“The art of medicine consists in amusing the patient while nature cures the illness.” Voltaire said this in the 18th century, when medicine really did have little to offer. Today, doctors and patients should still have conversations to find what really works for the patient. Sometimes, being understood and validated is all that a patient needs. It can be enough for doctors to just be there and listen. But when action is considered, doctors should engage the patient in a conversation about effectiveness—about what works and what does not.
Some medicine simply does not work. Take, for example, the use of probiotics to treat gastroenteritis in children. A recent article published in the New England Journal of Medicine demonstrated the futility of using probiotics for gastroenteritis in children. Gastroenteritis is a very common illness that causes diarrhea and vomiting, and it is often self-limiting. A randomized controlled trial—the best way we know of to determine whether a drug is effective—showed that for children with gastroenteritis, probiotics do not provide any clinically meaningful benefit. The children who took probiotics for five days did not have fewer symptoms, and their illnesses lasted just as long as the children in the control group, who had taken a placebo. In other words, we can confidently conclude that probiotics are useless for treating gastroenteritis in children, and they should not be used if the goal is to improve symptoms or reduce the duration of illness.
But is this the whole story? People do not take medicine solely to improve the outcome of an illness. Sometimes we take medicine because it is discomforting to do nothing when we are ill. The remedies we use help us feel that we are not just sitting idle—we are doing something. That feeling of having done something can be what allows an anxious parent to stay home instead of returning to the emergency room, worried about continuing symptoms.
Medicine entertains us while nature cures the illness. And nature will cure most illnesses. In the modern world, with the availability of good nutrition and hydration, almost all self-limiting illnesses get better. On the other hand, we could do better at living with our illnesses while we have them. There is privilege in being ill, and there is meaning in being ill. We appreciate our health better when we get a flavour of losing it. We are also humbled when we experience the momentary loss of what we take for granted. We connect with others through our vulnerability when we are ill. And others experience the privilege of caring for us. This is a good sacrifice to make others happy!
Being with the ill while they suffer is one of a doctor’s main privileges. And often, simply being there is what matters most to their patients. When patients are asked about what makes their doctor good, they say, “She cares,” not, “She knows how to prescribe the right medicine.”
Doctors are privileged to be with patients when they suffer, and it is a doctor’s responsibility to care and understand. Their job is also to advise patients on finding effective ways to heal and to coach the patient to find meaning in illness.
Both as a person and as a doctor, I believe we could try to find the meaning of who we are, where we are, in sickness or in health. We could choose to not take health for granted and instead be grateful for the health we enjoy. When we become ill, we could recognize that illness helps us appreciate our vulnerability, connect with the care of others, and understand the suffering of people.
But if we want to heal illnesses, let us only use what actually works.
The comments section is closed.
Reading the article, my first reaction was, sure use what works. Don’t use that which doesn’t, and so, do no harm. There was only a momentary intrusion of thoughts about all the exceptions and how complicated it all is, before the simple truth brings it back. For me, do no harm is the flip side of use what works.