In last blog, I tried to share with you some insights and information regarding medicine and post-graduate training. The objective was to help you understand how doctors are trained and dealing with the human body is very complex. Also, I wanted to clarify that a medical mistake doesn’t equal negligence. For instance if a doctor makes a mistake that doesn’t make him/her a bad doctor.
Today I would like to continue exploring the physician – patient interaction. Let’s start by saying that most of the time people go to the doctor for several reasons:
- A sudden change in their baseline health (acute)
- A follow up for a current condition (chronic)
- An annual check- up or a pre-employment evaluation
There are very clear expectations about the interaction with the doctor. But, sometimes the expectations might be unrealistic. Sometimes we expect to get better from an illness, a cure from a condition, or to prevent a bad illness.
I would like to discuss a little more about the expectations and explain myself when I said “unrealistic expectations”. In order to understand what I am talking about, we must get familiar about something called “Statistics”. By the way I took statistics as part of the curriculum in medicine, and I hated it! It was one of the few things I have hated in life!!
Statistics is very useful in heath care. In the area of public health, it allows to distinguish between an infectious out break or epidemic versus just sporadic cases that occur by fate. But also, there are specific statistical benchmarks for certain procedures that are useful to know. In my field, cardiac surgery, we use statistical benchmarks to advise our patients regarding the procedure they are about to undergo. These benchmarks are obtained after detailed analysis of thousands of cases per year performed by hundreds of surgeons.
Prior to the discussion about a procedure with a patient, I need to know what kind of health the patient had prior to the present condition. If the patient has too many health problems prior to coming to see us, then the possibility of complications increases. In other words, the sicker the patient was prior to surgery, the more difficult the post-op recovery will be.
When I discuss a coronary bypass with one of my patients, I have to explain the benefits of the operation but also the potential complications and the probability of having a poor outcome. We know what kind of possibilities or risk we are facing because we have special programs that assist us with the information.
Nowadays, the benchmark mortality risk for an elective coronary bypass is around 2%. It sounds very good but let’s be clear, it isn’t zero. So, this particular number can be seen in two different ways:
- If we do 100 consecutive cases with the same health profile, 98 patients most likely will survive
- If we operate on 100 patients, 2 patients most likely won’t make it.
To simplify what I am trying to say, this statistical benchmark is great as long as you as a patient belong to the 98 % surviving but it isn’t great if you are in the 2 %. I just used the example of mortality but also there is a possibility of having other complications and every time you are exposed to a procedure you are taking a risk while trying to obtain a better state of health.
My message today is that when you go to a physician you need to have a very open discussion about benefits and possible complications. It is also wise to write down questions that include success rate, benefits of the procedure, possibility of complications. It is a good idea not to leave the questions to your memory because you might forget.
You as a patient are entitled to a good discussion with your physician so you can make a good decision.