Caring and Curing

“The secret of care of the patient is caring for the patient.”
–Francis W. Peabody (1881-1927), Distinguished Harvard professor

Medicine during the 20th century and even later has been characterized by a persistent and all-encompassing “bug hunt.” Microorganisms are seen as the single “cause” of much disease. Apart from the development of many effective antibiotics, this era has found Americans on an endless crusade for new and improved cleaners, disinfectants, and air purifiers to evoke “cleanliness” while providing a multi-billion dollar market with minimal health benefits. There is growing recognition that much disease can result from real and perceived interpersonal conflicts, occupational and social experiences, and biological and environmental exposures.

White’s volume, The Task of Medicine, argues that physicians’ efforts are enhanced by understanding what produces distress, disease, disability, and death. Control of one’s occupational destiny, threats of unemployment, marital dysfunction, bereavement, and anniversaries (among other experiences) are all known to play roles of varying relevance in the precipitation of illness and disease. The recovery of health often depends as much or more in coping with these as it does on pills, potions, and procedures. Some surgeons will not operate on patients who are maxed out with one or more of these emotional and social afflictions.

There are also other factors that affect an individual’s health. The placebo effect provides some 30-35% benefit apart from that derived from any intrinsic pharmaceutical or even surgical intervention or action. The Hawthorne effect provides an additional 10-15% benefit as the patient “feels better” just by making an appointment to see a physician or entering the hallowed halls of a hospital.Remarkably therapeutic are caring and touching. Some could argue that medical care per se needs to provide more than a 40-50% benefit to justify its services. Medicine is gradually substituting the biopsychosocial and multifactorial model of the origin of disease for the out-moded single “cause” model that has prevailed for over a century.