Sometimes one of the more difficult aspects of a medical condition is deciding on whether to take a medication or undergo a medical procedure. In some cases, for example when you have have an abnormal test result but no signs or symptoms of illness, you may be deciding between treatment or no treatment. For example,if you have a high cholesterol or Prostate Specific Antigen (PSA)level, the danger that this poses for your health may not be clear. In the book Your Medical Mind: How to Decide What Is Right For You Doctors Jerome Groopman and Pamela Hartzbrand address this problem.
Deciding on Treatment to Prevent An Unwanted Outcome
In this post, I will address the resources that Groopman and Hartzbrand suggest to help people who have an abnormal test result, but no other signs of illness, to make a decision on whether to have treatment to avoid an unwanted oucome. I will assume that you are seemingly very healthy, but get a high reading on a cholesterol test.
Step 1: How Effective Is The Treatment?
Your doctor suggests that you take a cholesterol lowering drug called a Statin, and tells you that it will decrease your chances of a heart attack by 30 percent. That sounds impressive, but what does it meaan in your case? Not everyone with a raised cholesterol is at the same risk of having a heart attack. A 30 percent decrease in risk when you have a very low risk already, may not mean much.
Step 2: Evaluate Your Risk
Ask your doctor what your risk of heart attack is, given the test results and your current state of health. If she does not know, tell her that you will get back to her after you have done some research, and that you would like you test results for total cholesterol, HDL cholesterol, and your blood pressure. You need these in order to determine your risk of heart attack and how the reduction in risk you would get from a Statin will apply to you.
You can find your risk of heart attack by using these health check tools. You will be shown a long list of physical conditions, with information, tools and suggestions. Scroll down to ‘Cholesterol’ and click on ‘Risk Assessment Tool for Estimating Your 10-Year risk of Having a Heart Attack’, then put in the numbers it asks for and click on ‘calculate your risks’. A one-percent risk, for example, would mean that one person out of 100 would have a heart attack in the next ten years, the other 99 would not have a heart attack. For every 300 people with a one-percent risk, 3 people would have a heart attack without treatment. If all 300 people were given a statin, the 30 percent reduction in risk would prevent just one person from having a heart attack, and two would have a heart attack. The other 297 would not have heart attack even without the medication.
The number of people that must be treated by an intervention in order to prevent one unwanted outcome is known as the number needed to treat (NNT), and is an important figure to know in determining the impact of a treatment for an individual. So in this case the NNT is 300. If the risk without treatment was two-percent, then the NNT to prevent one heart attak would be 150.
Step 3: Ask About Possible Side-Effects of the Intervention and The Risk of Having One
All interventions have side effects. The major side effect of statins is muscle pain due to inflammation. The pain appears in about one to ten percent of those taking stains, especially in those on high doses. The pain can be severe and may continue even after the medication is stopped.
Step 4: Talk to Others Who Have Made this Decision
People have different prefereces and values when making decisions about treatmant. For some the regret they would feel if they decided against treatment and then had the unwanted oucome, would incline them towards the treatment however small the risk. For others, the regret they would feel if they develoed a side effect, however small that risk, would incline them to not have the intervention. In either case, listening to the anecdotes of others may help you to decide what to do. Try aznd find people who decided on the intervention, and those who decided against it. Also, if possible, find people who had side effects and ask them about their experience.
Step 5: Discover How You Can You Lower Your Risk Without The Intervention
Another option is to see what you can do to lower your risk of the unwanted outcome. This site gives the lifestyle changes you can make to lower your chance of heart attack if you have high cholesterol. And there is an on-line tool that will help you monitor how you are doing.
In this post I have used high cholesterol as an example of making a decision on medical treatment. But there are many other situations where you may have to make medical decisions. These articles and tools can help.
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