Personal views: Faith healing
Authors: Simon P Stephenson
Journal: BMJ (2002)

My 7 year old sister has a headache. “Make me better, Mr Doctorman,” she swoons, all junior school melodrama. As tests of clinical acumen go, this is more important than finals or membership exams: getting it right is finding Buzz Lightyear on Christmas Eve and personally introducing her to Harry Potter. Getting it wrong cannot be contemplated; she would think that I had been lying about being a doctor all along.


Casting myself as a modern Conan Doyle, I ignore the time honoured sequence of history-examination-investigations and cut straight to the remnants of raspberry ripple in front of her. “You have an ice cream headache.” 


Trust and autonomy aren't mutually exclusive



“What's the cure?”

“Simple. Close your eyes and think about somewhere hot.”

“Africa?”

“Africa's fine. Imagine you're in the desert there. The sun is beating down. How do you feel?”

“Hot.”

“And how's your headache?”

“Gone,” she says, opening her eyes in wonder. Not many interventions in medicine have such an immediately gratifying effect: relieving a tension pneumothorax or acute retention perhaps, but these are rare pearls amid the resident's work in the oyster fields of venflons and discharge prescriptions. Nevertheless, the episode triggered a curious wave of nostalgia for a plethora of almost forgotten pathologies.

Experience of these is universal. Who cannot recall the agony of shampoo in the eyes, a grazed knee, or a kick in the shins? But yet, exquisitely painful though these sensations were, how quickly relief came with a splash of water, a kiss better, or a dab from the “magic” sponge.

Why should this be? Are children gullible hypochondriacs? Out of my sister's earshot, I will confess that my ice cream headache “cure” was based on anecdotal experience of the short natural history of that affliction. Still, I think there is more to it: am I alone in noticing how premiership footballers and 7 year old schoolboys respond to the aforementioned sponge in precisely the same way? What can these groups have in common, apart from their elementary literacy skills? Might not the answer be that both cohorts actually believe in the sponge's power to heal? Children know nothing of league tables or numbers needed to treat—only that the man with the sponge will make them better. Blind faith in the medical profession has rightly evaporated, but perhaps the greater trust that was once shared between doctors and their patients was conducive to the healing process.

When I was young, our general practitioner was Russian, his leather waiting room couches occupied by an elegant cast of elderly consumptives. He sat behind a walnut desk and could treat every sickness you could name and plenty you couldn't; more impressively, he kept his consumptives alive each year. Although this was great testament to his skills as a physician, it wasn't what kept us returning to his tubercular waiting room. I am still yet to pinpoint it, and if ever I do I shall patent it and make my fortune selling it to young medical graduates—but somehow our doctor let you know that he would never fail to do his best by you; by way of reciprocation, we believed in him wholeheartedly. In later years, as family members confronted more grown up pathologies than ice cream headaches, this belief helped us through some trying times.

Thinking of these things as anxious relatives demand to know why a patient hasn't had a whole body MRI or where precisely our hospital lies in the league table, I find myself wondering whether, after all the headlines these last few years, we have lost one of our most valuable assets: trust.

I'm too newly minted to have experienced medical life pre-Bristol, Alder Hey, and Shipman; still, from the other side of the walnut desk, I know that at 12 I had few concerns about having my tonsils removed, because Dr Milyanov had recommended the procedure.

This is not to argue against well informed patients. Trust and autonomy aren't mutually exclusive concepts. No, my thesis is simply this: that as children we knew the role that trust played in healing. Although recent events may have combined to erode this trust and our belief in its abilities, we must strive to recall how effective a therapeutic tool it once was.

How it might be restored is a more difficult proposition. I have no easy answer, and will merely say one thing I am certain of: that the battle for trust does not take place in newspapers or at press conferences about the private finance initiative, but in the casualty cubicles and general practices of this land.

Perhaps we won't ever get back to those halcyon days. Nonetheless, I am sure that my colleagues will forgive me if they occasionally catch me day dreaming. Day dreaming of a time, not all that long ago, when our belief in the man behind the walnut desk was not so far removed from the faith of a girl who knows her big brother will do all he can to make her headache go away, and that belief created a bond strong enough to speed our convalescence from our tonsillectomy or ice cream overdose.