Healthcare Decisions

What should you consider before making a healthcare decision?

The last column discussed a guide to reduce unnecessary medications.  Doctors are encouraged to follow practice guidelines and if they don’t prescribe the recommended drugs – even when the benefits may be marginal – they worry they aren’t meeting the “standard of care” and may be sued if their patient has a bad outcome.   But, if a patient makes an informed decision and accepts responsibility for that choice, doctors can and should support them in that.

The following are some things to consider any time a senior needs a prescription (or test or procedure)—again keeping in mind the principle, First, do no harm.

All drugs have side-effects:  whether you have one depends on the dose and your sensitivity.

The more drugs you take, the greater the risk of side-effects—the risk of falling or injury increases in direct proportion to the number of drugs a senior takes.

Is your goal to ‘live’ or ‘be kept alive’?  This is the ‘quality vs quantity’ issue.  (The evidence increasingly suggests people live not only longer but with better quality when they focus on ‘comfort’.)

The potential benefit of the drug should greatly outweigh its risks.

Just because something is reported as “statistically significant”, doesn’t make it “clinically beneficial”.  It is difficult to apply large scale population statistics to individuals and therefore doctor and patient should decide together what might work best to help reach that individual’s goals.  If you are uncertain, then a trial of therapy for a month may be worthwhile.


Next time:  the Illusion of Certainty and how it can cause doctors and patients to make potentially unhealthy decisions.