A recent Ethics and Professionalism small group discussion has got me wondering, “What makes a real doctor, anyway?” Part of our discussion centered around placebos and whether it is ethical for physicians to knowingly provide treatments that probably don’t have a direct biochemical effect. (Note the many qualifiers in that sentence.) Someone made the assertion that doing so makes you a quack doctor. Basically, physicians should only do things that are scientifically well-understood and be honest to patients about the limits of what we can do. That’s fair, and for the most part, I agree with that principle. Doctors should realize that with our power comes a responsibility to use it wisely and judiciously. My thought is that, frankly, most of the time, the medical profession does not have an answer, nor do we know for certain that our answers are necessarily correct. So if all we can do is, well, nothing, but that very act of doing “nothing” makes a patient feel better, then, why not do nothing? When coining and cupping get mentioned in cultural competency lectures (and they always are), I think the message is always more or less, “So don’t just think that it’s physical abuse.” But we don’t really talk about how these alternative treatments make patients feel better, probably by a placebo effect. This is not to say that I would ever prescribe coining to anyone with a flu, but really my point is that people’s medical problems often don’t have a well-understood biological cause for which we have a well-understood biochemical treatment, and whatever we can do to alleviate pain, we should probably try (as long as it’s not doing harm).

I suppose I’m just comfortable with the touchy feely aspect of medicine because I fully expect that to be a large part of my practice as a primary care physician. Healing the body when it’s broken is easy. Healing the mind? That can take a lifetime.

So. What do you think? What makes someone a real doctor? Magical diagnostic abilities? Nimble hands? A sharp mind? Terrible handwriting?