I have a new concept which I will try to work through within the platform of this blog. It was not discussed at all in my book, which [thank God] was completed and sent off to Praeger with a great deal of sweat and aggravation. My kudos to Rev. Laurie Sue Brockway who has guided me as well as assisted me in the entire process of finding Praeger and getting the job done.
Back to this concept–I have not found the appropriate name for it but it is derived from a very pragmatic approach to health care and concepts of healing. It has been the platform by which I tend to make medical decisions in my practice. In rough terms it is knonw as the ‘risk, benefit ratio’. It applies to decisions regarding whether of not a procedure such as upper endoscopy or colonoscopy should be performed on any one particular patient. It should also apply to other specialties including cardiology and oncology as well. Who is an appropriate candidate for what drug or procedure in light of the risks involved and the ultimate benfit to the patient.
Knowing and understanding that no procedures are entirely without risk of complications and side effects, I attempt to rationally analyze each patient as an individual. For example, I am often called upon to attempt to elucidate the cause of iron-deficiency anemia. In most adults this results from bleeding, usually [unless it is a heavily menstruating female] it is from the gastrointestinal tract.
Endoscopy and colonoscopy are very well tolerated by the vast majority of the patients I see, yet there are side effects and complications which are possible with each, more with colonoscopy. In this case the bowel preps themselves are sometimes difficult to tolerate. In the elderly, or those with compromised hearts, lungs, kidneys, or liver the risk of the preparation and procedure must be balanced against the potential benefit from performing the procedure. Anesthesia, as safe as it is in the 21st century could jeopardize an extremely fragile patient’s health.
I attempt to analyze this risk/benefit ratio in every patient. The risk in a young otherwise healthy patients is extremely small. The potential information obtained is great. Therefore the ratio favors doing the procedure. On the other end of the spectrum is an elderly, frail patient dying of a degenerative disease such as heart disease, emphysema or even cancer. I will discuss this ratio with family members and the patients themselves.
It often comes down to this: is the information that I will obtain from doing these procedures worth the immediate risk to the patient. Can I effect any meaningful change in their prognosis? Will finding a colon cancer change the life expectancy or management of an elderly nursing home patient with Alzheimer’s dementia?
At times I will recommend the ‘easier’ of the two procedures, upper endoscopy. And perhaps if that does not reveal the source of the anemia, may actually discourage further testing [ie colonoscopy]. There is a fine line which I must navigate in these situations. Some family members understand and appreciate my point of view. Others become incensed and believe that I don’t want to ‘do everything’ for their loved one.
This ratio clearly represents the ‘art’ of dealing with patients, families and risk. It is ironic that I would refer to it as a ‘ratio’ as if it were mathematical in nature. Yet it does have a rational, cognitive component. It should be open to discussion and debate. My thoughts are not fixed and, in many patients, I am open to other opinions and can change my mind.
Now, the reason I am revisitng this concept is this–I believe it has application to metaphysical and spiritual beliefs. What we believe to be true about the universe, our metaphysical platform, influences how we view our own lives and the lives of those around us. I believe that we can choose that lens or paradigm through which we view reality.
If this is indeed a choice, then it gives us an opportunity to examine the equivalent of the ‘risk/benefit’ ratio in our own attitudes towards life.
I believe it is necessary for our ultimate peace of mind, happiness, or whatever term seems relevant to be able to examine and choose how to interpret our reality. We may need to examine the risk vs the benefit of our belief systems and ultimately choose what works best for us.
More to come….