Health Care Decisions Part 1: Understanding Efficacy, Weighing Risks
Today was a busy day at the office. As I sat at my desk trying to wrap things up with paperwork, I also tried to wrap my mind around my feelings surrounding the day's grind. I felt exhausted both mentally and physically, like I had walked a mile on a tightrope. The more I analyzed things, the more this perspective came into focus - I had walked a mile on a tightrope.
As a doctor, I have found that managing balance is a huge part of my existence. Understanding the balance that healthcare struggles with and espouses (sometimes ad nauseam) is vital in navigating healthcare and in medical decision making. For patients, I feel that embracing fair balance, rather than fearing it, leads to better informed, autonomous care.
"Fair and Balanced"
The phrase "fair and balanced" comes from the language of a piece of legislation called The Food, Drug and Cosmetic Act. It holds that all prescription drugs must strike a fair balance in their promotion, presenting both risks and benefits, containing truthful statements about both use and effectiveness.
The Act makes a move to abolish "snake oil" claims that medications will do what has not been proven with good research. Some claim, however, that the Act falls short in its failure to equally cover non-prescription drugs and nutritional supplements. In actuality, however, this happens in the practice of good medical care across the board of healthcare. It's just not so stark as a fast talking announcer at the end of a pharmaceutical TV spot.
The Game of Risk
I aim to provide personal care for my patients. I detest cookie cutter approaches to medicine and I enjoy putting things in perspective for my patients. I further make it clear that I am working for them. Together, we work toward making various decisions in their health care.
What are their cholesterol numbers, for instance?
What do they mean in the big picture of heart disease and stroke?
Should a medicine be provided to lower the numbers along with diet?
What are the benefits vs. the risks in taking a medicine?
Sometimes this weighing out process happens numerous times and on different levels in a single patient visit - a fair amount of fair balance.
From the minor procedures I do in my office, to the major ones performed by my surgical colleagues, there is some degree of risk involved. This is also true for medications prescribed. While medical procedures can cure, they can also kill. The same is true for drugs.
Penicillin, for instance, has saved countless lives from infection, but has also killed a fair number due to allergic reactions. It is our duty as healthcare professionals to educate patients on the expected benefits of what we are doing, but also to warn them about possible adverse outcomes. "Expect the unexpected," as they say. While most get it, there are some who just plain get hung up on the risk.
Sometimes fair balance in healthcare is seen as a measure of covering the behinds of providers and institutions. In a way, it is. It's a standard of care formally known as "informed consent". Basically, this breaks down to doctor tells patient what he/she is doing and the good/bad of the health intervention. The patient then demonstrates understanding and agrees to the health intervention, often in writing. Failure to provide the fair balanced education is a red flag for malpractice.
Weighing the Costs
Recent years have brought much more consumerism into medical care. Health savings accounts and large deductible plans have brought patients to the necessity of weighing cost against need for medical care. This plays out on several levels: brand name drug vs. generic, aggressive vs. conservative care, physical therapy vs. stretches found on Youtube. It is good care on the part of healthcare professionals to present all options and their relative cost as a measure of fair balance. This allows patients to be informed as consumers.
Fair and balanced medical care is in the spotlight of medicine. In truth, however, it has always been there as a part of good practice. As a patient and consumer, appreciate the balance of receiving all possible scenarios of a medical intervention, even when it seems belaborsome.