BBC Horizons’ fascinating programme, ‘Can my brain cure my body’, looked at the impact of the placebo affect and that of longer consultations.
They looked at a population in Blackpool with backpain. Staggeringly, one in five people in Blackpool suffer disabling back pain. They set out to see if fake pills could ‘cure back pain’. Patients were told they would receive either placebo or a powerful new painkiller.
They were blue and white stiped pills (this format has been shown to have the greatest placebo effect) and all contained a placebo, ground rice and no active drug. They came in bottles warning of side effects and the importance of keeping the bottles away from children.
One group then received a maximum of 10 minutes with a GP , the standard NHS consultation. The other group were given 20 minutes (we offer 30 minutes incidentally). All received the placebo, that is, inactive pills.
Three weeks later it was found, using questionnaires, that half had received significant relief from the pills, even though they were fake. All had previously been taking or had tried strong opiates, even morphine to no avail. Fascinatingly, those who had had the longer consultations benefited more than those with shorter consultations.
So, what made these hard to treat patients feel better?
Placebo is defined as a substance without medical effects. It has though been shown that placebo can result in the release of endorphins, natures natural pain killer. So the belief that something might work, can mean, that it does actually work.
How though did consultation length impact the results?
Consultation length has long interested GPs and policy makers. More time in the consultation has been linked to better blood pressure control and better recognition and management of psychological conditions. Increasingly, the standard ten minutes consultation is recognised as inadequate for the complex needs of an aging population. This inevitably needs to dissatisfaction for the doctor and the patient, neither of whom feels they are getting a good deal. It seems though, that the impact is greater than previously recognised. A longer appointment can actually help with health.
Societies where primary care physicians work, such as in the NHS, have shown to have significantly better health outcomes and reduced deaths, perhaps because of the continuity and oversight that general practice always offered. The question will be, does the current fragmentation of general practice into many part time doctors, result in a loss of continuity and a loss of the previously noted health benefits?
I would suggest twenty minutes should be a minimum consultation length and thirty minutes the optimal length. The result can be a more in depth understanding of the problems but also of the patient’ beliefs and wishes when it comes to agreeing a management plan.
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