After yesterday’s post entitled ‘What does a holistic doctor do that a traditional doctor doesn’t?‘, I thought it would only be fair to turn the question around and ask: What does a proper doctor do that a holistic healer doesn’t? The answers will upset a lot of practitioners of alternative medicine (SCAM), but so be it.
So, what does a proper doctor do that a holistic healer doesn’t?
I suggest several answers and hope that the readers of this blog will contribute to further points. Many of them center around safeguarding the public:
- Proper doctors avoid confusing or misleading the public with titles they do not have.
- They do have rigorous education and training.
- They avoid making false therapeutic claims.
- They adhere to the ethical standards of their profession.
- They resist the temptation to advertise their services to the consumer.
- They do their best to identify the cause of their patient’s symptoms.
- They treat the causes of disease whenever possible.
- They avoid pretending that they always have all the answers.
- They abide by the rules of evidence-based medicine.
- They are aware that almost any effective treatment comes with adverse effects.
- They try to keep abreast with the rapid advances in medicine.
- They know that a patient is more than a diagnostic label.
- They try to treat patients holistically.
At this stage, I can hear some readers shout in anger:
- Ahh, but that is rubbish!
- I know doctors who are not at all like that!
- You are idealizing your profession!
- This is little more than wishful thinking!
Yes, I know that many patients are disappointed and have had a bad experience with conventional medicine. That is one of the reasons many try SCAM. I know that many doctors occasionally fail to live up to the ideal that I depicted above. And I fear that some do so more often than just occasionally.
This is regrettable and occasionally it is unacceptable. Medicine is populated not by perfect people; it is run by humans like you and me. Humans are fallible. Doctors have bad days just like you and me. If that happens regularly, we need to address the problems that may the cause of the deficit. If necessary, the case has to go before a disciplinary hearing. There are thousands of experts who are dedicated to improving healthcare in the hope of generating progress.
The point I was trying to make is that there is such a thing as an ideal physician. It relies on:
- rigorous training,
- ethical codes,
- post-graduate education,
- swift disciplinary procedures,
- advances brought about through colossal research efforts,
- etc., etc.
Do ‘holistic healers’ offer all of these safeguards?
The sad answer is no.
For those who disagree, let’s briefly look at a recent example.
John Lawler died in 2017 after being treated by a chiropractor (as discussed on this blog before).
- Mr. Lawler died because of a tear and dislocation of the C4/C5 intervertebral disc caused by a considerable external force.
- The pathologist’s report also showed that the deceased’s ligaments holding the vertebrae of the upper spine in place were ossified.
- This is a common abnormality in elderly patients and limits the range of movement of the neck.
- There was no adequately informed consent by Mr. Lawler.
- Mr. Lawler seemed to have been under the impression that the chiropractor, who used the ‘Dr’ title, was a medical doctor.
- There is no reason to assume that the treatment of Mr. Lawler’s neck would be effective for his pain located in his leg.
- The chiropractor used an ‘activator’ that applies only little and well-controlled force. However, she also employed a ‘drop table’ which applies a larger and not well-controlled force.
As far as I can see, most of the safeguards and standards that apply to conventional medicine were not in place to safeguard Mr. Lawler. And that includes a timely disciplinary hearing of the case. Mr. Lawler died in 2017! The CCG has been dragging its feet ever since, and, as far as I know, the chiropractor was meanwhile allowed to practise. The HEARING BEFORE THE PROFESSIONAL CONDUCT COMMITTEE OF THE GENERAL CHIROPRACTIC COUNCIL has now been scheduled to commence on 19 April 2021.
I know, it’s just an example. But it should make us think.
I think the biggest differences differences between conventional medical doctors (whatever their failings may be) and the charlatans out there practising what ever variety of SCAM is their favourite are the following:
1) conventional medicine is based on sound scientific principles that are open to strict scrutiny and are continuously being examined, scrutinized and improved over time.
2) by and large most conventional doctors attempt to practise evidence and science based medicine according to the latest evidence based standards.
3) by and large most conventional doctors have quite a strict code of ethics regarding treating, informing and getting consent from patients.
This is in stark contrast with the vast bulk of SCAM which is based on magical thinking and fantasy, and not backed with any sound evidence and which does not change over time regardless of how much evidence accrues regarding its practices.
In addition the ethical standards surrounding SCAM are far more lax, permitting practitioners to exaggerate, dissemble and downright lie about their modalities, have huge conflicts of interest, disparage conventional doctors and spread serious misinformation for their own monetary gain.
The actual best interests of their patients do not seem to come before the best interests of the SCAM practitioner which is altogether wrong.
What is most dangerous about nearly all practitioners of SCAM is that they have a dangerous overconfidence in their beliefs that they can treat serious conditions with their silly magic and not sufficient self-awareness to realize that they are only “playing doctor” and so should get out of the way when someone is really sick.
Nor indeed the training and experience to recognise when someone is really sick.
Doctors spend years of their post-graduate training working in acute medical and surgical departments, seeing very sick patients on a daily basis. This way they learn to pick up on subtle signs indicating that somebody is about to deteriorate and what action to take to prevent it.
I guess well-trained pharmacists may play a ‘first-line’ role too.
My local pharmacist told me of an occasion where a lady came into his shop asking for something for an irritated throat. He had a quick look in her mouth, in the little consulting room, saw blood-filled bullae, thought “this could be thrombocytopenia”, said “Just come with me please”, marched her across the street to the health centre, got her seen immmediately, and immediately admitted to hospital.
I don’t think that would have happened in a ‘health store’.
I find that it is easiest to diagnose thrombocytopenia by looking at the skin of the abdominal wall, as for some reason the petechial haemorrhages are most obvious there, but I can see why a pharmacist would stick to the mouth if the complaint was a sore throat. Whether or not they knew what was wrong, at least they recognised that something was seriously amiss.
Nor is thrombocytopenia a complete diagnosis in itself as there can be many underlying causes, from Covid-19 to acute leukaemia as well as less serious ones, which is why it is so important not to concentrate on treating just the symptoms.
Years ago I was working regularly in Glasgow, not far from a ‘healthfood’ store run by a nice Indian chap. I used to buy bits and pieces in there, and one day, I noticed as he handled the money and worked the till etc, that the nails on one hand (not on all fingers) looked odd.
I thought it looked very characteristic of a fungal nail infection. As there was no-one else in the queue, I commented on it, and elicted the fact that he had recently been back to India on holiday. It all added up. He said he had been taking extra vitamins for it.
I said that he should really see his GP, because if it was a fungal infection, vitamins would make no difference whatever, and he should ask his GP about Terbinafine Hydrochloride, orally and topical cream. I wrote this down, along with the brand name. He seemed unconvinved. On subsequent visits, I saw that his nails got substantially worse, and the problem had spread to the other hand.
I do hope that in time he saw sense, and got a proper diagnosis. Healthfood store diagnoses don’t cut it!
Perhaps ‘honesty’ could be added to the list? Real doctors are usually honest to their patients in more than one respect, in particular when things get difficult:
– If they are not certain what is wrong or how to treat the condition
– If prospects are not good
– If they see no sensible treatment options any more
From what I see and hear, ‘holistic’ practitioners do nothing of the kind. When things get grim, they either keep selling their patients false hope until the end, or (slightly better) they cease their fruitless ‘treatments’, after which patients end up in the care of a real doctor again, who is then expected to clean up the mess.
And either way, the real doctor ends up looking like the bogeyman, saying things that patients do not wish to hear, and performing treatments that are often unpleasant – completely unlike that nice holistic ‘doctor’, who was always so friendly, and optimistic, and at the same time so confident, with mild, ‘natural’ treatments that could not possibly have side effects …
The most important issue is that a registered medical practitioner must obtain properly informed consent.
In the case of Ali, the judge determined that meant all information a reasonable person would need to have in order to make a rational decision as to whether to have treatment or not – even to be told about small risks (this was a case of complication with disc surgery).
In the case of camistry/SCAMS patients should be told: “I am proposing a treatment/therapy for you, but must advise that there is no plausible reproducible evidence to suggest the treatment will affect any pathological process which afflicts you. Spending time with me might provide benefit from the placebo effect. Do you agree to proceed?”
In the case of Mr Lawler – he was known to have ankylosing spodylitis, previous surgery, and his spine was rigid. Manipulation was contraindicated.
The coroner heard no evidence from a specialist in treating this condition or a spinal surgeon, but relied on the evidence of an ‘expert’ chiropractor who opined to the effect that it was reasonable for a chiropractor to have acted as she had done (using the drop table) – so misadventure not manslaughter.
But patients beware: There are proposals currently being developed by NHS employers to have the GMC licence ‘medical apprentices’ to practice as doctors (and compliant employees), after part-time training.
They will be expected to reach the same basic standard as regularly trained, university educated doctors, but how that can be achieved witout attending a university course remains to be seen. MApps will not have gained medical degrees.
And presumably these MApps are to be paid considerably less? Sounds like a cost-cutting gimmick. From time to time, college managements in Scotland have tried such tactics, seeking to employ persons as “tutors” or “facilitators” rather than Lecturers on the proper Lecturer pay scale. The ‘tutors’ or ‘facilitators’ were to get half the money.
No, they will be fully registered medical practitioners and employed on the same terms as all others.
The rates for all doctors might be lowered of course!
Wow. Well I have to say, that sounds very peculiar! How can they be paid the same, without having obtained a medical degree? How odd.
And what will be the academic entry requirements to access the MApps training? To get into medical school for a degree in medicine, you have to have superb exam passes from school.
That sounds rather like the situation in Mental Health. Anybody can do a short course and call themselves a counsellor. At the other end of the scale are clinical psychologists, who have to go through long and intensive post-graduate training, assuming that they can get a place at all as the entry requirements are higher than for medicine. In between (or off to the side, if you like) are counselling psychologists, psychotherapists, psychoanalysts and psychiatrists, the last of which are the only ones which are medically trained.
On paper they all do the same thing – treat people with mental health problems – and most of them can, to a lessor or greater extent, use congnitive behavioural therapy (CBT), which is one of the very few interventions which has any evidence to support it and has been approved by NICE. They are all on different pay scales. Which do you suppose those constrained by NHS budgets would choose to employ?
Actually for most mental health problems in the UK your first official port of call is self-help material available from the local library, together with interactive computer programs and vouchers for your local gym which your GP can issue. This last is probably more helpful for a lot of people than many counsellors that I have come across.
“Anybody can do a short course and call themselves a counsellor.”
Anybody can call themselves a counsellor: it isn’t a protected title (in the UK and elsewhere). Likewise, anybody can call themselves a psychologist; however, “clinical psychologist” is a protected title.
There is so much nonsense spouted on this forum by the usual suspects. There are many conventional and highly qualified physicians that ALSO practice SCAM (as you call it). In other words, they treat each patient as a unique human being that sometimes may require standard medical treatment and other times a holistic approach that may incorporate a less conventional approach sometimes referred to as SCAM, an outdated ACRONYM that has no place in this or any other forum. It’s a label that is too generalised and has no scientific, legal or medical definition. Time to get real me thinks.
1)”There are many conventional and highly qualified physicians that ALSO practice SCAM”
I never doubted that.
2) “they treat each patient as a unique human being”
all good clinicians do that.
3) patients “require … a holistic approach that may incorporate a less conventional approach…”
not if there is no evidence that the approach does more good than harm.
4) SCAM is “a label that is too generalised and has no scientific, legal or medical definition. Time to get real me thinks.”
please suggest a better umbrella term than ‘so-called alternative medicine.
5) “There is so much nonsense spouted on this forum …”
yes, not least by yourself.
Well, I coined ‘camistry, practised by camists on camees ‘ – less perjorative.
I have enjoyed your pertinent neologisms in “Real Secrets of Alternative Medicine”.
These physicians either decided that their patients might benefit from a placebo treatment(*), or they are deluded themselves. Either way, the patient is deceived, and that is not good.
*: I understand that many physicians do this to a certain extent, especially in the case of patients who regularly show up with vague complaints. These patients then get prescribed some innocuous painkiller or mineral supplement, and lo and behold: they feel a lot better. Until the placebo effect wears off, that is, and they return once more.
Related: IIRC, in certain countries (e.g. France and Italy), no less than 98% of GP consultations results in a recipe for some medicine or other, whereas here in the Netherlands, that percentage lies around 50% (disclaimer: I’d have to look up these statistics, can’t find them right now).
Unfortunately, far less consultations involve advice and interventions in the field of healthier lifestyle, probably because most patients prefer taking pills rather than spending at least half an hour every day on exercise and healthy food choices.
Anyway, I do not think it is good practice to prescribe all sorts of ineffective placebo treatments even if they make people feel better – at least not without telling patients that they receive a placebo. Also see my remarks about honesty earlier on.
I don’t have the statistics either, but I have heard that this is the case, particularly in France. Many years ago (possibly at medical school) I was taught that the number of prescriptions written per head of population in France was roughly three times as many as in the UK, which says something about the expectations of patients over there. I also believe that it is quite usual in France for drugs to be formulated for administration by rectum rather than orally; many drugs are absorbed better by that route, but it wouldn’t be very popular in the UK.
Historically many doctors used to prescribe something because their patients were expecting, or even demanding it. This was particularly the case for antibiotics prescribed for viral infections, where their activity is limited to reducing the possibility of a secondary bacterial infection. This is now heavily discouraged, the emphasis being on patient education instead.
@ Mike Grant
“and other times a holistic approach that may incorporate a less conventional approach sometimes referred to as SCAM, an outdated ACRONYM that has no place in this or any other forum.”
by less conventional I presume you mean alternative? But there is NO SUCH THING AS ALTERNATIVE MEDICINE.
There is only medicine. either a thing is shown to work or it does not. Less conventional is simply your way of saying “placebo medicine under the cloak of alternative medicine dressed up as homeopathy or acupuncture or some other bunkum.”
Patients deserve to get treatments that have been demonstrated by scientific means to work i.e. they are safe and effective. Doling out therapies that are ineffective or have not been demonstrated one way or the other is irrational, unethical and very poor practice. It also involves lying to people. It is a sham.
There is no good evidence that homeopathy, acupuncture or any of these other SCAM treatments works for any disease. Doling them out to patients whilst lying by saying that they do is unethical, fraudulent and misleading.
Pretending that this is acceptable by saying “placebo” is no good – it is still lying. And placebos have never been demonstrated to alter the course of any disease process or biochemical values etc. They only work on symptoms.
And who, may I ask, are YOU to declare unilaterally that SCAM is a term not to be used on this forum?
I happen to think that it is a very useful and apt descriptive term for the charlatanry used by those who dabble in alternative and complementary medicine and the ilk. These people know or ought to know that there is no good evidence that their products work better than placebo – yet they continue to lie to their patients and disparage conventional medicine and are by and large anti-vaccine and anti-science.
They are taking money from people under entirely false pretences when the only benefit to be derived is that of a placebo.
SCAM seems to me to be an entirely apt description of what is going on.
and don’t forget who inspired me to use the term:
“Intriguingly, my decision to use this term was inspired by Prince Charles, arguably the world’s greatest champion of this sector of healthcare. In his book ‘HARMONY’, he repeatedly speaks of ‘so-called alternative treatments’.”
@ Dr Julian Money-Kyrle
I wonder whether that has anything to do with the very large use of homeopathy in France as well?
Is it being used as a placebo for those who need “something” but not a real medicine – so they get a pretend treatment?
Or do doctors in France actually believe in homeopathy?
I am presuming that much of the homeopathy use in France is driven by doctors and not just by some kind of licensed homeopaths as largely the case in the UK but I don’t know.
Either way I can’t see that giving in to unrealistic and unfounded patient expectations can be a good thing in the long term – as you say education must be the way to go. Otherwise one is merely re-inforcing unsound ideas and encouraging patients to re-attend for even more unnecessary treatments. I suppose if there is a pay-per-item system there may even be an incentive to do this but it is hardly good practice.
That would once again seem to me to be a difference between Evidence Based Medicine and SCAM.
Am I right in thinking that homeopathy in France tends to be less “classical” homeopathy, and more low-potency (Decimal scale serial dilution) and multi-remedy formulations?