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We tend to move in the direction of our greatest expectations.
We have spoken often of the way in which our beliefs and expectations influence our biochemistry and physiology. When we have a strong belief in a medication or treatment plan, our bodies will often turn our beliefs or expectations into biochemical realities. Norman Cousins used to say that "we tend to move in the direction of our greatest expectations." This holds true for our physical body as well as for our goals and dreams in life.
As such, we as doctors, have a responsibility to help patients foster a positive outlook regarding their treatment plan. Positive expectations are best generated when both the doctor and the patient have a shared belief in each other AND in the treatment plan. This demands an open and trusting atmosphere where both the patient and the physician can mutually discuss all concerns and questions regarding the different possible treatment options.
One intriguing study in the New England Journal of Medicine reveals just how much our positive expectations can influence our health and healing. Most studies compare the results of a particular drug or treatment against those of a placebo (or inert pill, the so called "sugar pill"). In this particular study, when the authors looked at just those subset of patients who were only taking the placebo, they came upon a fascinating finding: those patients who took their "medicine" (in this case, their placebo) regularly did better than those patients who failed to take their "medicine" (placebo). In fact, of those patients who failed to take their medicine (placebo) regularly, 28% died. Of those patients who took their medicine (placebo) regularly (defined as at least 80% of the time), only 15% died.
This dramatically shows the effect of positive adherence to the treatment regimen, even in those taking "only" a placebo. Somehow our belief in the doctor and in the treatment plan protects us and allows our body to derive positive physiological benefits even from an inert pill. We are not saying that we should go back to the days of giving patients sugar pills and selling snake oil off the back of the covered wagon, but we should realize the tremendous power of a vital, open and trusting relationship between the physician and the patient.
(For more information, read: The Coronary Drug Project Research Group. Influence of Adherence to Treatment and Response of Cholesterol on Mortality in the Coronary Drug Project. New England Journal of Medicine 303 (1980): 1038-41)