Balancing precaution and the apparent risk in medicine

One will find many examples of precaution and their corresponding examples of risk in how medical care is provided by physicians and accepted by patients. In fact, not only do these two elements correspond but at times the price, itself, of precaution becomes the risk.

Risk is everywhere in medical practice. Risk is present when a patient is selecting a physician. The risk is becoming the patient of a doctor whose professional behavior does not meet the goals of a “good doctor” set by the patient. It is often that the patient really has no chance to predict how the doctor-patient relationship will turn out since the patient is often immersed in the relationship already by the time the uncertainty about that doctor begins to develop.

Ideally, the patient should be cautious of all physicians from the onset as to how that relationship will turn out unless the patient doesn’t care. Recommendations by neighbors, family or even other physicians may be helpful but are only the views of others regarding what is strictly a personal relationship. Precaution in the making of a selection of a physician is not often fully available due to time and medical urgency and inadequate communication between patient and doctor. The price of precaution in this example can be what turns out to be unnecessary and harmful delay in diagnosis and treatment in the attempt to find a satisfactory medical provider. On the other hand, not accepting a physician for personal consultation without an introductory “get to know you” appointment, if accepted by the physician, would be of great benefit for the patient’s comfort with subsequent medical consultations.

It appears that patient physical modesty issues become a risk. The visitors write about the emotional risk of examinations and procedures in terms of their emotions associated with that modesty. It is related to the presence of those attending or looking on being of the opposite gender than the patient. The inability to obtain an environment free of those of opposite gender including the physician, nurses and technicians may lead to a decision by the patient to avoid the exams or procedures even if their life was at stake. Such is the price of their caution.

Yet, even absent the context of physical modesty, precaution may be elicited in a patient’s decision whether or not to accept a necessary medical or surgical procedure in face of the risks of that procedure. Presumably, that decision is based on information regarding the statistical value of the procedure vs the side-effects and life risks of the procedure. A patient’s precaution decision against the procedure may have a price of further sickness or death.

Risk may often be warranted and thus beneficent to the patient. It may turn out, in medical practice that the price of precaution is not worth the benefit permitting a risk. The physician the patient received before searching for others may be the one who could diagnose promptly and correctly and cure the patient. It could be that the risk of emotional upset related to the physical modesty issue, concerning opposite gender presence is not worth the outcome of avoiding the examination or procedure. And finally, the price of precaution leading to the rejection of a procedure based on statistics instead of “taking a chance” on being the statistical outlier who would benefit despite the risk would be to the detriment or even the death of the patient.

What is your philosophy regarding balancing precaution and the apparent risk in medicine?

Maurice Bernstein is a physician who blogs at Bioethics Discussion Blog

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