Monday, March 19, 2007

Life is Full of Risks

The next time you step into your car, stop and think for a moment about the risks. The following things might happen. You could have a fender bender or bump into an inanimate object, causing damage to your car, someone else's car, or some one's property. It will be expensive to repair, your car insurance rates might rise and if it happens repeatedly you may become uninsurable. You could have an accident in which you are injured--perhaps with broken bones that will take months to heal, internal bleeding which may require emergency surgery and cause organ damage, or anatomically unnoticeably muscle or nerve injuries which could cause you years of chronic pain and disability. You could have injuries which leave you scarred and disfigured, you could become paralyzed and never walk again, never have use of your arms, require a respirator to breathe. You could die. And even if you're a very safe driver, there is no guarantee that someone else on the road isn't intoxicated or simply careless. And maybe you're not a great driver, and in a moment's distraction while you fiddle with the radio or respond to a child's request, you are at fault in an accident that disables another human being. You may be sued. You may have to live with a lifetime of guilt for the distress you've caused others in a moment too short to contain an ounce of bad of intent.

And while the likelihood of something bad happening is low for any given trip to the store, in the course of driver-lifetime, it is not an unlikely thing. Nearly everyone has had a fender bender; many many people have been in car accidents resulting in some form of injury to someone, thousands of people die in motor vehicle accidents in a given year-- nothing about the risk is anything but in your face.

And still, you will get in your car, just as I will soon get into my car. It's important to get to work, we all need to pay the mortgage. And we're out of chocolate sauce, what is ice cream without the topping? The kid really should learn to play guitar, gotta get him to those lessons. We take the risk because we do it so much, we've extinguished our anxiety about a very real danger. We take the risk because we've decided the quality of our lives is better if we do. And there are a whole host of reasons why every car doesn't simply have the very best safety rating and why someone would purchase any car that isn't the absolute safest one available.

This was a long way of saying, when you take a medication, there are risks. The prescribing doctor should tell you those risks, even if the patient is also a doctor, even if the patient really needs the medication but won't take it if he's told of the one in a million shot of death. The risks may be immediate, they may be long-term, they may be unknown, especially for the medium and long term. Each doctor decides what risks to tell patients, and honestly, these decisions are colored by some very non-scientific things. If the doctor took the drug and it didn't work for him or he had an unpleasant side effect, if he just saw a patient who had a dramatic bad effect even if it's known to be rare, if the last seven people walked in thrilled with how much better Drug X has made them feel, all with words of praise for the wonderful prescriber. No doctor tells a patient every possible side effect-- we simply can't remember them all, time doesn't allow for such lengthy discussions, many patients don't want to hear it. And while a patient should be warned of the more common side effects, will be told of any potentially life-threatening possibilities as deemed by the fated Black Boxes, many are coming for treatment because they are in pain or anguish, physical or mental-- they want the distress to go away and it's obvious that there is risk involved-- they're willing to accept at least some risk in exchange for the possibility of relief.

Stayed tuned for the next post: The Good, The Bad, & The Ugly -- more about medication. But first, I need to run to the store.