The very nature of health practice in medicine and related professions is interpersonal. The concept of the person – practitioner relationship is central. This relationship is established and maintained at a level sufficient for acceptable standards of  health care only if and when effective communication is achieved.

Unfortunately, most orthodox medical practice seems deficient in this key area. Even medical textbooks on the topic talk about the "doctor – patient" relationship. Notice that the doctor comes first in this dyad. Further, the profession’s cultural norms are evident in the language they prefer, like the socially strong term for themselves and the very passive term, ‘patient’ for those who seek their services (although they prefer the phrase, need their treatment).

Today I glanced at the Observer Magazine in The Guardian and noticed yet another example of the ineptitude of the orthodox medical profession. For example, a woman named Sue Jennings sent in this question.

I am 70 this year, have no arthritis or joint pain of any sort and am also free of heart disease, diabetes or any other limiting ailments, thank God. In order to try and keep it this way I used to take glucosamine, but this upset my gastrointestinal tract (glucosamine has also allegedly been proved to be ineffective). Therefore I moved on to cod-liver oil capsules, but the same thing happened to my genito-urinary tract. Can you suggest anything else that will not have the same result? I am also following a Pilates DVD.

The paper then provided answers to this question from three so-called experts. Their replies are rather more informative than most people would recognize. Let’s see how they score.

The first reply scores quite poorly in my evaluation. I’m sure that would really irritate its author, who seems rather pompous. Here is what he said.

Unless you have a significant vitamin deficiency (which usually presents itself medically), then there is no evidence that dosing yourself with vitamins and antioxidants on a daily basis delays the effects of ageing. Still, most safe supplements are inexpensive, so if you want to try them, feel free – talk to a registered dietitian about your best options. Many doctors believe that no more than 30 to 40 per cent of life longevity is solely attributable to genes, so an early detection of any medical problems, along with lifestyle changes (more exercise, less fat in the diet, no smoking, moderate drinking) are your best protections against illness.

Have regular checks at your GP for blood pressure and blood cholesterol (for heart attacks and stroke risk), a blood count (for anaemia) and a fasting blood glucose test (for diabetes). Pilates is a fun and perfectly reasonable way to keep yourself healthy.

This is from Cameron Swift, Emeritus Professor of Health Care of the Elderly, King’s College London School of Medicine. Perhaps Cameron spends too much time in university commitees and is too busy professing to find the time to keep learning. If he did, he would discover an abundance of evidence that supports the use of those supplements and might have adopted a less ignorant and arrogant posture than the assertion that "there is no evidence". As a medical professor however, he is likely to be so paradigmatically bound that he is now quite blind to evidence not consistent with his and his profession’s cherished (and self-serving) views of the world.

The predictable and somewhat patronising suggestion to run along regualrly to a GP is merely self-serving medical cultural artifact. The suggestion to consult a "registered dietitian" is a way of keeping control, since such dietitians are of very little value, having been trained very much within the limited "scientific" perspectives consistent with the medical model.

Notice Sue’s question. Does she need to be told to have more exercise etcettera, as the inept professor suggests? In a word, no. One could ask: more exercise than what, less fat than what? What does he know of her exercise and diet other than that what she follows has ensured her good health? Nothing at all to warrant his response. He has failed to listen to this individual, failed to connect and failed to adequately answer her explicit and implicit questions.

So perhaps a suitable medical specialist would do better you may think. Well, we have one to consider, so let’s see. The following reply is from Dr John Hunter, a consultant gastroenterologist at Addenbrooke’s Hospital, Cambridge.

I see no reason why you need to take ‘preventative’ medications such as glucosamine and cod-liver oil, as you are in perfectly good health. It sounds very boring, I know, but the best way to protect yourself against arthritis, heart disease and diabetes is to follow a well-balanced diet with some meat and plenty of fish, lots of fruit and vegetables and plenty of chewy foods, such as wholemeal breads. I’d also recommend as much exercise as you feel comfortable doing. Your reaction isn’t necessarily an age issue. People from all age groups can get upset by certain foods, such as fats, milk and wheat. If you decide to continue taking supplements, you could try taking a pro-biotic (available in most supermarkets) to help settle your bowel, although pro-biotics are a lottery – you have to hope that the particular bacterium you’re missing in your gut is present in the pro-biotic.

Yes, this response is actually much better. The clinician seems to have paid far more attention to Sue’s details than the academic. In terms of the communication thus demonstrated I would rate this a definite passing standard. John demonstrates the problem one finds in many orthodox medical doctors in his well conditioned thinking. For example, he refers to glucosamine and cod-liver oil as "medications" when they are in fact nutritional supplements. They are foods, not drugs. He rightly identifies the usual culprits for gastrointestinal upset, as one would expect. His rather throw-away remarks about probiotics demonstrate his lack of knowledge in this area but probably make him seem very avant-garde to his colleagues. Overall though, quite a good response.

Now I have saved the best for last. The following response demonstrates good "listening". It connects with the details of Sue’s questions and is more empathic in dealing with her history. It provides reassurance regarding Sue’s supplement choices and suggests a rationale for her experiences. It also goes the extra mile by providing a recommendation tailored to Sue’s age and personal history. There is no evidence of either gross ignorance or arrogance. Take a look.

Several well-conducted studies have found glucosamine to be effective in the treatment of osteoarthritis (‘wear and tear’ arthritis). I have also found it in practice to be helpful in maintaining joint health, and think that your idea to try it was a good one. Very rarely do I find that it causes gastrointestinal symptoms.

Cod-liver oil is also usually well tolerated. You could try other brands of glucosamine and/or cod-liver oil, as it might be something in the formulations you have tried (rather than the active substances themselves) that you are sensitive to. However, your reaction might mean your gut is unduly sensitive. This is common in the elderly as our gut lining can degenerate. I can therefore recommend one remedy to regenerate your gut lining. This is L-glutamine (not to be confused with glucosamine). I suggest a dose of 1g, two or three times a day for two months.

The above response was from Dr John Briffa, a holistic doctor specialising in nutritional medicine. Although trained originally as an orthodox doctor, John was less than impressed and moved his practice in a more holistic direction. If only more would follow the lead there would be dramatically less disease and much more real health in society. Unfortunately, this represents more nightmare than dream to orthodox doctors.

It is, of course, unfair to evaluate interpersonal interactional quality on the basis of some written snippets from a newspaper’s magazine section. However, an intelligent deconstruction of the responses does indeed give some quite clear insights into critical foundations of such communication. Read them and judge for yourself.

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