Is placebo relevant in syncope?
“What the scalpel is to the surgeon, words are to the physician”
Time and time again, “expert” syncope doctors are asked to review patients who have been referred after seeing several different doctors including general practitioners, cardiologists, neurologists occasionally several different specialists. One of the most striking findings when an “expert in syncope” reviews a patient is how little the patient understands of the vasovagal syncope, and what simple management strategies are to combat syncope.
As far as syncope is concerned, to put the power of placebo into a single word, it is this: Hope.
With hope, comes expectation. The crystal-clear expectation of improvement. Which in turn comes from an effective understanding of the illness process, and a strong belief that with the process of healing starts immediately. Not in 2 days, or 2 weeks, or 2 months but right now, at the time of the patient’s consult. This steadfast belief in health improvement is anchored by a clear understanding and acceptance of a management strategy tailored to the patient’s own illness experience. With respect to syncope, this allows patients to adhere to the treatment strategy, and to stay the course, even on down days. Think of it as an improvement peppered with small setbacks which take you one step back along the healing pathway, but with the clear expectation that there will be an inexorable rise to better health.
So how to do you communicate “hope”?
Philip Tumulty, renowned clinician and teacher at Hopkins and the founding director of the Division of General Internal Medicine, in a his opening lecture to students in their course “Introduction to Clinical Medicine” at Johns Hopkins University of Medicine, 1970, communicated this perfectly.
“The impact of sickness upon a person is always multifocal, and the effect highly complex, involving as they do the whole person, with this spiritual, intellectual, emotional social and economic components…Once analysis of the clinical evidence has led to a diagnosis, and a plan of management for the patient’s problem has been constructed, the physician comes to a highly critical point in his relation with his patient he must explain to him the nature of his illness and formulate for him the program of management. Unless these matters are handled with clarity and sensitivity, so that the patient understands fully what is wrong and also has the will to marshal his personal resources to co-operate fully, the correctness of the diagnosis and the soundness of the therapy may have no practical meaning whatever for the patient. Ignorance, misconceptions, fears, insecurities, resentments, hopelessness and unanswered queries may block his response.”
For a short summary of the impact on placebo on illness, read this New York times article: What if the placebo effect isn’t a trick?