needles, flower essence, placebo and other health tools

clinic has gotten busy lately. we are now seeing on average 15 people per half day with jumps up to 25 at times. sicker people. the word has spread that we can do D&Cs for early pregnancy loss at least 1-2 women a week show up with miscarriage and we've had a rash of women with cholecystitis who have wound up hospitalized and surgerized with very complex medical/surgical cases. one woman required an eight hour surgery. interestingly enough, i haven't been able to send a single patient to the public hospital (University) because they are so full, there are no beds. and when given a choice, these very poor patients would rather get respectful care, receive a much higher bill and hope for some mercy from the non-profit hospital (Presbyterian). dignity and respect definitely rank higher than inexpensive, hostile care.

so last night, in the middle of a busy clinic, an older gentleman came in complaining of severe pain that he could no longer tolerate. he had a recent diagnosis of Rheumatoid Arthritis and Heart Failure, and he was sad and upset with the deterioration of his body. he was well insured and under the care of a primary care doctor, an arthritis specialist and a cardiologist, all of whom were very responsive to his needs. he was already on percocet for pain, a fairly sizable dose, but it wasn't taking care of his pain.

i was confused at first, i wasn't sure what i could do for this man. he made it clear that he wanted to try alternative medicine for his pain, try anything actually, that worked, and he had heard that we did integrated medicine at the clinic. i must admit, i felt a moments hesitation and insecurity, what could alternative medicine do that steroids and opiates couldn't for pain?

we dug a little deeper - he was clearly interested in acupuncture as a potential treatment. both the nurse practitioner and myself were trained in ear acupuncture for helping drug addicts detox more comfortably. neither of us claim to practice acupunture. that requires years and years of education and study. but i was on the spot last night. he was in pain, asking for help, strong drugs weren't cutting it and compassion moved me to "PRACTICE" medicine. I informed him that my skills were limited but that i could insert some needles in his ears and we would see what happens. this was after giving him a referral to a real acupunturist, but it was late in the day and there was no way to know when he would get the appointment in the future.

fortunately, i had also actually studied reflexology which uses the same map of the body on the ear so i was familiar with other points aside from the detox points. i put five needles in each ear, on the major joints and some "master" points that assist the body overall in healing. i left the man in the waiting room on a comfortable couch and started seeing other patients. about 45 minutes later i checked in with him and he had a HUGE grin on his face; he felt better. he was thankful to me and left eager to get a full acupuncture treatment.

don't ask me to explain how it works, i can't give you a mechanistic description. but clinical evidence is clinical evidence and this man benefited. at a cost of $30 for the consultation and the needles.

in the world of primary care, whether we are MDs, DOs, DOMs, NDs, NPs, PAs, Chiropracters, Massage Therapists, Traditional Medicine practitioners, Herbalists, Energy healers, etc, we all have the same task - diagnose the problem with some degree of accuracy, help people find their health when they are out of balance, and identify people who are so out of balance that they need hospitalization or specialist care to address their dis-ease. this requires humility and courage. the humility to know your limits and the courage to truly "practice" medicine, to try things with attention to minimizing cost, harm, grief (yours and the patients) and suffering.

there is NO ROOM to do any of this in the managed care world. the incentives, the environment, the "standard of care" all define the parameters of what's okay and what's not okay to do. there is no place for intuition, for reasonable, cautious experiement, for learning completely new and potentially amazing tools. every change in the system is a battle, a power game, a decades-long struggle by "alternative medicine" practitioners to earn the right to have insurance companies pay for their services.

boring. lame. gag me with a spoon.

i'm appreciating working in an environment where we can play, where we can try things out that seem utterly ridiculous on the surface, that have no scientific explanation (yet) but put smiles on our patients faces when "standard of practice" medicine can't do the job.

primary care calls for some creativity but there should be a method to the madness.

here's my theory of everything -

1. diagnose the problem. do this with as little invasive technology as you can, stay humble and re-evaluation your diagnosis if there is poor therapeutic response to treatment.

2. figure out the cheapest, simplest, least side-effect, most human dignifying solution, even if the success rate is not guaranteed to be 100%. placebo is a great example. in study after study of high tech drugs, placebo always comes in a close second on cure. CURE. not feeling better or some soft endpoint. CURE. it averages around 30-40% CURE. sit with that for a while if you are a practitioner. it's amazing. imagine the personal and social cost savings if everyone were to try placebo first and the 60% of treatment failures were then to move on to more expensive modalities. with this as a known scientific fact, you can't go too far wrong trying almost anything that is non-toxic, inexpensive and potentially useful. it gets weird (and criminal even) when you start pushing a particular "remedy" that cures everything, that costs alot and that you make tons of money off of. this is a form of abuse of placebo that charlatans can use to play off people's suffering.

3. the first line therapy may be antibiotics, flower therapy, flax seeds and aloe juice, ear acupuncture, a short course of benzodiazepines, prozac, hospitalization, surgery. it all depends on the diagnosis, severity of illness and your breadth of knowledge.

4. if first line therapy fails, move on up the ladder of cost, invasiveness and dependency.

5. remember that every step of the way it is the patient who decides (this is primary care, not a major trauma in th ER where the rules are different) and you who offer suggestions, insights, ideas and recommendations.

in our clinic we are learning to use inexpensive, interesting home remedies, nutritional remedies and energetic remedies (like flower essence and homeopathy). with the patients consent, these become first line BEFORE major antidepressants or anti-anxiety drugs, before laxative treatments or antacids and proton-pump inhibitors. those who fail the less expensive options can be quickly switched over to cholesterol lowering drugs and the purple pill (nexium) and xanax and prozac and all the mish mash of pharmacological glory our generation of scientists has produced.

as with any scientific endeavor, we are tracking patients who are beginning on these therapies and doing case studies to document success and failure. anecdotally, first response is very positive. within two years i'd like to have a whole series of independent interviews analyzed that can help to understand the usefullness of this approach amongst our patients.

andru