Over the course of these blog posts, I hope we’ve learned the importance of congruence, context, and expectation in treatment. These are all factors established in relationship and cannot be “objectively” measured. Further, it is not what we do that matters; it is the patient’s resulting benefits from what we do that counts.

From the perspective of the patient in pain, for example, it is unlikely to matter whether pain relief derives entirely, primarily, or not at all from the inherent or characteristic properties of the treatment. The treatment is beneficial insofar as the intervention plus the context in which it is delivered produces benefit to the patient.

In fact, the subjectivity of the patient cannot be taken out of the equation.

“The reputation of modern medicine has been based on its scientific objectivity. Therapeutic power derives from the ability of physicians to discern the facts about disease and its modification by means of treatment interventions. The benefits and risks of therapies are generally understood as deriving entirely from the outcomes of applying the properties of treatment interventions to the objective bodily processes of the patient.

“However, viewing the benefits and risks of symptomatic treatments through the lens of the placebo and nocebo phenomena reveals that therapeutic benefits and risks of harm from these treatments cannot be determined independently of the subjectivity of the patient. The placebo and nocebo principles are not brute facts about pathophysiology and its modification by medical technology.” (Miller & Brody, 2011,pp 229-243)

In other words, it is often the commitment and alignment to what one feels is right that makes the difference, not the actual procedure, treatment or medication taken.