What you want to hear


I have been thinking a lot the past few days about the placebo effect. It is a known fact that believing in something (especially a treatment related to one’s health) tends to make it much more effective, and ultimately real. It is also an unfortunate corollary of the placebo effect that if one tends to not believe in something, or to believe in a negative outcome, that too can become a self fulfilling prophecy. Ultimately, although our minds are not all powerful and cannot cure or worsen everything related to our health, what we believe about our state of being does have very significant health implications. These thoughts have occupied much of my thinking over the past few months as various health problems have presented themselves. These things are aided and abetted (or worsened) by various health care professionals, each with their own stake in the outcomes of their patients and what that means in terms of validating their own world views.

Let’s take the example of my shoulder injury. A few months ago (as many of you know) I started experiencing pain in my right shoulder and reduced range of motion. My doctor sent me to get MRIs which seemed to confirm some tears in the area, and then sent me to a specialist, Dr. Levy (who I had a rather awful visit with). Dr Levy (an orthopedic surgeon) minced no words with me, telling me that although I could try some other tactics like physical therapy, there was no getting around the fact that I would be needing surgery. He was an expert, this was his area of expertise, and that was that. I left somewhat disheartened (not to mention off-put by his bedside manner), but basically believing his analysis. I am not an expert, what did I know? Then again, I do know that when all one has is a hammer, every problem tends to look like a nail.

Over the past couple of months I have been too busy with moving and work projects to pursue any treatment, and my shoulder has gotten progressively worse. I finally decided a couple of weeks ago to make an appointment with a physical therapist, to see if I could at least have the pain abated a bit while I saved up money and courage for my inevitable operation. Something was slightly tugging me inside away from this decision, and there were competing voices in my head. A small “practical” voice in my head said why pay for something that won’t change the final outcome anyway, why not just schedule the surgery? Another voice, more feeble, held out hope that maybe I could avoid surgery after all, and what did I have to lose by at least meeting once with a physical therapist?

I am glad that smaller voice won out. After getting some recommendations from friends, I went to go see a physical therapist yesterday, armed with my MRI report and various other documents related to my shoulder. He examined the report and told me that for my age it was not at all unusual to have some small tears reported, and that they bother some people and others not at all. He then gave me some motion and stress tests, and asked me what treatment I had been following up til now (essentially, none). He prescribed an anti-inflammatory to take for the next month, as well as an icing regime and physical therapy, which I will begin tomorrow. He told me based on the exam that surgery could probably be avoided, and that I should recover full use and strength with a couple of months’ treatment. I was thrilled.

Could this doctor be guilty of his own hammer and nail syndrome? Sure. Could this just be the response I want to believe? Sure as well. But as we know from the placebo effect, my chances of getting better are vastly improved by me believing it to be so. And avoiding the more radical and expensive option of surgery is a good way to go whenever possible. Western medicine, like the western mind, generally favors quick fixes (surgery) over gradual process (therapy). It prefers to see problems as discreet, not part of a system, and I can be guilty of this at times as well. Will this treatment route result in healing? We will see, but I feel a lot better about it in my head than I have in a long time, and that is a very important component of getting better.