Confessions of a GP

Alternative medicine

I view alternative medicine a bit like I view prayer. I believe that both only work if you really have faith in them. They are also similar in the fact that neither can be explained by evidence or science, yet live on after thousands of years. My own personal belief is that both prayer and most alternative medicine practices only work via the placebo effect. However, as a doctor it is important that I put aside my personal reservations and accept that many of my patients believe in non-conventional forms of medicine. Trying to inflict my own scientific beliefs onto my patients just makes them feel defensive and alienated by modern medicine. I want my patients to feel that regardless of our differing views, they can always come and see me to discuss their health.

As a GP, patients often ask me what I think about specific alternative practices. It is important for me to tell them that they are not all the same. It would be rude to compare a chiropractor with a crystal therapist or a fully qualified herbalist with a faith healer. I am usually fairly non-committal on the subject and say, ‘If it works for you, then go for it.’ I am particularly keen not to put off my more difficult patients from trying alternative medicines, particularly if it means that they might be encouraged to not visit me quite so often.

One of the original founders of psychotherapy talks about the doctor being ‘a drug’. This is the idea that regardless of what we diagnose or what medicine we give, simply our spending time with a patient, listening to them and possibly reassuring them is in itself often an effective treatment for many ailments. This form of healing is perhaps being lost in the modern general practice of targets and ever shorter appointments. Regardless of whether they offer homoeopathy, acupuncture or Reiki healing, the alternative practitioners are filling that gap by giving the time and attention that GPs don’t have an opportunity to offer.

One gripe I have with alternative practitioners is that they are ultimately private. Somebody is making money out of your illness and having only ever worked for a free at point of access health service, I find that an uncomfortable concept. I am fortunate enough to have never had any problems with my back, but I am fairly sure that if I presented to a private chiropractor, he would examine me and diagnose me with various weaknesses and instabilities and then recommend a set of ten sessions for £50 a pop. I expect a lot of alternative practitioners do similar things. Doctors working in private practice are no better. I had a patient who returned from a skiing trip in Bulgaria. He had had an accident and injured his leg. The doctors did an X-ray to exclude a fracture, which is reasonable enough. They also did an ultrasound scan, a CT scan and prescribed five different medications. All this for a bad bruise! The doctors were playing on the patient’s fears of being unwell and fleeced him for a small fortune. Unfortunately, I think that many private doctors play this game and it is a real relief to me that I don’t have the temptation of earning more money by prescribing more drugs and ordering more tests.

Most of what I prescribe as a GP is based on evidence and I talked about this earlier in the book. The concept is that I can’t just give any medicine for any ailment. For me to use a medicine there has to have been a large non-biased trial that showed that this medicine worked better than a placebo. For some treatments such as homoeopathy these sorts of tests are fairly easy to carry out and most of the evidence would suggest that there is no difference between a homoeopathic treatment and a placebo. For other alternative treatments, conducting these sorts of trials is more difficult but it can be done. For those of you unfamiliar with Reiki, it consists of a specially trained Reiki ‘master’ laying his or her hands upon the patient and controlling the energy forces that pass through the body. Advocates of Reiki talk about the amazing feeling of a glowing radiance and heat that passes through them during a Reiki healing session. Apparently, an experiment took place where several actors watched a Reiki master perform and then they imitated his healing technique. When the actors impersonated the healer using realistic but completely made up mystical chants and movements, the patients were just as aware of the radiance and heat passing through their bodies and were unable to tell the difference between the work of the Reiki master and the actors.

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.