Tuesday, April 04, 2006

coyote medicine?

At my med school we have something called Capstone -- it's two weeks of "lectures" stuck into the two months we have off before graduation. Supposedly it's a time to discuss the touchy-feely stuff that isn't taught in med school. Yesterday was our first day and we had a guest speaker -- Dr. Mehl-Madrona author of Coyote Medicine. Dr. Mehl-Madrona is board certified in family medicine and psychiatry and practices Native American healing. Some interesting topics from his talk: The mind is very powerful and can heal disease if harnessed; every person has a "story" and knowing it is essential for healing; religion is good for you ("If you don't have a religion, get one. If religion was a drug you would get sued for not presribing it.")

Some of what he said I understand and agree with. We all know how powerful the mind is and that believing you will get better can help you get better. The placebo effect is a real entity; I'm just not sure that a doctor's job is to hand out placebos. He described a patient who had rheumatoid arthritis and requested penicillin. Dr. Madrona made a deal with him -- I'll give you penicillin and if in 10 days you haven't improved you won't ask for it anymore, but if you are better than I'll give it to you whenever you ask for it. Well, after 10 days there was a dramatic improvement in this man's RA. Does that mean penicillin caused the improvement? No. It could be some placebo effect or the flare ran its course and would have improved on anything or nothing. Don't we have a responsibility to educate patients? And don't we have a responsilbilty to use medications properly, esp. antibiotics to try to slow don't the epidemic of drug resistance?

Another problem I have with his ideas is part of his "everyone has a story" thing. He told us about a patient who had heart surgery and then lost 100# by changing his diet. Some time later he regained 80#. When asked what happened he said that he couldn't stick to his diet because it hurt his family to not eat whatever was prepared at home, which was fattening foods. And that hurt his heart more than the weight. So Dr. Madrona stopped pushing the diet and weight loss because it didn't fit this man's story. I have a real problem with this one. I know that you can't force someone to change their lifestyle or take medicine, you have to suggest and prod and convince. But you can't ignore a problem or disease. Smokers like smoking and don't want to stop, alcoholics with liver disease don't want to quit; you still bring it up. Every time I see a smoker in clinic I ask them if they have thought about quitting and encourage them to try because of the health benefits. Sure, it's often pointless, but sometimes they just needed some encouragment to try quitting again. I was discussing this with one of my attendings a while back and we were talking about what makes a patient pleased with his medical care. It basically comes down to getting his needs met. Of course we don't always know what these needs are. We may focus a visit on hypertension and diabetes when the patient is really worried about his toe nail fungus. He may not care about his blood pressure, not think it's important, not want to take medicine, do hammering away at it and ignoring his real concern will leave him frustrated. OK, I agree with that and I should discuss his funky toes, but it's not okay with me to ignore his blood pressure. I need to educate this patient on the dangers of high blood pressure and the importance of getting it under control. Sure it may be like talking to a brick wall and months or years may go by without him understanding, but as a doctor that's my job. High blood pressure and its effects will kill him and I can't ignore that just because it isn't in his "story"; instead I have to change his story. Now if I can just figure out how to do that.

Feel like reading better written and more informative medical blogs? Check out this week's Grand Rounds at UroStream.


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