A Cleansing


“Joel, let’s not kid ourselves. Whatever we diagnose, most patients, if they don’t die, get well by themselves. Our job is mainly to try to make them feel better. Do no harm.”


Leonard Quinhagak, the Healer (Northern Exposure)

I never enjoyed covering for Dr. Ferguson. She was a nice woman and her patients adored her. She advised them on not only their medical conditions and their treatment, but also recommended vitamins, supplements, herbals and macronutrients. A patient who came to see her for a simple cold usually left with half a dozen prescriptions or recommendations for over-the-counter remedies.

When she was out of the office and I happened to see any of her patients for some type of respiratory infection, I always had the feeling they were disappointed and confused. They seemed to expect more than my minimalist treatment suggestions for their self-limited problems.

In my view, no treatment is entirely harmless. Decongestants can stimulate the heart. Antihistamines suppress young children’s breathing. They can also thicken mucous and cause sinus infections, and in older men they can cause urinary retention. Cough suppressants can cause psychiatric side effects. And antibiotics can cause everything from yeast infections to allergies to superinfections.

The allopathic physician community has gradually started to turn away from prescribing unnecessary antibiotics for respiratory infections, but many of us are instead recommending Echinacea and other non-prescription remedies, often without experience or formal training and without basing their use on the same kind of evidence we base our allopathic treatments on.

My brother-in-law and sister-in law are both chiropractors. We don’t talk shop a whole lot, but I remember vividly how they handled their little boy when he was miserable with cold symptoms. They would wipe his red and congested little nose and tell him he was going through a cleansing. They made it sound like something good, almost as if it would leave him a healthier person after he was through with it.

How refreshing, providing a context, framing the experience, rather than suppressing it with substances that could easily backfire.

In Northern Exposure, the TV drama series from the early 1990’s, a young New York physician ends up in a Public Health Service position in a small community in Alaska. He clashes with the Native American healers now and then when he claims to have a monopoly on treating his patients. Many of them freely seek the advice of both the medicine man and Dr. Fleischman.

When a young female patient develops a scaly, itchy rash over most of her body, Dr. Fleischman diagnoses an allergy and prescribes steroids.

Leonard says to Dr. Fleischman:

“It’s wonderful how quickly you can make a diagnosis.

I, on the other hand, spend hours with patients. Sometimes days.

I go fishing with them. I eat with them.

I spend the night in their homes.

It’s not just time consuming.

It’s taxing.”

Shelly continues to be miserable. Leonard, the Healer, spends time listening to her stories and memories and helps her see her rash as a renewal process, a shedding of her old skin, and not something frightening. Her condition resolves and her skin becomes smooth and healthy again.

In the TV episode, Leonard had asked to observe Joel at work, but it is the young physician who has the most to learn from the older Healer’s visit to his office.

1 Response to “A Cleansing”

  1. 1 Arthur July 17, 2011 at 6:28 pm

    one of my favourite episodes of Northern Exposure…and how wonderful to hear a practicing physician refer to this story to illustrate the ‘do no harm’ principle. thank you

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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