Realities of Decision Making
Whenever a decision must be made about diagnosis or treatment, two tasks must be accomplished. The first is to choose from a variety of information resources to help determine the best course of action. The second is to apply what is learned from those information resources to the individual person's situation.
There are several challenges. One challenge is time. Many decisions must be made quickly. Doctors and patients may not have enough time to gather and evaluate all the information available. The doctor must also help patients weigh the quality of information from several sources. For example, the doctor may feel that his personal experience merits more trust than results from a clinical trial.
The doctor must judge the potential effects of any diagnostic recommendations. He must help the person weigh the consequences of overlooking a serious condition even if the diagnosis is unlikely.
The same type of reasoning is used in deciding about treatments. If a person has a mild condition that will eventually get better on its own, a doctor will probably not recommend a treatment that may cause serious side effects. Conversely, if the person's condition is grave, such side effects may be worth the risk.
The doctor and the person may not share the same perceptions of risk. A person who hears about a possible side effect of a drug may be very concerned because the side effect is serious, regardless of how often the side effect occurs. The doctor may not be as concerned if the possibility of that side effect is remote. Or the doctor may not understand that what might seem to be a relatively minor side effect for most people may cause great problems for a particular person. For example, if a person drives for a living, it may be difficult for him to regularly take a drug that causes drowsiness.
Often, however, the balance between the risk of the disease and its treatment is not so clear-cut. A doctor may judge the risks and benefits of a treatment differently than the person being treated does. Understanding risks can also help a person weigh options. A doctor may outline several approaches and ask the person to decide among them. By evaluating the relative and absolute risks of the various choices and then factoring in his own values, a person can make more informed choices about medical care.
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