QUOTE OF THE MONTH:

# 82 December 2006

"But I am sure I have always thought of Christmas time, when it has come round - apart from the veneration due to its sacred name and origin, if anything belonging to it can be apart from that - as a good time: a kind, forgiving, charitable, pleasant time: the only time I know of, in the long calendar of the year, when men and women seem by one consent to pen their shut-up hearts freely, and to think of people below them as if they really were fellow passengers to the grave, and not another race of creatures bound on other journeys. And therefore, uncle, though it has never put a scrap of gold or silver in my pocket, I believe that it has done me good, and will do me good; and I say, God bless it!""

A comment
from Scrooge's nephew
to the old miser himself

from The Christmas Carol
by Charles Dickens


(continues below)

mental health professional trainings
primary care professional trainings
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Shawn Christopher Shea
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INTERVIEWING TIP OF THE MONTH

# 82 December 2006

"Enhancing a Patient's Belief in a Medication and the 'Talisman Effect'"

TISA Description of the Problem: In my opinion, all medications have a potentially beneficial placebo effect arising from the power of a patient's belief to actually impact on pathophysiology. Hope works. Skilled clinicians tap this power by the simplest of phrases and gestures. There truly is an art to medicine, and I believe it can be taught. The following very simple tip, from Grant Chernick, M.D. can be surprisingly powerful and demonstrates, in my opinion, the value of enhancing a medication's placebo effect.

Tip: When working with patients, I feel it is useful to maximize the power of belief. I always like to give a medication the best possible chance of being held in a positive light. The power of suggestion is a real power, and here is a way to enhance it. As I hand a patient his or her prescription, I look the patient in the eye, and gently, but confidently, say:

"Well, here's your prescription, I trust it will help!"

TISA Follow-up: I really like this simple tip. In particular, Grant's use of the word "trust" functions almost like an Ericksonian hypnotic suggestion. It is very similar in nature to a tip from my newest book - just released! - Improving Medication Adherence: How to Talk with Patients About Their Medications (Lippincott Williams and Wilkins, October, 2006). In the book I describe over 40 tips that help patients to better understand their medications, weigh the pros and cons, and enhance their interest in taking those medications that they feel may help them. One of my favorite tips from the new book is called "The Talisman Effect." and it is excerpted here:

"Our written prescriptions are not only sterile communications to pharmacists about medications, for some of our patients they are tangible symbols of hope. It is curious to note, that from the perspective of cultural anthropology, prescriptions share some striking similarities to talismans, even to the point of being partially written in a secret language (Latin) that is understood by the healers of the culture but not by those people seeking the help of those healers. I'm not suggesting that prescriptions are talismans, but I am suggesting that symbolically - like talismans - they may be powerful enhancers of the placebo effect in their own right.

As such, it may be useful, from a psychological perspective "to charge them" with the power of our own belief. A patient with intractable pain, debilitating depression, or AIDS is looking for hope, even if the hope is for just a small relief in suffering. This is a hope that talented physicians sometimes enhance, not only by their choice of medications, but by how they handle the pieces of paper that procure those medications.

If I have a good feeling that a particular medication is going to help a patient, I have found it useful to do the following. As I hand the prescription to the patient, while we are both holding it, I explain the directions. After I'm done, (while we are both still holding the prescription) I look the patient directly in the eye and say the following:

'Well, good-luck with this. I've got a really good feeling it is going to help you.'

It is a simple gesture. It takes no time. But it is the type of gesture from which hope is sometimes born."

Tip provided by:

Grant Chernick, M.D.
chernick@shaw.ca