Healthcare decisions can be difficult. Three major factors determine how healthcare decisions are made. When considering a treatment or a procedure the factors that need to be considered are the risks, the benefits and the cost. The main challenge is to be able to predict the potential benefit of a treatment or a procedure compared to the risk of the treatment or procedure. The other challenge is to know if the cost is justified by the potential benefit gained.
These factors will vary depending on individual circumstances. Important questions need to be considered. What is a patient’s general condition? How old are they? What is their life expectancy? How will the treatment or procedure benefit an individual’s quality of life? Will the cost of the treatment cause financial hardship?
The last thing a provider wants is to have a patient hurt by a treatment or procedure, especially if the procedure is a screening test. Unfortunately, procedures and treatments have risk. Research is necessary to provide data to demonstrate the risks compared to benefits. Guidelines are established based on this data. For example, the benefit of early detection of cancer by colonoscopy for otherwise healthy individuals justifies the risk of the procedure. However, when patients have other significant medical problems or are over 75 years old, the benefit is not justified by the risk.
Some treatments have low risk and can provide great benefit and these circumstances lead to easy decisions. An example of this may be taking an antibiotic for a bacterial infection.
Patients and providers are willing to accept more risk if the potential benefit is greater. An example of a high-risk treatment would be chemotherapy for a cancer diagnosis. The medication is toxic, expensive, and can have serious side effects, but there is great potential benefit since the cancer could be fatal. Some treatments have small benefits but are safe and inexpensive. Since the risk is small, the small benefit is justifiable. An example of this is taking a baby aspirin on a daily basis if there are risk factors for heart disease.
When considering elective surgical procedures, the risk benefit analysis can be challenging. Some surgeries (like cataract extraction) have low risk. Other surgeries (like joint replacements) have intermediate risk. High-risk surgeries include heart, lung, vascular, and open abdominal surgeries. It is helpful to have a provider who is familiar with your social and medical history. I have had patients in their 90s who have been terribly disabled with pain and limited motion of a knee or hip. In selected cases these people were willing to take the risk to have a joint replacement done and have done well. A thorough preoperative evaluation often is necessary and advantageous to assess the risk for each individual. Studies show that patients with heart disease, kidney failure, type 1 diabetes, COPD, and severe obesity are going to have higher risk than patients who do not have these problems.
Sometimes problems are more of a nuisance than a serious danger. In those cases it may be best and safest to live with the condition. It is appropriate to ask what would happen if nothing were done when the risk or cost of fixing or treating the problem is high. We all take some risks. Getting in a car has risk but the benefits outweigh the risk, so we do it. Weighing the risks and benefits of medications or procedures on an individual basis is the challenge in health care decisions. Today’s technology does give us access to more information but still decisions need to be made on an individual basis. Stay healthy my friends.
By P. Michael Shattuck, MD, Community Health Network Family Physician
