Medical Decision Making

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March 25  |  Blog, York ENT Blog  |   James Rejowski

Using Dr. House to explain medical decision makingParadigm: A group of ideas about how something should be done or thought about.

Although all parts of the patient’s visit to a physician are important, the concluding aspects carry a special significance.  Recommendations are made regarding evaluation and treatment.  It is also, most likely, the time where the patient feels the most vulnerable, since in effect they are being asked whether they agree or disagree with the advice being given.  It is easy to see how difficult it could be to discern the message from the messenger.  Who would dispute the words of these esteemed physicians?

The answer to this dilemma is to employ a deceptively straightforward scheme, or paradigm, of medical decision making.  It involves consideration of the following three elements:

  1. The illness
  2. The treatment
  3. The benefit

ENTT_2011_08_pp22_01It is important to get a feel for the significance of the medical problem itself.  Is it painful, like an ear infection or tonsillitis?  Does it interfere with normal activities?  If symptoms are not present now, as in hypertension or elevated cholesterol, will it cause health problems down the line?  Does it cause physical or aesthetic deformity, like a large benign tumor or a lipoma?  Could it be malignant?  Basically, before going forward, the illness has to pass the “worth it” test.

The recommended treatment has to be taken into account.  Even well-intended, treatments can be inconvenient, expensive, and not always without risk.  The relative risks of the treatment need to be weighed against the potential risks and downsides of the malady left to its own design.  It would be difficult to proceed if the treatment was worse than the illness.  Other perhaps less invasive treatment options, if available, should be considered.

Finally, the recommended treatment has to have a very substantial probability of success.  Inexpensive innocuous treatments without any chance of benefit don’t really have very much to offer.  If therapy is not much better than no therapy, go with no therapy.

Patients need to involve themselves in this process.  Second or even third opinions are often helpful.  One should never hesitate to bring a list of questions to their visit.  There are no silly questions.  Self-research online has some potential pitfalls, because information there is more readily available than knowledge, but people are comforted when they find that the advice they are receiving is consistent with the accepted prevailing medical opinions posted.

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