difficult to reach a fair balance between these two opposite demands. A passage from “The death of Ivan Ilych” (2), a minor work by Leo Tolstoj, well describes the feelings of a terminally ill man a few months before his death: “What tormented Ivan Ilych most was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and the only need keep quiet and undergo a treatment and then something very good would result. He however knew that do what they would nothing would come of it, only still more agonizing suffering and death. This deception tortured him -- their not wishing to admit what they all knew and what he knew, but wanting to lie to him concerning his terrible condition, and wishing and forcing him to participate in that lie. Those lies -- lies enacted over him on the eve of his death and destined to degrade this awful, solemn act to the level of their visitings, their curtains, their sturgeon for dinner -- were a terrible agony for Ivan Ilych. And strangely enough, many times when they were going through their antics over him he had been within a hairbreadth of calling out to them: "Stop lying! You know and I know that I am dying. Then at least stop lying about it!" But he had never had the spirit to do it”. Ivan Ilych is aware of his illness and that all those around him know how serious his state is and how long he has got to live for, but he also knows they are lying when they reassure him on his destiny. He knows and would rather stop them from lying. Although Ivan Ilych himself, as Tolstoj effectively underlines, “had never the spirit to do it” welcoming, after all, their lies. In the Greek myth of Pandora, Prometheus arrives too late to close the box, opened by his brother Epimetheus, from which all the evil and suffering of the world have already escaped. When the box is finally closed, only the Hope is left inside. It was later Aesculapius, the founder of our art, who opened the box again letting the Hope to be freed. As Ivan Ilych’s story shows, to keep hope alive one may need to restrain from saying the whole truth, not being completely honest. 1. Smith R. Medicine and man’s fall. BMJ, 2004; 328; 2. Tolstoj L.N. The death of Ivan Ilych,1886, chapter VII, in http://home.eol.ca/~command/ivan.htm Competing interests: None declared |
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Erik R Johnson, n/a Incline Village 89450
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One of the greatest failures in medical communication is the strange perception of some General Practitioners that a patients description of pain that is "Everywhere" means pain that is "Nowhere". The misunderstanding and confusion that any physician experiences in dealing with CFS/ME because of the "lack of precise bodily location" is puzzling and confusing to the sufferer because the location of the pain was described clearly and succinctly: "Everywhere". Michael Moores documentary "Fahrenheit 911" shows a wounded soldier with both his hands amputated describing his sensation of having both his hands crushed despite the fact that they are no longer there. Would anybody who understands the basic function of the nervous system dare to dismiss his "Phantom pain" as illusory and a matter of mental attitude since it is quite obvious that his hands cannot be crushed if they no longer exist? It is dysfunctional for a physician ask a sufferer who is experiencing a neurological or systemic dysfunction that sends messages to the brain that "The pain is everywhere" to limit their description to "Where does it hurt the most". It is illogical and a lack of common sense for a physician to conclude that a sensation described as being everywhere "lacks a precise bodily location." "Everywhere" is indeed a precise location and a description that is fraught with meaning. -Erik Johnson Competing interests: None declared |
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Erik R Johnson, n/a Incline Village NV 89450
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Can a patient trust a physicians defense of a drug when that physician has accepted "consulting fees" from the pharmaceutical company? Such a conflict of interest introduces the element of doubt and removes the objectivity essential to the gathering of data for "evidence based medicine". If the outcome of the application of drugs on a broad scale is in perfect equipoise, why does the evidence continue to accumulate that the scales will tip in favor of the "marketable results"? An article from the Psychiatric News proposes that the system is flawed.(1) But if data is consistently being skewed toward results that are economically desirable instead of scientifically valid, the failure of the system can only be laid upon those individuals who allowed their personal interests to overcome scientific method and professionalism. -Erik Johnson 1 Jim Rosack. Clinical Trials Controversy Spotlights Flawed System. Psychiatric News July 16, 2004 Volume 39 Number 14 © 2004 American Psychiatric Association Competing interests: None declared |
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