In medicine, theater can go a long way. The seemingly simple acts of laying hands on a patient, leaning in to listen to them, and giving them instructions to follow can be therapeutic. Sometimes this is labelled as part of the so-called placebo effect, but whatever we call it, physicians (and priests) have been doing it for thousands of years. But how far should we push it? As medicine becomes more science-based, relying on actual evidence to guide practice, where does theater fit in?
One argument is that since this difficult-to-quantify intervention can clearly do something, we should use it like any other intervention. But where is the ethical line to be drawn? If a patient of mine is frightened and I lay a particularly firm hand on their shoulder as I listen to their lungs, this may provide them comfort. But what if I hand them a bottle of bitter herb extracts with no proven pharmacologic benefit but tell them it will help? If I play it right, the patient may indeed feel a bit better in some respects, but what of the deception? And what happens when I start to believe in my own magic? What might that lead me to do?
I know of many doctors who advise the use of placebos, sometimes knowing that they are chemically inert, sometimes not. Patients love—love—to be given a bottle of bitter liquid when they have a cold or other self-limited illness because it works—they always get better. And it’s pretty easy as a doctor to convince someone it was my action, rather than the natural course of the illness, that caused them to feel better.
I find this whole approach seductive and dangerous. I regularly tell my patients with colds to drink hot tea with honey, hot soup, and to treat their symptoms with any other soothing technique that works for them. It may seem to be fulfilling part of my ethical obligation of beneficence to hand them a bottle of bitters and tell them that it will help with their cold, but it’s a lie, and if I start to believe my own lies, where does it end? Where will my belief in my own magic take me?
Real medicine based on science and compassion is hard, but we have certain rules and ethical principles in place to protect our patients, and to protect us from ourselves. We are not gods and we shouldn’t behave like gods, even when to do so might make someone feel better. The risk is too great.