How to understand medical decisions

What are the possible outcomes of each of these options that had been considered and how often are they expected to happen?

The answer to the above question should list all of the patient’s existing symptoms (e.g. pains, other distressing sensations and disabilities noted by the patient), physical signs (only noted by the doctor e.g. high blood pressure and test results (e.g. blood sugars) and their possible outcomes.  For each finding there could be a number of outcomes e.g. that fatigue had improved, was fatigue unchanged, or that the fatigue was worse.  The possible adverse effects of all the options being considered should also be listed in the same column (e.g. weight increase on treatment, rash due to a medication, death under anaesthetic, etc).  

 

If there were a total of 4 treatment options then each of these options could be written as a heading for a column.  There would be a row for each possible outcome.  The percentage with each outcome for each treatment option can then be displayed as shown in Table 1 (this information is the kind used for technique of 'Decision Analysis' that calculates and estimated overall well being experienced by the patient when all the posotive and negatives effects are taken into account for different treatment options (4 in the table below).  Ideally the choice should be based on on direct experience from a randomised control trial conducted on patients with a similar age, gender, symptoms, examination findings and test results to the patient on whom the decision is to be made.

 

It is important that the patient understands what the terms mean.  Many decision aids provide video recordings of patients with the various treatments and outcomes that have to be considered.  This allows the patient to form a personal view about each outcome and adverse effects of treatments on the basis of how it would affect them. There is much research being conducted into techniques that to improve patients' ability to make their own choices and decisions.

 

© Huw Llewelyn 2016

Table 1

                          Below is % with each outcome on each treatment combination

Outcome

                               Diet alone Diet + Metformin  Diet + Gliclazide Diet + Insulin

Fatigue improved    40%            50%                     60%                   70%

Fatigue the same    40%            40%                     30%                   25%

Fatigue worse               20%            10%                     10%                   5%

Weight lower                     50%             65%            50%                   45%

Weight same              30%             25%                      20%                    15%

Weight higher              20%             10%                      30%                    40%

Etc

Etc