I remember being told by a senior colleague about his “magical cure” for “snakes in my stomach” – similar to IBS, but oviously a very different understanding of the disease aetiology. He used barium, x-rays and methylene blue to convince the patients they were cured. Sometimes you have to resort to original thinking, and some unconventional remedies.

http://undead-doc.blogspot.com/2009/11/bewitched.html

During a good number of my patient visits, I find I am fighting against my patients’ inability to deal with ambiguity and uncertainty. A visit will start like this: “I have had back pain off and on for 2 years, and I think I need an MRI. I really want to know what is going on.” When I tell them that the MRI probably won’t tell us much more than we already know based on exam and history, they are surprised. When I tell them the MRI may cause them harm by finding red herrings that we have to chase down, they are shocked. High tech tests have been oversold as a definitive diagnostic tool.

In the end, though, they are grappling with a difficulty in handling not knowing EXACTLY what is going on. The idea that we may never find a definitive answer as to the precise cause of the pain can be very difficult for them to get their head around. They stress it could be “cancer or some other bad thing.” If I then go on to explain that, yes, there is a microscopic chance that it is “cancer or some other bad thing”, but they have a GREATER chance of being harmed by the zillion dollar workup for such a very unlikely thing, I have now spent 20 minutes on a 15 minute back pain visit, and I still haven’t started to discuss the management plan. On top of that, they still won’t believe my explanation, because “everyone knows” that “detecting cancer early is better”. The remaining ambiguity and doubt that there might be something dangerous going on (however small that chance is) and we can’t do anything about it really seems to bug them.