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Last post, I talked about the importance of both doctor and patients believing in the chosen treatment to most positively effect healing. The mind cannot be removed from the healing process—not the patient’s mind, not the doctor’s. Case in point: New brain research shows the effects of nocebo on the healing process. No, no, no…not placebo—the perceived or actual improvement in a medical condition from a sham or simulated healing intervention—the nocebo effect!

The nocebo effect is the belief that a person will either fall ill or experience pain, or both. This phenomenon was studied via sophisticated experiment where 22 subjects were zapped with a heat-beaming device onto their legs until they rated the pain as a 70 or more on a 100 point scale.

The researchers then hooked up an IV to give the subjects a powerful morphine-like painkiller remifentanil, which is typically used for surgery patients. It works rapidly but also is metabolized rapidly, so it was able to be switched on and off as researchers alternated between giving the drug or plain fluid.

The volunteers’ brains were scanned as they described how much pain, and pain relief, they experienced at different times. When the researchers induced the burn and clandestinely turned on the drug, the volunteers said their pain improved a fair amount. The painkiller was working, expectations aside.

But here is where mind took over: The researchers next told the volunteers they were about to inject the painkiller even though they’d never turned it off. Those pain ratings dropped even more—meaning expectations of relief doubled the drug’s painkilling benefit.

Finally, the researchers lied again, saying they were stopping the drug and that pain would probably increase. Sure enough, the volunteers’ pain levels soared back up to almost their pre-treated level as grim expectations canceled out the effect of a proven and potent painkiller. Anxiety levels fluctuated similarly.

Why? The brain scans showed changes in neural pain networks that prove the people really did experience the changes in pain that they’d reported. So essentially, the nocebo effect is getting the pain you expect.

Moreover, expecting more pain fired up sections of the brain that control mood and anxiety, the researchers recently reported in the journal Science Translational Medicine. In contrast, anticipating pain relief fired up different regions previously found active in people given placebos. Wow!

Remember, as I said last post, the patient has to believe in the treatment. When a patient goes in expecting not to be helped, expecting to be ill, or expecting pain…well, they’ll likely get it. On the other hand, a patient believing that they will be well, that they will heal, or that a healing technique will work for them will actually set the healing process in motion.

I wrote an article a few years back describing what I call The Five Mental Blocks to Healing, where I described the five ways in which the mind acts as a saboteur in the healing process.  Uncertainty, not trusting the treatment or doctor, or expecting failure are some of these blocks.

Nocebo is a real phenomenon—I’ve seen it plenty in my office. I know when somebody (usually a heterosexual male) is in my office only because his spouse or children wanted him to come that he will probably have a retarded healing experience. Unless, of course, I get through to the person which, fortunately, sometimes I do.

If you are in a situation that needs healing you’ve got to seek and believe—seek treatment and trust the process, that’s all.

It’s nice to have a doctor who really knows you.  I always say, there’s a big difference between healers and technicians.  Technicians know the ins-and-outs of their discipline, but they often lack the interpersonal skills necessary to make their patients feel comfortable.

Knowing one’s patients–their lives, family details, what drives them, their values–helps a doctor effectively communicate recommendations, and increases the likelihood that the patient will either follow through with the plan, or at least that the two can work together to find an alternative course of treatment.  Without having this type of interaction, the doctor-patient relationship runs the risk of becoming one of authority-subordinate, nag-nagged or money grubber-chump.

Take my doctor, Dr. W, for example: he knows me.  He knows my family, my work, my job, my beliefs, and so on.  But best of all, he knows my health habits.  He knows that I work out regularly; he knows that I take vitamins, and he knows that I don’t do drugs or alcohol.  To top it all off, he knows that I am probably not going to take his statins.  Yes, that’s right–I don’t care if my LDLs are one-bleepity-bleep–no statins for me, thank you very much.

I love that he knows this about me.  When giving me my annual physical exam results, he leaves a nice voicemail message, finishing it off with, “And your cholesterol is high.  I’m recommending statins, so I’ll call the pharmacy and leave the prescription because I know you’ll probably tell me that you’re not going to take them.”

Ah, good ol’ Dr. W.  He knows me in and out.  He knows what I’ll do and what I won’t.  He genuinely cares about me, my work, and my family; and that’s why I keep going back to see him.  Dr. W is a healer because he knows how to listen, is observant and doesn’t try to overpower me with his health-authority bull$&*!  Good health care, Dr. W, and I appreciate it.  But I’m still not taking any statins.

Your doctor’s decision to pull the plug might be connected to his or her religiosity.  Yes, doctor’s belief in God may color their views on ending life.  So says a recent British study that shows nonreligious doctors to be twice as likely as religious ones to make decisions that could end the lives of their terminally ill patients.

The study surveyed more than 3,700 doctors across the UK, of whom 2,923 reported on how they took care of their last terminal patient.  Doctors who described themselves as “extremely” or “very nonreligious” were nearly twice as likely to report having made decisions like providing continuous deep sedation, which could accelerate a patient’s death.  Doctors taking part in the survey ranged from neurologists to family practitioners, with those specializing in elder and palliative care also included.

The author of the study, Dr. Clive Seale, professor at Barts and the London School of Medicine and Dentistry, concluded that doctors and patients should discuss beliefs in order to best comply with a patient’s end of life wishes.  Whereas “nonreligious doctors should confess their predilections to their patients,” Seale also found that doctors who were religious were much less likely to have talked about end of life treatment decisions with their patients.   

Doh!  Looks like neither side is honoring the patient.  Bad doctors, go to your rooms!  No, seriously–probably a good idea to have this discussion upfront, doctors.  Kind of like, “Were gonna cut your penis off, is that okay with you?”  Duuuh!  You’ve got to ask.

In those rare events when patients are unable to communicate their wishes, doctors must not simply rely on their own values, but that they “should take all reasonable steps to maximize the patient’s ability to participate in the decision-making process.”

So here’s my suggestion: Discuss your end of life wishes with your doctor on your first visit.  If you have a doctor now, discuss it at your next appointment, and have them write it down in your chart.  Even better, get your wishes documented in a will or trust.  Don’t leave it to your physician who probably has his own beliefs.  Finding out your doctor’s belief system while getting your last sedation will probably bum your trip out.  Or if you’d rather a little help…a pious position might just stand in the way of your peaceful passing–probably not the way you want to go.  So do the smart thing now–discuss it with your doctor first chance you get.

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