Skip to main content

Medical Risks and Benefits - Shades of Gray

Image
By

Readers know how strongly I feel that my profession is suffering from the twin chronic diseases of Overdiagnosis and Overtreatment.  Here's a primer on how physicians make medical recommendations to our patients.

Take a look at this grid I prepared, which is worth a full year of medical school.


                                    Low Benefit                   High Benefit

Low Risk                                                           Medical Sweet Spot!

                                 ________________________________________
                       

High Risk                DANGER ZONE!


When we physicians are contemplating a treatment, or are weighing one treatment against another, we are aiming for the Medical  Sweet Spot highlighted in blue above.  We want low risk and high reward for our patients.   Would we ever consider a treatment within the DANGER ZONE?  We would if the patient’s medical circumstance were dire and there were no superior options.  For example, if a patient was under a serious threat of a severe outcome, we might consider a treatment with considerable risk that had limited evidence of efficacy.  Of course, it may be that an informed patient might decline the treatment. 



There are times when the Danger Zone is reasonable.

Obviously, medicine is a murky discipline and most treatments do not fall neatly into one of the 4 quadrants of this grid.  Moreover, medical experts often disagree to the extent that a treatment is safe or effective.  In other words, different physicians may place the same treatment in different regions of the grid.  This is one reason why pursuing a second opinion can become more bewildering than clarifying.   Just because a second opinion is different from the original, doesn’t make it right.  To further confuse you, two differing medical opinions can both be right!

How does an average patient make sense out of this morass?  By asking the right questions.
  • What are my reasonable treatment options?
  • What is the scientific evidence supporting each of these options?
  • What is the scientific evidence of the risks?
  • Does my personal medical situation favor one option over another?  (For example, if a medical option’s risk is to suppress the immune system, and you already have a diminished immune system, then this option may not be suitable for you.)
  • How will I be monitored for adverse drug reactions? 
  • Is no treatment an option?  Where would this choice fall on 'grid'?
In my view, the 'no treatment' option should be considered much more often.  Why do so many patients and physicians move this option ‘off the grid’?






Labels:

Comments

Post a Comment

Popular posts from this blog

When Should Doctors Retire?

By
I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and studying, two longstanding personal pleasures, could be ext
68 comments
Read more

The VIP Syndrome Threatens Doctors' Health

By
Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients?  Are there specific challenges treating folks who have a deep knowledge of the medical profession?   Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease.  This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses.  So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit.  Physicians, after all, are members of the human species.  A pulmon
7 comments
Read more

Should Doctors Wear White Coats?

By
Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today
43 comments
Read more