Risks, Benefits, and Alternatives

The problem with risk in medicine is that complications happen infrequently, but dramatically change the lives of the patients it befalls. When I, or any doctor, talks about the risks of what we do, we are serious. But it's hard to be sure a patient really understands. If the risk of a complication is only 1%, 99 out of a hundred people will do fine. But that one remaining person may suffer tremendously. How do we convey that to a patient? I can say it many different ways and ask a patient to repeat back to me, but how does our brain comprehend such statistics? Is it fair that we put these abstract numbers out there and expect them to make sense?

We think our health care system so advanced, our medications and technologies and surgeries so cutting-edge, but we will never take risk out of the equation. It may be banal to talk about risk, but it strikes me so profoundly when I hear about that 1 in 100 unfortunate outcome. I read case studies in journals. I hear about these situations from colleagues. For example, bypass surgery seems like such a common thing, and it is. So many people have had it. It seems so safe. Yet the risks and complications do exist. A patient has a paradoxical reaction to the blood thinner and clots off his blood vessels. A small surgical tear in an artery leads to hemorrhage. A patient wakes up from surgery with a stroke. These are rare, but they change everything for that one patient.

This is not to say that I don't believe in modern medicine. I am proud to do what I do, and I accept those risks I take and do my best to help patients understand them. But I blog about it because there are so many nuances. How do we communicate these things clearly? When that rare bad outcome happens, how do we help our patients? How do we cope with it ourselves? Risk is inherent in what we do. Complications happen without our making a mistake, without our committing malpractice. They are part and parcel of medicine, and we (you, I, patient, doctor, medical community, society) must determine how much we can accept.