Medicine
Take thrice daily
John Rowan Wilson
The great physician Sir William Osier once said that the desire to take medicine was one of the principal factors distinguishing men from the lower animals. Whether this statement is strictly true or not (my dog often seems to eat grass when off colour, in a crude attempt to make himself sick), the fact remains that man as a species has a deep fascination with therapeutics, which is reflected both in his purchase of patent medicine and in the expectations he entertains from a visit to the doctor.
We in the medical profession used to believe we knew the reason for this. We reckoned, in our simple-hearted way, that homo sapiens took medicine because he wasn't feeling his best and hoped that the consumption of some favourite nostrum would put him back into something like normal health. Medicines given by the doctor were regarded as falling into three categories. There were the curative drugs with which we hoped to remove a disease altogether; the palliative ones which were effective in suppressing symptoms; and the placebos which were inert substances given from the knowledge that some patients simply will not accept treatment unless they can pour it out of a bottle.
In recent years this categorisation has come under the eagle eyes of the psychologists and the social scientists, and has been rejected as an oversimplification. As a consequence, considerable number of detailed studies have been carried out, to investigate exactly why medicine is taken, in what form, and for what reason.
A classical example of such investigation has been published under the title Medicine Takers, Prescribers, and Hoarders by Karen Dunnell and Ann Cartwright (Routledge and Kegan Paul £3.25). The authors, who are from the Institute for Social Studies in Medical Care, have carried out an exhaustive study, covering fourteen diverse areas of the United Kingdom. Over 1,400 members of the public were interviewed, and 598 GPs were also approached, though unhappily only 326 responded. The results cover 182 pages of print, and thanks and acknowledgements to various individuals and organisations cover a page and a half.
The information gleaned from all this conscientious activity can be summarised fairly rapidly. It seems that, as some of us had already suspected, people are taking More medicine than they used to, and that the efficacy of some of this may depend not so much on the ingredients as on simple faith. Self-medication is common, but may sometimes be dangerous when Patients self-treat conditions which require Medical intervention. Repeat prescriptions of sedatives and tranquillisers have implications in relation to drug dependence. The authors sum up by saying that " some of the demand for drugs probably arises because of inadequacies in the doctor-patient relationship, some is a reflection of the impotence of the medical profession and medical science to cure or relieve many common ailments."
Well, well, well. At last science has revealed all. And in case you think this book is an isolated example of laborious investigation of the obvious, you can try Balint et al.'s Treatment and Diagnosis which first laid bare the astonishing fact that doctors prescribe placebos because some patients feel miserable without them, or a recent investigation by the Office of Health Economics which discovered that possibly because of changes in society, "much medical care is now concerned with symptoms which appear to be of essentially social or psychological origin."
This last publication goes so far as to suggest that in future the medical schools ought to teach GPs more about human behaviour, presumably using as a basis the pearls of wisdom detailed above. I would like to suggest to the sociologists that most of the matters they are so assiduously investigating are common knowledge to anyone who has sat in a surgery for a few years listening to patients telling him their troubles. The reason why doctors spend more of their time learning about technical matters than about behavioural study is that taking out an appendix or controlling a cardiac arrhythmia is an obvious benefit to humanity, while wandering round asking people questions is only too often a confounded waste of time. And if the sociologists can make suggestions about medical education, perhaps we can return the compliment. How about taking some of those nice girls off the questionnaire game, and let them train for nursing, where they could do some good?
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