Medical Matters: On being informed by his new well-trained general practitioner that his cough was "just a virus" and did not really need the requested antibiotics, the old man drew himself up to his full height and declared: "There were no viruses in this village until you got here, Doctor."
This is a good example of a fault line between the patient's belief in antibiotics and the new doctor's belief in the evidence which shows that most coughs are viral and won't respond to antibiotics which work on bacteria.
The late Prof Petr Skrabanek of Trinity College ruefully pointed out that while doctors were seeking more and more evidence for their actions, patients were pursuing more and more non-evidence-based therapies. This confuses scientifically trained doctors while others adapt by using the values and language of the marketplace.
Since time, immemorial women have suffered morning sickness when pregnant. The 1960s brought us Thalidomide which was seen as good and relevant medical progress for a condition that, though normal, was difficult and, in some cases, disabling. The drug caused significant and obvious damage to the baby's limbs. At the time of Thalidomide, conventional medicine was in the ascendant with widespread public hopes invested in new drugs. It was also a time when alternative medicine was on the decline as people put their hopes in modern pharmaceuticals.
After Thalidomide, both patients and doctors had to revise their hopes. The tragedy of Thalidomide has been a significant factor that has helped the gradual increase of alternative therapies.
The use of alternative therapies is increasingly related to social class. You don't see many homoeopathists, acupuncturists, reflexologists and health food shops in our deprived estates. You don't see much pressure on the Minister for Health to provide alternative therapies under the medical card. And alternative therapists are not out there lobbying for office space and low rents in Jobstown, Knocknaheeney, Rahoon or Ballymun.
They would, of course, do great good if they built alliances with sympathetic local doctors. A nice massage might be a better option for a stressed patient than a course of vitamins or Valium. Acupuncture would be just as good for back pain as a course of anti-inflammatory capsules. If morning sickness was treated with homeopathy, we would avoid the dangers of more hazardous medications.
It is an odd social conundrum that patients in deprived areas now have access only to conventional medicine with its often limited evidence for good. The better-off have become more sceptical about conventional medicine and more likely to use alternative treatments. Twenty years ago, the reverse was the case when the better-off relied on conventional medicine while the less-off, especially with rural backgrounds, used alternative treatments.
It is odd that the health effects of prayer have not been promoted in Ireland. We have long traditions of holy wells and cures which would seem to provide a good starting point. There is now published evidence which shows the positive impact of prayer on well-being and on physical and psychological health.
The sick, prayerful Pope John Paul may well be an impetus to help us establish links between health and prayer. Our deprived communities have often a plethora of religious groupings from many traditions who provide support for the vulnerable. It is yet another fault line that health professionals have yet to cross.
There has always been a stand-off of sorts between alternative and conventional medicine. There was a time when patients would not tell their doctor they were attending an alternative therapist. The assumption was that the doctor would disapprove or maybe discredit the therapy. Doctors have now learned to live with it and to endorse some therapies for the individual patient. It does not mean it is easy to live with. Patients report what they have been told by a therapist which may conflict with the doctor's scientific training or, indeed, experience.
Because of the stand-off, there are few opportunities to discuss areas of difference, inter-referrals or joint approaches. Some of the more physical therapies have shared scientific models while others have little in common with traditional medicine. It's probably a bit like Christian unity - seems obvious but damn difficult in practice.
Us conventional doctors pay out thousands of euro each year for indemnity to protect ourselves against malpractice claims. As we face five-yearly licensing and regular competence checks, can you blame us for being confused when patients appear to pass our doors for the unlicensed and often uninsured alternative practitioner?
Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP.