A couple of years ago I scratched my thigh during a mountain-bike ride. It was a tiny scrape that hardly broke the skin. I quickly forgot about it. A couple of days later, I felt a nagging pain at the site. The line had grown thicker and turned brighter red. An infection had set in. I’ll wait and see; the body has an immune system for a reason, I thought. The wound got worse; red streaks traced up my leg. I showed it to a surgeon while we ate lunch together in the doctor’s lounge. He said, “If you like having two legs, take antibiotics.” I did, and my leg improved rapidly.
Most medical decisions these days aren’t quite this clear-cut. Excluding emergencies, such as heart attack, cardiac arrest and stroke, most heart disease treatments allow for preferences. There is time to think; there is time for slow medicine.
I like to think of medical decisions as forks in the road. There are almost always multiple paths, and each path presents different possibilities. But how do you choose? When your doctor recommends a treatment or a test, here are four questions you should ask:
What are the odds this test or treatment will help me? Benefit is the main reason doctors recommend action. It’s our bias. I call it the “do something” bias. But the chance of benefit turns on many factors. Take screening tests, for example. A person at high risk of a disease is far more likely to benefit from the test. Situations and people vary a lot. This is where you rely on a doctor to help you sort through the odds. I like to give patients an estimate of the odds for benefit.
What are the chances this test or treatment will harm me? It is not zero. All actions in medicine come with a cost—not just dollar costs, but the risk of a bad outcome. There are no flawless doctors. A procedure or drug may offer a potential cure, but are you willing to take the chance of a complication? In my case of the leg infection, I was initially worried about the risk of antibiotics. But when my leg worsened, it was clear that the benefits of taking the drug outweighed its risks.
What will happen if I do nothing? It seems trite to say this but one of my favorite medical treatments is time. The human body has incredible healing powers. The trick is to harness this power. I often recommend “giving peace a chance.” And when time fails to heal, sometimes the best option for patients is to make peace with a disease. In some cases, treatments can be worse than the diseases they treat. I call this the no-treatment option. Its greatest advantage is that you eliminate the possibility of harm from medical care.
What are my alternatives? Every test or treatment has an alternative. In heart disease, the most common alternative is lifestyle change. It is harder to prescribe eating less, moving more and sleeping better, but these basics often outperform drugs and procedures. Sometimes the alternative is to wait, or live with the disease, or try something less aggressive first. Whenever I recommend a test or treatment, I offer the most reasonable alternatives.
Doctors are the experts in medical science, but you are the expert in what is important to you
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