Perceptions And Great Expectations

What you get may be just what you expect

We found on Quackwatch (a site whose address is on our links page) a long article by a psychologist on mechanisms of quackery, from which we gleaned some ideas.

Two factors contributing to the success of any form of therapy are patient perceptions of illness and expectations of results of treatment.

Some perturbations of the otherwise healthy body can be detected with the unaided eye and two or three brain cells. Extremities bent into unusual positions, large bleeding gashes, and coma are conditions easily recognized by patients as out of the ordinary. Only a person who is himself comatose could fail to perceive the need to treat these aberrations, which are, fortunately or not, just a few of the reasons patients seek medical help.

Since only about twenty percent of medical office visits involve conditions which must be treated, what makes a person perceive the need for a doctor visit?

There is an amalgam of influences ranging from early parental concerns to personal experience and exposure to medical information. An individual's feeling of need for medical attention is directly proportional to his education and income levels. We humans have a tremendous range of tolerance of discomfort which is itself influenced by factors such as heredity, anxiety, depression, and social environment. Ultimately, a decision to look for a good doctor is often based on perceived need rather than actual need. This opens a huge door on to medical management options, not all of which are appropriate.

Assuming two help-sources, traditional and "complementary / alternative", we can follow a patient into the system and see what happens. (Our mythical patient thinks he is sick, but he has nothing that can't be cured by time or TLC.) If the choice is "traditional", his provider will recognize (we sincerely hope) the benign nature of the condition.

Treatment may consist of simple reassurance and attentiveness (the best method), or the doctor may take the quick and easy route, and prescribe a few tests and a drug or two. (Offhandedly: "Try these, they might help.") The latter treatment will produce pain in the wallet and undesirable side effects from the medication, resulting in a black mark against "traditional" medicine. The disgruntled recipient of this therapy then goes to the office of an "alternative" person for a second opinion.

Why this isn't more widely known remains a mystery to us, but the first rule of success in dispensing "alternative" medical care is complete validation of the patient's perception of illness. Once this little feat has been performed, the rest is ridiculously simple. First, our patient who lost his gruntle (and is now disgruntled) can say to all who will listen, "I knew that MD didn't have a clue and was just after my money!"

Second, the bag of treatment tricks of the alternative person is now widely open and available for use. Anything he does for this patient will have a good outcome because it is harmless, not as expensive as, say, Prilosec, typically of no proven value but with a lot of hype (mystique). There is also plenty of assurance that the proposed therapy is a lead-pipe cinch to cure the problem. How could anyone NOT get better?

Perception of illness got us this far, and we have followed a person who perceived sickness (wrongly, bless his heart) , was casually handled by one healthcare purveyor but strongly validated by another. This newly converted devotee of "alternative" is going to get better with his bag of dried up leaves because he was told he would by the same person who agreed that he was ill. Amazing coincidence or clever slight of hand?

Well, it really has more to do with expectations. The person who tells me what I want to hear is also going to be my savior because I strongly expect him to be, and to be good at his job.

Lest it appear to you we are not even-handed, we hereby state that this two act play could be done in reverse, with the traditionalist playing the roles of validator and savior. There are even times when one could say, using a big stretch of the imagination, that behavior of the type we describe isn't dishonest. What the heck, the guy got well didn't he?

More appropriately, here's what we'd like you to take away from this exercise: How we perceive our health status and what we expect from our chosen system strongly influence how we respond to therapy. This is not a cook-book thing where results vary depending solely on how well the cook can read.