Podkayne, that word was listed before as “nocebo”.
With regards to treatment, my doctor is very explicit in explaining the difference between viruses and bacteria, and prescribing antibiotics only for bacterial cases, and not for suspected viral ones. There are now guidelines for physicians that unless specific symptoms occur they generally wait about 7 days before prescribing antibiotics, as it it likely a virus and will cure itself, and antibiotics won’t help. No more giving out antibiotics just to make the patient think you’re doing something. Medications to help with symptoms are acceptable. Information goes a long way to placating patients (at least to me).
Regarding the ethics of placebo, I think it depends on circumstances, but I feel it is ethical for a doctor to prescribe a placebo if he feels that the condition is not something that there is a real treatment for, and if he is aware he’s using placebo. And probably the seriousness of the illness is a factor. This is why I do not support the current notions in nursing that are pseudoscience but being passed on to nurses through their school and certification programs as if they actually work and are grounded in demonstrated science. There could possibly be some minor benefit to using these methods as placebos, but as currently used they are passed off to the health care professionals as effective treatments without validation. That is scary to me, far scarier than a doctor resorting to placebo when there’s no other treatment available.
I was ill with either a urinary tract infection or a virus about a year ago. My regular doctor was on vacation and his partner prescribed an antibiotic without ascertaining whether it was viral or bacterial. I thought that was very irresponsible, but I took it.
If someone is a hypochondriac, shouldn’t a doctor recommend a psychiatrist? Perhaps the person needs treatment for some mental disorder that makes him a hypochondriac. Perhaps the person has a somatoform disorder, for example. Do doctors ever do that?
“I was ill with either a urinary tract infection or a virus about a year ago. My regular doctor was on vacation and his partner prescribed an antibiotic without ascertaining whether it was viral or bacterial. I thought that was very irresponsible, but I took it.”
A doc can usually tell pretty easily whether someone has a urinary tract infection and urinary tract infection more than 90% of urinary tract infections are caused by any one of a small number of bacterial species so it was probably NOT irresponsible of your doc’s partner to prescribe an antibiotic. It was a mistake, however, to fail to explain the purpose of the treatment to you.
“If someone is a hypochondriac, shouldn’t a doctor recommend a psychiatrist? Perhaps the person needs treatment for some mental disorder that makes him a hypochondriac. Perhaps the person has a somatoform disorder, for example. Do doctors ever do that?”
Do you mean, do docs ever refer hypochondriacs to shrinks? Yes, they do. However, (1) it often makes patients very angry, (2) it may not do the patient a service since the patient may do just as well venting to a GP and getting a B12 shot (or something else innocuous) for 10 minutes every couple of months as visiting a shrink for a half hour every week at great expense.
As a Respiratory Therapist, I sometimes have to teach patients how to use MDI’s (metered dose inhalers, or just “inhalers” as they are known to the lay public). To do this I use a “practice” inhaler which contains only air and has the word PLACEBO printed on the side.
On one occasion I explained to a patient that “this is just for training purposes, and the inhaler you pick up from the pharmacist will be the one called Ventolin.”
A little while later, I walk by the ER room and the patient calls out to me, “Hey DOC (I hate it when they do that) that thing really helped my breathing!”
Well, you can see my dilemma, can’t you? Admittedly, I did not give the patient enough information during the training, but was I gonna stand there and make him feel stupid by telling him it was just air that he was breathing?
I just hope he doesn’t come back demanding a prescription for the Placebo because the real MDI doesn’t help!
Sorry, I’d had just skimmed Baloo’s post because I understood nocebo to mean a detrimental effect caused by the patient’s belief that they were getting a strong medicine that might have side effects–or because they thought someone was putting a voodoo curse on them or something like that. That definintion of nocebo is used in almost every web site I can find. In fact, many sites say that nocebo derives from the Latin nocere, meaning “to inflict damage”, not from the English “no” (presumably for “no effect”?).
I’m pretty sure that there’s a different term for the treatment being ineffective because the patient doesn’t believe in it. Set me straight if I’m wrong!
While I certainly understand the frustration with the number of people who show up at the clinic for minor complaints, but what about all the advice out there that boils down to, “If you have any doubts, see a doctor.” People are supposed to consult physicians before taking OTC drug X if already on any other medication, if the symptoms OTC drug Y helps persist beyond 3 days, before starting a new exercise regimen, before starting a new diet, and so forth. Do you know how many helpful FYI articles and TV segments describe horrible diseases as having “flu-like symptoms?” It hardly surprises me that people go to the doctor for head colds when the guy last week on the Today show said that “acute hyperspasmodic tetryon occlusia feels just like a cold right up until your liver dries up and falls out your keyster.”
I said “I was ill with either a urinary tract infection or a virus.” I did not say that my doc’s partner knew it was a uti. He took no urine sample. I did have a uti a few months prior. I felt ill with symptoms that could have been another uti, but could have been a virus. He asked me what my doc had prescribed before. I told him, so he prescribed the same thing and said that if it were a virus it would not do any harm.