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Archive for July, 2010

gormley edinburgh

gormley edinburgh

gormley edinburgh

gormley edinburgh

I found four of the six sculptures on one day’s walk, but I’ll need to go back and try and find the other two.
One thing which really struck me about these figures is how different they are in their individual contexts……not just a bit different, but VERY different.

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Here’s a scenario to try with any health care professional you know –

Imagine a patient presents with an infection in their bladder (cystitis), with burning pain passing urine, frequent need to pass to urine and some blood in the urine. You send a sample of the urine to the lab and they grow “E Coli” (a commonly implicated bacteria) sensitive to “Trimethoprim” (an antibiotic). You prescribe the recommended “Trimethoprim”. What does it do?

The only correct answer is that it kills the bacteria.

So, how does the inflamed, swollen, bloody bladder wall return to normal?

Only through the body’s natural healing system.

Drugs have effects. Antibiotics in particular can kill bacteria which might otherwise cause us great harm. But prescribing a drug is only part of the job needing done. If we only prescribe a drug and do nothing to support or stimulate self-healing, then we leave healing to chance……as if healing isn’t part of a health care professional’s job.

So, here’s something I wonder about. Why don’t they teach how to heal people at medical school? Why do they only teach how to “manage” diseases, remove diseased tissue, or suppress symptoms?

There’s the BIG gap in biomedical practice – how do we encourage and develop healing?

Shouldn’t we be using approaches which focus on healing as well as those which focus on disease?

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The first time I saw Antony Gormley’s “The Field“, I was transfixed. The room filled with those hundreds of small terracotta creatures all gazing at me gazing at them!

It’s an image which has stayed with me ever since and it’s one I think all health care professionals should expose themselves to.

Every patient I see has something in common with some other patients I’ve seen. That’s the basis of “diagnosis” in the way biomedicine considers disease. But every patient I meet is different. No two have the same experience of this disease. No two tell the same story. And here’s another aspect to that…….nobody stays the same, the story constantly evolves and changes. Without attention to the present, without an open-ness to difference, we fail to see what makes every single human being unique and special.

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Myth 1

There are two kinds of treatments available – those which work, and those which don’t.

The real world isn’t so simple. There’s not a single treatment on the planet which “works” for every person who receives it. I’m sure the drug companies wish they did have such a product – it would have no competitors. Even treatments which work for most people, don’t work for ALL people.

Myth 2

The placebo effect is distinguishable from a pharmacological effect.

Randomised controlled trials typically have two groups. One group receives the study drug and the other, the placebo. If the improvements in the first group statistically exceed those in the second group, the drug is considered to be effective. However, the placebo effect occurs in both groups. It is impossible to know whether any individual in the first group has gained their improvements from the drug, and not from the placebo effect.

In clinical settings, with any individual patient, it is impossible to know whether the drug has “worked” or whether the improvement is due to placebo.

Myth 3

Giving a placebo is the same as doing nothing

This graph is from Irvin Kirsch’s “Emperor’s New Drugs“. It clearly shows that placebo and doing nothing are not the same.

Myth 4

The NHS only funds “evidence based” treatments.

51% of treatments rated by the BMJ group’s “Clinical Evidence” are of “unknown effectiveness”

Myth 5

Objective findings are of value, and subjective reports are value-less

Health is a lived experience. Only a person can report that experience. To dismiss the patient’s narrative is bad medicine.

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