holistic medicine? shadowing

[Xinlitik]

How is holistic medicine looked upon by med schools? I have had just awful luck with Drs (seriously, I've called ~20 and received nos from all), but finally one said yes. He is an a family practicioner with an MD, but he practices holistic medicine and is certified by the American Board for Holistic Medicine.

This is the 1st time I've heard of it so I'm just curious to know whether I'm looking at something like homeopathy. What I can find on google doesnt seem too bad...

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[Perrotfish]

"holistic' or 'whole person' medicine is a buzzword used by every CAMartist and quite a few doctors as well. It can mean anything from common sense family practice (I know you're here for a cold, but why don't we talk about your diabetes too) to unabashed attempts to rob patients with CAM charlatinism (I know you're terrified of your recent heart attack and trust me, so would you like to sign up for my $300/treatment acupuncture therapy?). I have no idea which one your FP is going for, but if you want to find out shadowing is a good way to do it. Googling that board he's certified by is another good idea.

In any event on your medical school app you're not going to say you shadowed a holistic healer, you're giong to say you shadowed an FP.

Edit: I looked up their website. It took some digging to actually find any details on what they're certifying you in, but it looks like CAM. Acupuncture, naturalism, chiropractic, and similar crap.

 

[TooMuchResearch]

The Scientific Community section of this Wikipedia entry sums up my feelings on alternative medicine fairly accurately: http://en.wikipedia.org/wiki/Alternative_medicine#Scientific_community

The ABIHM board certification form gets pretty funny after page 4: http://www.holisticboard.org/downloads/ABIHM_application_2010.pdf

Sorry for not answering your question. I have no idea how schools will view your experience.

 

[Xinlitik]

"holistic' or 'whole person' medicine is a buzzword used by every CAMartist and quite a few doctors as well. It can mean anything from common sense family practice (I know you're here for a cold, but why don't we talk about your diabetes too) to unabashed attempts to rob patients with CAM charlatinism (I know you're terrified of your recent heart attack and trust me, so would you like to sign up for my $300/treatment acupuncture therapy?). I have no idea which one your FP is going for, but if you want to find out shadowing is a good way to do it. Googling that board he's certified by is another good idea.

In any event on your medical school app you're not going to say you shadowed a holistic healer, you're giong to say you shadowed an FP.

Edit: I looked up their website. It took some digging to actually find any details on what they're certifying you in, but it looks like CAM. Acupuncture, naturalism, chiropractic, and similar crap.

Yea, I have mixed feelings. I'm gonna check it out just for the heck of it, though. His website looked really bad to me--like a scam--but I checked the tests he used and they were pretty much conventional medical tests. I guess the difference is how he treats them. Anyway, my only concern is whether they will google his name, because it immediately pops up his website which looks really fishy heh. Do adcoms actually do any research into shadowed drs?

 

[softmed]

Yea, I have mixed feelings. I'm gonna check it out just for the heck of it, though. His website looked really bad to me--like a scam--but I checked the tests he used and they were pretty much conventional medical tests. I guess the difference is how he treats them. Anyway, my only concern is whether they will google his name, because it immediately pops up his website which looks really fishy heh. Do adcoms actually do any research into shadowed drs?

It is highly unlikely they will check up on him. As long as he's not a well-known quack they won't know who he is. Just make sure if he does anything dumb, like prescribes homeopathy/acupuncture/etc, you don't mention that. If you get a feel for it and that's all he seems to be doing, maybe it's not the best experience to have. They'll definitely ask about it in your interview, and it's going to look bad to many doctors if the only experience you have is with someone who is a quack. You're getting into science based medicine, and they might think you're better off becoming a naturopath or homeopath.

 

[TooMuchResearch]

Of course, no ones saying you actually need to include the experience on your application. I'd say check it out and see how it goes.

 

[seelee]

Yea, I have mixed feelings. I'm gonna check it out just for the heck of it, though. His website looked really bad to me--like a scam--but I checked the tests he used and they were pretty much conventional medical tests. I guess the difference is how he treats them. Anyway, my only concern is whether they will google his name, because it immediately pops up his website which looks really fishy heh. Do adcoms actually do any research into shadowed drs?

Two thoughts:

1) You shadow Dr. Feelgood with his poncho and birkenstocks and realize that his aura-cleansing, homeopathy, reiki, and herbal remedy-filled nonsense is exactly as much hokum as everyone has said, and in your PS you write about how the experience steeled your resolve to learn to practice evidence based legitimate medicine etc. Definitely something that stands out. The risk is that your application could be read by one of the few folks that buys into the hokum and tosses it aside.

2) You shadow a non-pot smoking doc. Have a typical and un-remarkable shadowing experience. Not much that stands out, but less risk of turning someone off.

Me personally, would probably do the first one provided that I had some mainstream clinical exp. as well.

Good luck.

 

[clifftacopter]

I'd go ahead and do it. Medical schools are not going to check and make sure this guy is practicing legitimate medicine. The only downside is that it may skew your perception of how family medicine works toward something that is generally not the norm. I'd shadow, but take in everything he does with a grain of salt... particularly if he is a big advocate of sketchy complimentary and alternative treatments.

In the mean time, keep your eye out for alternative shadowing opportunities, and jump ship as soon as you have something else lined up.

 

[Xinlitik]

Yea, I guess I'll go for it. Worst case, I don't include it on my app. thanks

 

[dr zaius]

I'd go for it. It would be interesting to see what he comes up with, or how he integrates traditional medicine with holistic stuff. I think it would be fun.

As was said earlier I wouldn't mention anything holistic in your application. It's primarily looked down upon due to no evidence of most of the stuff actually working other than anecdotes ("My grandma had this friend with a huge tumor and her holistic doctor gave her 7 lbs of vitamin C and she ate it and it went away in a month!" insert colloidal silver or DMSO or any other chemical they think has magical powers for vitamin C etc etc).

 

[learnmdabc]

I'll be an interesting experience. Go for it.

And see if you can learn anything about and from alternative medicine. I think you'll see why more and more patients are flocking to these so-called sham practices, and why many western doctors are beginning to adopt these modalities. Could it be that the doctor-patient relationship has eroded to a degree that people just want someone to listen to?

I worked at a holistic practice, observing accomplished MDs work side by side with acupuncturists and chiropractors. I've interviewed 100s of patients for their feedback about the integrative approach, asking them why they choose this type of integrative practice for their healthcare. And indeed, there_is_a reason why chemotherapy patients visit a hole in the wall in Chinatown for herbs and acupuncture.

Perhaps you'll decide that alternative medicine is BS, that the integrative approach is merely buzz. But at the least, you'll have a more fair-handed approach as you explain to your patients the cost and benefits of the alternative treatments. Which are not going away anytime soon.[/QUOTE]

 

[Law2Doc]

Yea, I guess I'll go for it. Worst case, I don't include it on my app. thanks

On the app, steer clear of anything that doesn't sound like evidence based medicine. Terms like holistic and naturopath and "alternative" medicine had a long and despised history in this country, starting with the "snake-oil" salesmen of the 1800s, to very similar questionable herbalists today. Best to do it for your own edification, but find someone whose credentials scream out "real doctor" for application purposes. Giving the people an unproven cure for every ailment isn't medicine, even if that's what the public wants.

 

[Perrotfish]

I worked at a holistic practice, observing accomplished MDs work side by side with acupuncturists and chiropractors. I've interviewed 100s of patients for their feedback about the integrative approach and why they chose to come to this type of practice. And indeed, there_is_a reason why chemotherapy patients visit a hole in the wall in Chinatown for herbs and acupuncture.

Because patients who are in agnonizing pain and maybe dying as well are willing to throw their money at anyone who is willing to promise them results, no matter how hollow those promises might be?

and why many western doctors are beginning to adopt these modalities.

Because a few unscrupulous physicians have realized that they can trade on the trust that our profession has built over centuries to rob the desperate and dying of their grocery money?

Seriously there is nothing new about ****bird doctors proscribing desperate, untreatable patients sugar pills and charging them an arm and a leg for it. All that has changed is that we are now for some reason condoning the scam rather than unlicencing and jailing the physicians involved.

 

[learnmdabc]

Holistic practices do not deal with acute. If the patient is dying, intervention is clearly in the province and specialty of the allopathic. Most holistic practitioners recognize this situation.

But what if someone deals with chemotherapy side effects? Suffers from nebulous symptoms and back pain for years? Why is it unethical to suggest treatments with low risk margins that might help them? Especially when there is evidence that acupuncture and herbs help for both of the aforementioned situations.

And hollow promises are always bad. But you seem to automatically assume that alternative practitioners always give these outrageous promises. If you've actually worked with them, you'll see that they never make these grand proclamations of miracles. MDs, working in a holistic practice, are especially cautious about doing so.

And of course, there are BS practices. But there are more and more legit ones also. Why are major medical schools like UCSF adding integrative branches in their curriculum? I do respect your opinion as a medical student; for I, too, am going into allopathic medicine. But I don't believe it's as cut and dry as you pronounce.

Because patients who are in agnonizing pain and maybe dying as well are willing to throw their money at anyone who is willing to promise them results, no matter how hollow those promises might be?




Because a few unscrupulous physicians have realized that they can trade on the trust that our profession has built over centuries to rob the desperate and dying of their grocery money?

Seriously there is nothing new about ****bird doctors proscribing desperate, untreatable patients sugar pills and charging them an arm and a leg for it. All that has changed is that we are now for some reason condoning the scam rather than unlicencing and jailing the physicians involved.

 

[Perrotfish]

Holistic practices do not deal with acute. If the patient is dying, intervention is clearly in the territory and specialty of allopathic treatments. Most holistic practitioners recognize this situation.

I've seen several who don't, but for the sake of argument I'll spot you this point.

But what if someone deals with chemotherapy side effects? Suffers from nebulous symptoms and back pain for years? Why is it unethical to suggest treatments with low risk margins that might help them? .

1) There's not reputable evidence that these therapies work. They don't make sense theoretically (you can't realign your chi's flow along meridians with metal needles because there is no such thing as chi or meridians) and they don't hold up to scientific testing (sham acupuncture has the same effects real acupuncture).

2) When you are charging for a treatment, it is unethical try a therapy merely because it 'might' help. This is why we have such a long FDA approval process: two of the three phases of FDA drug approval are concerned entirely with determining whether a drug works, not just whether or not it harmful. We consider it unethical to take a patients money in exchange for a drug that mere 'might' work, you need proof that it actually does work. Of course most of CAM has actually been proven again and again to not work at all, which is even worse. When you take money in exchange for sham treatments you are conning your patients, and a con artist is every bit as much a thief as the guy who puts a gun in your face and takes your wallet.

And hollow promises are always bad. But you seem to automatically assume that alternative practitioners always give these outrageous promises. If you've actually worked with them, you'll see that they never make these grand proclamations of miracles. MDs, working in a holistic practice, are especially cautious about doing so.

A promise is hollow if the therapy doesn't work, no matter how little they're actually promising. I'm aware that the promises are usually vague and noncommital. That's how they can keep doing it year after year. If they promised cancer patients that they could cure cancer they would be out of business (and in jail) pretty quickly. However if they promise a canceer patienthat they can maybe improve some of their chemotherapy pain, then at the end of the year it's hard for the patient to know if the therapy actually worked. I mean, wouldn't it have been even worse if they hadn't have gotten the therapy? The CAM practicioners are still relying on the desperation of miserable people to help them steal money. It's unethical.

And of course, there are BS practices. But there are more and more legit ones also. Why are major medical schools like UCSF adding integrative branches in their curriculum? I do respect your opinion as a medical student; for I, too, am going into allopathic medicine. But I don't believe it's as cut and dry as you pronounce.

The reason that they're adding integrative branches into their cirriculum (and into their hosptials) is that they're profitable. They're cash businesses with no overhead, all it costs is your integrity. That's what's disappointed me so much about the push for doctors to do CAM: it is the most blatant conformation I've ever seen that Doctors care more about money than their patients.

 

[learnmdabc]

Thank you for great response -- it gives me something to think about.

1. According to Patricia Tsang, an UCSF MD specializing in TCM, Qi is simply a term for blood circulation. So increasing Qi is a fancy way of saying improving circulation. And if improved blood flow were one of acupuncture's mode of action, comparing acupuncture and sham acupuncture just doesn't make sense, really. Increased blood flow will always help remove cytokines and stimulate healing.

So the placebo effect in testing acupuncture will always be an issue. But acupuncture is often used on animals to great success. Pet owners deluge the local vet during the allergy season to seek acupuncture -- with great results. So the effectiveness in animals seems to argue against the placebo effect. (Pet-lovers, however, might disagree).

2. I'm not too familiar with the FDA approval process, I admit. So thanks for telling me about it. I'll try to learn more in this regard.

But another question of mine is this. Is it even more unethical to withhold therapies with very low risk and some evidence of efficacy, than it is to not offer them the option at all, especially if they are willing to pay? For example:

[Survival time of advanced gastric cancer patients treated with integrated traditional Chinese and Western medicine therapy]

CONCLUSION: Integrated traditional Chinese and Western medicine can prolong the survival time and improve the quality of life of advanced gastric cancer patients, and enhance the comprehensive effects.

Many similar studies have come out from China. I will admit that Chinese studies are bound to have a regional bias, since TCM is so ingrained in their culture.

3. I agree with you. A promise is hollow if the therapy doesn't work. But I haven't seen any practitioners at the holistic clinic promise anything of that sort, like a cure for cancer for dying patients. Good holistic practitioners, despite their bad rep, have scruples also, and are not as unethical as you set them out to be. And they often employ the sliding scale of evidence. The greater potential risk of a treatment, the greater evidence that is required. So you need lots of evidence about chemotherapy, but not so much with yoga. The MD I work with uses this model of thinking.

4. Perhaps you are right about the money thing. That disenchants my idealistic self a bit.



Okay, I typed too much for now.

I've seen several who don't, but for the sake of argument I'll spot you this point.



1) There's not reputable evidence that these therapies work. They don't make sense theoretically (you can't realign your chi's flow along meridians with metal needles because there is no such thing as chi or meridians) and they don't hold up to scientific testing (sham acupuncture has the same effects real acupuncture).

2) When you are charging for a treatment, it is unethical try a therapy merely because it 'might' help. This is why we have such a long FDA approval process: two of the three phases of FDA drug approval are concerned entirely with determining whether a drug works, not just whether or not it harmful. We consider it unethical to take a patients money in exchange for a drug that mere 'might' work. A con artist is every bit as much a thief as the guy who puts a gun in your face and takes your wallet.



A promise is hollow if the therapy doesn't work, no matter how little they're actually promising. I'm aware that the promises are usually vague and noncommital. That's how they can keep doing it year after year. If they promised cancer patients that they could cure cancer they would be out of business (and in jail) pretty quickly. However if they promise a canceer patienthat they can maybe improve some of their chemotherapy pain, well that's hard to measure, isn't it? They're still relying on the desperation of miserable people.



The reason that they're adding integrative branches into their cirriculum (and into their hosptials) is that they're profitable. They're cash businesses with no overhead, all it costs is your integrity. That's what's disappointed me so much about the push for doctors to do CAM: it is the most blatant conformation I've ever seen that Doctors care more about money than their patients.

 

[Law2Doc]

Holistic practices do not deal with acute. If the patient is dying, intervention is clearly in the province and specialty of the allopathic. Most holistic practitioners recognize this situation.

But what if someone deals with chemotherapy side effects? Suffers from nebulous symptoms and back pain for years? Why is it unethical to suggest treatments with low risk margins that might help them? Especially when there is evidence that acupuncture and herbs help for both of the aforementioned situations.

And hollow promises are always bad. But you seem to automatically assume that alternative practitioners always give these outrageous promises. If you've actually worked with them, you'll see that they never make these grand proclamations of miracles. MDs, working in a holistic practice, are especially cautious about doing so.

And of course, there are BS practices. But there are more and more legit ones also. Why are major medical schools like UCSF adding integrative branches in their curriculum? I do respect your opinion as a medical student; for I, too, am going into allopathic medicine. But I don't believe it's as cut and dry as you pronounce.

Not to echo Perrotfish but (1) some holistic doctors do treat (mistreat) acute issues (often right into the grave). But even if you steer clear of non-acute issues, you certainly still can make a chronic patient sicker (2) in terms of chemotherapy side effects, there are allopathic treatments. No reason to resort to holistic. And more importantly "holistic" is in some cases just a fancy word for "untested". The nice thing about allopathic medicine is it's evidence based. If something hasn't been shown to work, you don't put it into your arsenal. Various "alternative medicine" types give the untested meds without them having been shown to be useful, or even safe. (3) just because something is an herb doesn't mean it isn't a dangerous drug, that it doesn't have adverse side effects, that it doesn't interact with allopathic medication in dangerous ways. The allopath is keyed into all this. Typically the homeopath, without as much concern for evidence based study and general "proof" ignores this kind of stuff, to the patient's detriment.

Now acupuncture is one of the better studied "alternative medicine" fields, and there are some studies that are bringing this practice to mainstream for VERY LIMITED, primarily pain control, reasons. With further study it may get more of its practices moved to the mainstream. But that is but a single application in but one of many practices that fill the CAM world. Most of the rest doesn't stand up to scrutiny when studied. And yet "practitioners" still offer them as medicine.

 

[Law2Doc]

... Is it even more unethical to withhold therapies with very low risk and some evidence of efficacy, than it is to not offer them the option at all, especially if they are willing to pay? ...

You are assuming you can determine either "low risk" or "some evidence of efficacy" without doing adequate scientifically accepted and scrutinized study. You can't. And the CAM folks don't. They offer the treatment without really knowing the risk or efficacy. They have some anecdotal history of success and ignore the science. And no, in this country we don't give potentially dangerous, untested treatments to patients so that they can hold out hope. We give people every possible treatment that has been borne out by reputable study, but draw the line there. And that's pretty reasonable. The public wants to believe in magic. Physicians have a duty not to play into this naivete. CAM folks often don't uphold that duty. They give the people what are often sham treatments, take money from the most desperate, and are not accountable by showing actual demonstrable reasons why their treatments should or do work. When you scam a dying person out of their money in other professions (eg law) it's a crime. When you do it with a very dubious remedy, somehow it all of a sudden become "alternative" medicine. They should change the term from "alternative medicine" to "not medicine". At least then the public might understand that no physician considers this a viable alternative. If it were accepted practice borne out by study, it would become part of allopathic medicine.

And for the above reasons I would be careful about putting this kind of stuff in my app unless it is more than balanced out by allopathic stuff.

 

[learnmdabc]

owned. lol.

Thanks for writing this out. It's hard to have a balanced perspective when I work at a holistic clinic with so many MDs practicing there. To be fair though, they seem to be more conscientious than the "CAM folks" you mention.

You are assuming you can determine either "low risk" or "some evidence of efficacy" without doing adequate scientifically accepted and scrutinized study. You can't. And the CAM folks don't. They offer the treatment without really knowing the risk or efficacy. They have some anecdotal history of success and ignore the science. And no, in this country we don't give potentially dangerous, untested treatments to patients so that they can hold out hope. We give people every possible treatment that has been borne out by reputable study, but draw the line there. And that's pretty reasonable. The public wants to believe in magic. Physicians have a duty not to play into this naivete. CAM folks often don't uphold that duty. They give the people what are often sham treatments, take money from the most desperate, and are not accountable by showing actual demonstrable reasons why their treatments should or do work. When you scam a dying person out of their money in other professions (eg law) it's a crime. When you do it with a very dubious remedy, somehow it all of a sudden become "alternative" medicine. They should change the term from "alternative medicine" to "not medicine". At least then the public might understand that no physician considers this a viable alternative. If it were accepted practice borne out by study, it would become part of allopathic medicine.

And for the above reasons I would be careful about putting this kind of stuff in my app unless it is more than balanced out by allopathic stuff.

 

[seelee]

owned. lol.

Thanks for writing this out. It's hard to have a balanced perspective when I work at a holistic clinic with so many MDs practicing there. To be fair though, they seem to be more conscientious than the "CAM folks" you mention.

Holy ****, someone conceding a point on SDN??? This has to be a first.

 

[Perrotfish]

\

Holy ****, someone conceding a point on SDN??? This has to be a first.

 

[mmmcdowe]

Someone is innevitably going to mention Dr. Oz, so I'd just like to point out that Dr. Oz is required to support CAM if he wants to continue to have intimate relations with his wife.

On a more serious note, medicine is not and has never been about giving hope. It is about giving certainty and empathize with it. Hope with no chance of success is possibly the worst thing a doctor can give. We take the bogeymen out of aches and pain by enlightening. That, even more than healing, is the founding principle of medicine.

 

[learnmdabc]

Here's another diametrically opposite perspective on placebo and hope. Here's a quote from Dr. Bernard Lown, a famous doctor that invented the defibrillator:

"In the most cloudy situation, one can discover a silver lining. This has little to do with truth or falsehood. It flows from the deepest intent of doctoring, to help a patient to cope with a condition. Even when a cure is impossible, that does not mean healing is impossible. The very sick are not taken in by phony optimism, but they are eager for a warm touch and the caress of human concern. While medical science has limits, hope does not. I believe the maxim proposed by the physician Edward Trudeau about a century ago: "To cure sometimes, to relieve often, to comfort always." Miracles reside in the capacity for comforting and healing. Doctors can reclaim medical professionalism by resuming the role of a "placeboist."

http://bernardlown.wordpress.com/2008/11/18/the-doctor-as-a-placebo/


Edit: Ahh, oops. I realized I derailed this thread too much. OP, do whatever you like : )

Someone is innevitably going to mention Dr. Oz, so I'd just like to point out that Dr. Oz is required to support CAM if he wants to continue to have intimate relations with his wife.

On a more serious note, medicine is not and has never been about giving hope. It is about giving certainty and empathize with it. Hope with no chance of success is possibly the worst thing a doctor can give. We take the bogeymen out of aches and pain by enlightening. That, even more than healing, is the founding principle of medicine.

 

[Perrotfish]

Here's another diametrically opposite perspective on placebo and hope. Here's a quote from Dr. Bernard Lown, a famous doctor that invented the defibrillator:

"In the most cloudy situation, one can discover a silver lining. This has little to do with truth or falsehood. It flows from the deepest intent of doctoring, to help a patient to cope with a condition. Even when a cure is impossible, that does not mean healing is impossible. The very sick are not taken in by phony optimism, but they are eager for a warm touch and the caress of human concern. While medical science has limits, hope does not. I believe the maxim proposed by the physician Edward Trudeau about a century ago: "To cure sometimes, to relieve often, to comfort always." Miracles reside in the capacity for comforting and healing. Doctors can reclaim medical professionalism by resuming the role of a "placeboist."

http://bernardlown.wordpress.com/2008/11/18/the-doctor-as-a-placebo/


Edit: Ahh, oops. I realized I derailed this thread too much. OP, do whatever you like : )

I actually think that the idea of perscribing placebos to patients is at least arguable, from an ethical standpoint. On the one hand I think there is something to be said for giving a patient hope, for making them feel that something is being done. On the other hand the sham treatmeants would erode patient trust in us and our profession, and they don't treat the patient as an equal capable of making their own informed medical decisions. I think the cons outweigh the pros, and I think the law agrees with me, but it's at least a debatable point.

What's not a tough call for me, though, is the ethics of charging for the placebo effect, which is what CAM practicioners do. In my opinion that's theft, and doubly so if you're a physican and you know perfectly well that CAM doesn't work.

 

[Law2Doc]

I actually think that the idea of perscribing placebos to patients is at least arguable, from an ethical standpoint. ...

Doctors do it all the time when they start a PCA line (patient controlled anesthesia) on a patient. The patient is told he can push the button whenever he feels pain, but not told that a bolus is only administered every 6 or 8 or 10 minutes. As a result he gets the benefit of thinking he's getting pain relief even more frequently. Actually works pretty well. But as Perrotfish indicates, you aren't billing for the placebo effect, just the quantity of drug actually used.

 

[MossPoh]

My host mother in Germany was a "holistic medicine practitioner" and I dated a girl that was getting her doctorate in chinese medicine. It sounded nuts but I humored both of them and gave it a whirl....and felt like a dumb***** afterwards for even humoring them.

 

[jl lin]

Wow. The "dig your heals in bias" seems clear.

I suggest people get some true balance on the issues. The are loads of problems with "evidence-based" practice too. I have also seen a fair amount of careless, ineffective, and problematic allopaths and those that hold hard and fast to ONLY EBP as well. Truth is, at some point this all gets like politics--one political set of biases over or versus another.

You have to find some reputable integrative and alternative practitioners. In reality, you probably won't get an unbiased view here. It's ridiculous to argue it point for point here, and you will, in all probability, NOT get a fair or balanced perspective on it.

You must be as one of the other responders noted above, and do you own research and get your own experiences, look at information from Europe and other countries, and then decide for yourself. Don't be too quick to take one position over the other. This will be a test of TRUE open-mindeness.

And remember; there is a huge difference between being broad-minded and open-minded. Broad-minded means you are likely to believe anything in vogue or that comes along. Open-minded means you are willing to investigate legitimate perspectives and possibilities.

 

[KeyzerSoze]

Doctors do it all the time when they start a PCA line (patient controlled anesthesia) on a patient. The patient is told he can push the button whenever he feels pain, but not told that a bolus is only administered every 6 or 8 or 10 minutes. As a result he gets the benefit of thinking he's getting pain relief even more frequently. Actually works pretty well. But as Perrotfish indicates, you aren't billing for the placebo effect, just the quantity of drug actually used.

As a patient, I had a post-surgical PCA line, and I was certainly told that it would only dispense medication at most every x minutes. Is it really standard to not inform patients of that?