Following Doctor’s Orders: Risk vs. Reward, As in Life

We undertake nearly every activity in our lives with the assumption that the rewards are greater than the risks, a determination made either consciously or not.

Consider driving to work. In rare cases, driving to work is a deadly activity. However, given that the risk of death is remote, and the need to get to work critical to our livelihoods, we determine that the rewards outweigh the risks, and we drive to work. (You can substitute any mode of transportation for driving. Walking to work can be deadly, too.)

This same risk vs. reward scenario plays out with every medical intervention recommended by a physician: taking a medication or supplement, undergoing surgery, or even engaging in various forms of therapy. In some cases, as with complex surgery in an unstable patient, the odds of reward may just barely win out over the risks. And in other cases, the risk/reward balance remains unclear, and the recommendation is more professional judgment than clear science.

Regardless, the goal is always the same: for the potential rewards to trump the potential risks. “First, do not harm,” is the timeless mantra, but an accurate corollary would be “ensure that the chance of harm is less than the chance of benefit.” There are no risk-free interventions in medicine.

Accurate communication of this inherent risk/reward balance can be tricky. Consider the “important safety information” document, or ISI, that accompanies all prescription medications. The ISI is the tightly folded piece of paper that lists out, in fine print, all the mundane as well as dangerous potential side effects of a medication, everything from dizziness to death. These are scary documents but required by law—for good reason—so that patients can be fully informed.

The problem is this: there is no similar official “risk” document that accompanies the diagnosis or disease itself. Assume you have a new diagnosis of diabetes, and the ISI that accompanies your prescription medication scares you so much that you decide not to take it. Would it have been helpful, in your conscious or subconscious risk/benefit analysis, to have a counterbalancing ISI for the disease? The one for diabetes might read: “failure to control your diabetes may very well result in blindness, impotence, limb amputation, heart attack, stroke, or early death.”

Or, you could spin the same information into a positive, as a “reward”: “faithful adherence to this medication will significantly lower your chances of blindness, impotence, limb amputation, heart attack, stroke, and early death.”

So, just as we focus on the rewards of driving to work, we also need to focus on the rewards of various medical interventions, not only on their risks. In the proper light of considering both risks and rewards, we can then make decisions based on knowledge, not fear.