The good neuro

[Balderdash]

Bas Bloem

FROM GOD TO GUIDE

youtube.com/watch?v=LnDWt10...(Not working as expected?)

[etterus]

In real estate its location, location,location. In healthcare its collaberate, collaberate, collaberate.

[BillDavid]

Balderdash.....thanks for the reference to the you tube video.....alternately, I can be located by Googling "TEDxMaastricht from god to guide". One implication implied by the video is the Healing or non-Healing impact of the Doctor Patient relationship. I believe as a PD Patient this deserves some thought.

The impact the Doctor has on the course of the Patient's Disease. An outcome of the greatest personal importance. This issue is addressed in MInd Over Medicine a book by Dr Lissa Rankin MD, in her third chapter: The Healing Factor that can make all the difference - The Doctor as Medicine. She quotes (p 40) Dr Ted Kaptchuk, Director of Harvard's Program in Placebo Studies and the Therapeutic Encounter, "A sugar pill doesn't do anything. What does something is the context of healing. It's the rituals of healing. It's being in a healing relationship....when we study placebo effects......actually study just the act of caring

......That's, I think, what we're measuring." I will vote for that, being in a healing doctor/patient is critical.

Yet are all Doctor/Patient relationships healing? They are not. Something, I think, important to consider.

Previously mentioned in a post, is the BBC, Horizon 2014 presentation the Power of the Placebo (this video can be found in you tube) Twenty-nine minutes running time into it, an example by Dr Stoessel from Vancouver, shows a Placebo effect on a Patient, Where MRIs of the Patient's brain's Striatum demonstrate

that the Placebo used caused as much production of dopamine, there in the Striatum where it counts,

as a typical administration of medication. The subject, himself, showing moderation of his PD symptoms while only being treated by the Placebo. Beyond amazing! Later is this same video, Dr Ted Kaptchak demonstrates a placebo showing the Doctor/Patient Relationship itself as Placebo. This involved an acupuncture treatment. Impressive.

In another video, locate in you tube by "Googling " "Ted Kaptchuk - One the Placebo Effect", Kaptchuk discusses the protocol he used in the BBC Program demonstration of the Doctor/Patient Healing Placebo.

He describes embedding the "Healing" Placebo in his provision of care. Mechanism of the Placebo....Doctor provides Compassion, Trust and Hope. The Ritual of Treatment itself can be the Placebo.

Components of this Placebo (structure of Protocol tested). Doctor....(1) Attentive listening...repeating the words the Patient used, (2) Looking at the Patient in his/her eyes, (3) Expressing Empathy, (4) Feeling connected to the Patient....to the serious questions in their lives, (5) Express confidence in outcome. (6) Touching the Patient physically, (7) Patient feeling being taken Care of ......by Doctor/Provider.

Doctor / Patient belief in treatment has also been shown to be a major predictor.

Seems to me, in my way of thinking,,,,,,,,that Compassion, Trust and Hope are important to consider. The Doctor as Medicine ?

What do you think?

BillDavid

[michaela13 in reply to BillDavid]

I absolutely agree. Especially when you've been brought up with a distrust in medicine.

[paddyfields in reply to BillDavid]

If I remember right even when some people were actually told they were going to ne given a

placebo they still improved.

[BillDavid in reply to paddyfields]

paddyfields.....that is what they said they showed....Kaptchuk talked about the protocol they used in the other video I referenced. As I understood. they required the subjects to get the placebo pills from a Doctor they had a strong relationship with. They were informed of the placebo, by the Doctor telling them this would work like Pavlov and his dog, or something similar about Pavlov and his Dogs. My impression of this scenario is that given the relationship with the Doctor and the subjects, and the explicit outcome of the Pavlov, Dog, explanation.......that this amounted to placebo by induction. I don't see this as a problem. They also showed a Dentist extracting a tooth while managing pain using hypnosis. However, I don't see this as amounting to a placebo working after informed consent. I am sure that doctors actually use placebo without informed consent.

Back in the 1950s (Yes I am an old guy)I worked in a drug store where Rxs were often compounded in house and dispensed in gelatin capsules and narcotic prescriptions required an elaborate protocol that could take a few days. Several older persons were bed ridden and required narcotics for pain management. The problem being that the narcotic involved caused constipation. The solution was that the druggist and doctors made a deal. When renewed, the RX had a placebo instead of the narcotic used in compounding the capsule which was identical. The same protocol as an actual narcotic was used. It was seamless, the placebo managed the patient's pain as well as the narcotic.

The constipation was avoided. The patients themselves, thought they were getting narcotics. Neither they or their families were ever informed.

BillDavid

[paddyfields in reply to BillDavid]

Thanks for filling in the gaps. I'm pretty sure I was prescribed placebo (I can't remember what for) a good few years ago because when I said to the doctor "It's just like I wasn't taking anything at all" he looked very startled but naturally said nothing.

[Moodyblue in reply to BillDavid]

At the other end of the scale from placebos having a positive effect comes the real medicine which the patient expects to help - but it doesn't. I wonder now, having seen this video and read the comments, is this because of a poor doctor/patient relationship? Every Neurologist I have seen in my 20 years with PD has been safe on his/her ivory tower and none have ever explained anything or advised anything beyond writing prescriptions, assure me that I'm doing very well and tell me that I must expect to get worse.

[Balderdash in reply to BillDavid]

BillDaivid thanks for the interesting reply The Doctor as medicine,placebo effects,being taken care of, it all about making a connection,I think that is what brings trust and hope and that then gradually empowers. You need that to build confidence and to motivate, It takes time to find or build all of this.I feel better than I did ten years ago,but Im not.The difference is,I understand my illness better and have confidence I didnt have ten years ago.

As Etterus said collaboration collaboration and more collaboration

[movinngroovin]

AMAZING!! I PLAN ON SENDING THIS TO EVERYONE I KNOW!!

[Balderdash in reply to movinngroovin]

This is the article from 2010 of Bas Bloems patient experience.

nytimes.com/2010/04/01/heal...