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Friday, August 8, 2014

Wanting To Please Your PHysiican

I've seen more and more talk about the effectiveness of the administration of placebo. With the implication that placebo care is no care at all. And not so, because as patients and physicians we care very much which is at the root of the "pleasing principal." As a gyno I feel that just knowing the origin of this fascinating phenomenon's term explains the essence of placebo to me. The phrase I Shall Please is powerful, and it is the the meaning of the Latin verb placere. Placere in the plural is the derivative of the word placebo. Most of us mentally think of the phrase, "placebo pill" when we think of the word placebo, but is is not just a pill it is an entire physiologic process that acts to produce the responses seen when a placebo is administered. More correctly, the "I Shall Please" process is a 'placebo effect." It is why administration of the placebo medication in research trials almost universally produces salutatory treatment results as opposed to typical untreated patients.And the key to the phrase is the interaction. It is that inexplicable bond between health care provider and patient, it is thus explained by Leon Eisenberg to be a "healing response" or a "response to care", in fact he emphasizes that it is an important response. We of course knew this in Avicenna's time, a 11th century Persian physician who wrote over 450 documents on medicine, including the fact that the treatment will not work unless the physician believes in it and conveys that to the patient. So the pleaser has to get that feedback from the pleased, so I prefer to call this a "healing dynamic" as well as a treatment response!

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