The medical decision as a gamble

The medical decision–to have a screening mammogram, to take warfarin, to undergo a catheter ablation–is, at its core, a gamble. We pit the treasure of the win (benefit) against the pain of the loss (harm). In times past, medical gambles were easier. You took the antibiotic or you lost your leg. Most medical decisions today are hardly that clear. We say they are preference-sensitive. Many factors determine these preferences. The digital revolution notwithstanding, what a patient prefers turns substantially on how the decision is framed. (Wear this vest or you could die.) How the decision is framed depends on the doctor’s preferences. What a doctor prefers turns on how key opinion leaders and policy people think. (Get blood pressure to this level.) How key opinion leaders and policy people think depends on a lot of things, maybe even their industry relationships. And so on. It is like a symphony of human behavioral psychology. A gumbo of bias. (Grin.) I read two articles today that made me think about the act of deciding things in medicine. Drs. Aaron Carroll and Austin Frakt wrote in the New York Times today about the way we measure a treatment’s potential for harm. I am drawn to this sort of work because harm avoidance is a core feature of heart rhythm care. Their pictorial of the benefits and harms of screening mammograms underscores something I preach everyday: all medical decisions are a gamble. Here is the risk quandary for AF: Dr. Scott Aberegg i...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs