Returning to primary care office work (seeing patients routinely and getting follow up vs the take care clinic band aid work) I can see a repetitive occurrence of people leading unhealthy lives; coming in for short fix prescriptions; coming back with temporary but unsustained response; going onto multiple rx management, eventually being sent to the specialist care for BIG medicines or surgery. On the flip side- around every 20th patient is taking my advise for beginning a relaxation practice, switching to some form of nutrition practice, starting a supplement and fixing sleep. I had a lady with severe symptoms of hypothyroid/fibromyalgia/sleep disturbance see me last month very frustrated with previous docs....made a few recommendations like the aforementioned and 1 month later she is a different person. (that is one of the fastest turn arounds yet!) My pessimistic self says maybe it is all placebo and just the fact that I told her she will get better orchestrated the flip of her switch. My optimistic and evidence based self said she is getting better because she removed herself from poor nutrition practice, supplemented for deficiency, started breath work and templated a healthy schedule of sleep and exercise. Bottom line is -doesn't matter how it happened, I just have to help guide change and keep the ball rolling.
I feel that in most cases, the reason pills give a temporary response is because no one changed the unhealthy thinking/eating/activity of the person taking the pill. New drug will give a nudge to the system. Forcing the brain to simulate happiness: the gut to stop secreting acid: the body to ignore inflammatory signals from twisted body parts....but if no change is made to the "body part" then this magnificent machine called the human body will find another way to send signals saying SOMETHING IS NOT RIGHT!!!. At least until a different medicine is used to suppress the annoying alarm. Better than spraying foam on the kitchen fire is turning off the gas main.
A patient yesterday said she was worried before she came in that I was a Family Medicine doctor and not Internal Medicine trained. She went on to say"....but I can tell you are different and that makes me feel hope". I believe telling people their "blood tests say the medicine is working, see you in a few months" is reassuring. I feel guiding people to develop sustainable changes in areas they didn't recognize needed change -is empowering. Pulitzer prize winner Dr Siddhartha Mukherjee said "Physician honesty need not equate with hopelessness". He was referring to life ending disease. As a primary care doctor I deal with life altering disease but the same fundamentals are in play - don't just surrender to the disease and wait -empower people to live life with hope.