Dr Peter Moore: You can't separate mind and body in medicine

The latest plans allow the NHS and local government to produce 'integrated care systems'

Even the most 'physical' problems have an emotional aspect - Credit: Getty Images/iStockphoto

One of the most upsetting impressions a patient can get from a doctor is the idea that 'it’s all in the mind'.

The implication is that the patient is making it up. But even the most 'physical' problems have an emotional aspect.

A kick in the shins when walking down the street may feel very different to an identical kick when playing football.

In the game the excitement drives the natural endorphins to a high level which act in the same way as morphine.

Being unwell affects more than the body.

If an office worker twists his or her ankle at the weekend it is unpleasant and annoying but will not affect their life, especially if working from home.

If, however, a professional sportsman or a builder twists their ankle it is a far bigger problem. The physical injury has a huge emotional impact.

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In the vast majority of cases when someone has a serious disability, the carer is working hard to help. These couples would love to get back to a normal active life.

But, just occasionally, someone needs to be seen as a 'patient'.

When I worked in a hospital we admitted a woman with possible bowel cancer.

The tests were clear and, despite a careful search of the notes, I could not find why she was a wheelchair user.

We carried out  some tests, all of which were normal, and so we arranged for some physiotherapy.

The physio managed to get her up and walking. When discharged, she walked out of the hospital and I patted my self on the back. I had 'cured' her.

I was wrong. When seen for her routine follow up in outpatients she was back in her wheelchair.

Being 'disabled' was important for her and her husband.

These cases are rare and nearly all wheelchair users I’ve met since would love to be able to walk but in this case she needed to be 'ill'.

We also know that placebos or dummy tablets work well.

When I was first in practice a patient came in with warts. She said that the skin specialist had given her a course of tablets and the warts disappeared. Please could she have the same tablets again?

My problem was that I had never heard of tablets to 'cure' warts and so I wrote to the consultant. A few days later he rang me up.

“I didn’t want to put this in a letter,” he explained. “I had just finished a study comparing a new drug with a placebo. At the end of the study I had a few placebos left over and so I gave them to her. The warts disappeared.”

This dummy treatment was so successful that he presented her case at a South West dermatology conference.

He showed before and after photos without telling his colleagues his 'treatment'. They were amazed.

He then admitted that the warts had gone after the dummy pills.

Of course, it might not be that the placebo worked. Warts do eventually go without treatment. It could be that they were about to disappear anyway, but it could also show the power of placebos.

In one study it was shown that red painkillers are more effective than plain white, even if they are both exactly the same drug.

This is why the 'bedside manner' is important. Giving a prescription in a positive way is more effective than 'I suppose you’d better take this'. 

When I was taking phone calls for Devon Doctors someone rang in with what sounded like a mild viral illness. I listened and suggested paracetamol.

“Thank you so much,” the patient said. “The last doctor just told me to take paracetamol.”

Wasn’t that exactly what I had done? Like a good joke, it’s the way you tell them.  

Every illness is partially in the mind.

It is never possible to separate mind and body in medicine.