Monday, 19 January 2015

T.E.E.T.H. And Getting What You Pay For

When someone trained as a healthcare practitioner of any kind in the past (I'm not sure about now), they learned various abbreviations and acronyms such as NAD (Nothing Abnormal Detected), GCS (Glasgow Coma Scale) and U's & E's (Urea and Electrolytes) so that they didn't have to spend the whole day scribbling this stuff down.  Herbalists are no different because clearly we need to communicate with other professionals and in a medical context it's not a good idea to make up your own shorthand because it may confuse others and then people could die.  I wouldn't generally have much need to use GCS, for example, myself, although it might come up in the previous medical history section of a patient's notes.

People also use slang of course, and doctors are no exception.  Therefore there are various other initialisms floating about which are less officially sanctioned, often with dubious connotations.  For instance, there is JPFOOG - Just Plain F-----g Out Of Gas - for a patient who is obviously going to die soon, considered in a holistic way come to think of it, because clearly action can be taken and heartbeat and oxygen can be sustained as a result, but it won't do them any good because they've had it.  You can already feel, presumably, the somewhat dismissive and harsh tone taken there, but please be reassured that it isn't mine, and at least that abbreviation offers some degree of protection to the feelings of relatives.  Another one is GROLIES - Guardian Reader Of Low Intelligence In Ethnic Skirt - which might describe me.  A lot of them have F's in them.  Fortunately, these abbreviations are in decline, hopefully due to increasing respect for patients but possibly due to the fear of being found out, although at least that fear might cleanse medical subculture of such approaches.  Also, they probably express things like frustration at limited concordance and just the way people are, and it's true of course that people can be annoying, but I can guarantee you that I have never used an abbreviation like that.  To be cynical of course, a doctor gets paid anyway so when a so-called "heart sink" patient comes through the door it can have that effect, but in my case a patient usually means a couple of things - an interesting new acquaintance, someone whose life story I want to know and someone I want to help, and also of course, someone who is about to give me money.

One acronym, however, which is close to my heart, is "TEETH":  Tried Everything Else, Try Homeopathy.  I imagine the colouring of this particular thing is that nothing at all will help someone's health condition, so in the doctor's view the next stage is literally to try nothing at all, i.e. the allopathic and quasi-sceptical view of what constitutes homeopathy.  I'm not going into that now but you might want to conjecture that my own view of homeopathy is not the same as that of the average soi disant "skeptic" (spelt the American way of course for reasons that aren't obvious without veering off-topic).  It makes complete sense to me to replace the word H stands for there with "herbalism", and this acknowledges an important truth.  My patients have often tried everything else to no avail.  Herbalism is often a last resort to them, even after CAM therapies have been tried.  This can mean, of course, that all the "easy" problems have been weeded out ("a weed is a plant growing where you don't want it" - well I want those weeds, figuratively and literally) and I'm left with the toughest nuts to crack, to mix metaphors but stay in the vegetable kingdom.  Note, by the way, that it's the cases which are the nuts and not the patients.

It might then be thought that I am then left with a load of patients I can't help.  It might even be thought that I am using this argument to justify an appointment diary full of patients whom I can't help because my chosen therapy just doesn't work.  Obviously I'm not going to believe that, if only for psychological reasons, but I do also believe that it's rational not to believe that - dare I say be sceptical about the idea that herbalism doesn't work?  This is because in my experience, the opposite is so.  Patients come to me, I do my thing with them and their health improves.  When I say it improves, what I mean is that not only does it improve subjectively - they feel better - but also in measurable ways.  High blood pressure goes down, peak flow goes up, excessive thyroid hormone levels sink, areas of skin affected by skin diseases reduce, joints move further and hair grows back.  You can see it happening.  Of course, many conditions improve without intervention but after someone has had something for many years and it just happens to improve when they come to see me, I would say that means something.

I mentioned before that I am very happy to see people who, among other things, are about to give me money.  Well, this works both ways.  To a considerable degree, you get what you pay for.  Sarada and I were recently offered counselling free to us and decided to turn it down because we believed that we would value it less and it wouldn't work as well. We are people with relatively little faith in the accuracy of money as a standard of measurable value - it's incredible what people are willing to pay for and what they aren't willing to pay for.  Nonetheless it does influence us, and free counselling lacks the added value of being expensive to the person benefitting from it.  We turned it down, and of course that may have been a bad decision, but the point is this:  if a patient perceives herself (incidentally on the comment yesterday, yes, most of my patients are female) to be paying for my treatment, she may get better more quickly for that very reason.  She values it more.

This is an advantage over the National Health Service, because although we do all pay for it, in VAT if nothing else, we often don't perceive ourselves to be paying for it.  Consequently, people often do get better more quickly if they pay for something.  Therefore, in a sense you get what you pay for.

Of course, this may be a comforting myth so that I can continue to fleece the public, but what would be good, and I don't know how this could be done, would be to find a way to divorce the act of monetary payment from its effect.  If we can get better on our own if we pay for something, even sugar pills or water (that's not a comment on homeopathy incidentally, but on orthodox clinical trials of medicine which need to eliminate the placebo effect), surely it would be useful to research how this effect can be separated from the actual need to pay?  Someone could still be paid of course, perhaps to train the person to deploy the placebo effect consciously.

To finish, then, don't insult your patients, try herbalism before you've tried everything else, and if you can pay, do, because it will help you.