special subjects
Medical Treatment Decisions
Providing perspective
Because medical information can be complex, perhaps the primary care practitioner’s most useful role is to provide perspective on the potential risks and benefits. For example, advertisements for various drugs on television and in magazines are accompanied by a long list of potential side effects that range from mild to disastrous, but these advertisements do not provide information on any of the following topics: How many people will experience these side effects The consequences of these side effects The consequences of not treating the disease As a result, a person who might benefit greatly from a treatment might refuse the drug for fear of experiencing any number of these advertised side effects. For example, many people who have high blood pressure stop treatment because they have side effects from the drug they were given. Doctors can explain to people that even though they feel fine now, treating high blood pressure is important because it significantly reduces their chance of heart attack, stroke, and kidney failure, which are leading causes of death and disability in the United States. If people understand that side effects might be avoided or minimized by using a different drug or a different dose, they might be more willing to assume the risks of treatment. By contrast, the effects of a heart attack or stroke are often serious, irreversible, and life-threatening, meaning that the potential benefit of taking a blood pressure drug greatly outweighs the potential risks for most people. Doctors can also provide perspective by comparing the person's circumstances with the circumstances of the people in whom a drug or treatment was originally studied in a clinical trial. For example, a person who is sicker than the people in whom the drug was originally studied might benefit less from the drug and perhaps experience more risk. On the other hand, a person who is healthier than the people in whom the drug was originally studied might have better outcomes than those of the study group. 