Realizing the domain of hazards, transgressions into any
venture are replete with the unknowns. There lie the risks of “what could be,”
rather than “what should be.” The imperatives of knowing the risks do not
minimize the potential of something that is not understood or a hazard that is
not known to exist.
Humans live in the wild frontier of the Lewis and Clark
expeditions. A snake here, a wild boar there and life ends. Health expectations
seem to follow such traditions of the unknown. Even though most pathology is
well known, the constant exposure to newness and its interaction with the
physiology create the “wild boars.”
Risks
Mitigating risks is the overall desire of all physicians
when they undertake the cause of healing. No, it cannot simply be “do this and
that will happen.” One has to think the minutia of so many iterant that the
multiprocessing brain through experience is most times able to eek out the
right answer. And here lies the bleeding reason where not all decisions given
the human capacity, are correct. The risks are both from the disease, that
compels towards injury and directed medical therapy that has an embedded
intolerance to the functions of the individual cell. The balance that permeates
between the two is what is considered “success.”
While considering all the nuances of most known risk factors
that might rear their ugly heads, a physician then also has to consider the
capacity of the patient to relate to the risk of the proposed therapy. For
instance, is the treatment more harmful than the disease it is purported to
eliminate? Is the individual able to withstand the side effects of the therapy
or is he or she in a weakened state of being and that even though the therapy
is the correct one with the most benefit, yet the weakened state of the
individual, would of necessity certainly endanger the patient. One might also
then consider weather the short term benefits of the therapy create the
long-term collateral side effects and that whether such a therapy may well not
be employed and a lesser or no therapy (placebo) be employed? These are
questions of great concern both to the patient and to the physician. As the
science of medicine has shown us that the overall benefit has to consider the
underlying risk and the capacity of the patient to withstand such therapy.
Additionally such proposed therapy should be considered only when short-term
benefits do not outweigh the long-term injury to the patient.
Capacity
The physiology and neuro-psychology of an individual at play
in this interaction of “to do or not to do,” is of immense importance. An
individual’s vanishing immunity within from the pain of the affliction has to
be considered in the reasoned efforts by the physician. At times the wisps of
such relational issues bear significance, in that minimizing therapy of the
patient may have more long-term benefits then otherwise. A weak immune system
is ripe for coercion from many potentially devastating ailments, including
cancer.
"...to suffer the slings and arrows of outrageous fortune..."
and
"... whips and scorns of time..."
An appropriate example here would be the short-term benefit
of corticosteroids and the implications of secondary infections, osteoporosis
and suppression of the adrenal gland function. From a orthopedic point of view,
one might also review the overuse of steroids within joint cavities and the
untoward effects on the ligament weakness and potential rupture.
The weight of this argument is conceived in the thought that
before any therapy is embarked upon, a measure must be established between
risk, capacity and the true potential benefit to the patient.
Tolerance
At all times in today’s world of “patient-centric
decision-making” the patient is a willing and able decision-maker along with
his or her physician. It must be so for the proper and ethical undertaking of
the care of the patient. However, here we arrive at the slippery slope of the
improper effect of this causal behavior. For instance the right therapy may be
rejected by the patient through improper understanding or as a result of the
short-term side effects from such therapy. A patients self image and ability to
withstand the toxic effects to gain the benefits may be conjured in a most
negative light and the potential curative intent may be lost. Is the patient
then like the consumer (in business world) always right, no matter what the
decision? Thus the implied risk of intolerance to proposed therapy then,
accidentally becomes the cause of deviating from a path more profitable to the
patient? These questions bear a deeper level of understanding. One cannot
simply “cut and paste” with the “one size fits all” mode of reasoning.
Acute illnesses
All diseases fall into the categories of “acute” and
“chronic.” The former expressly involves a larger share of suddenness of a
deviation from a normal existence. The relative change is both sudden and quite
disruptive. It carries with it the burden of a lowered threshold of signs and
symptoms, where each symptom is perceived excessive and “life-altering.” The
intent of the patient is obvious as is that of the physician; to control and
mitigate all such complicating insults. The need is great and the desire even
greater. Again, even here a balanced reasoning is needed by both parties to
reach appropriate results. A patient with a sudden cough, fever and asthenia
yearns in today’s world to get their hands on an antibiotic, anticipating an
end to their malaise and other symptoms. The physician in an attempt to please
may offer such a band-aid, knowing at all times that such therapy will have
little or no benefit, yet with that lurking distrust of the unknown is
compelled to acquiesce. Here lie the seeds of discontent to so many future
ailments. Excessive antibiotic use, especially of the “next-generation”
variety, can and usually does make for selective genetic pressures on the
offending viral/bacterial/fungal agents. Thus therapy is laying the foundation
of a future debacle for human race needing better and better manipulation of
the chemical codes to thwart such mutations in these offending infectious
agents.
The likes of MRSA, VRE, mutant TB, E-Coli and the like are a
testament to such profligate misuse.
Chronic Illnesses
When chronicity compounds the problem, the patient may over
time learn to create various means to accept such changes. For instance a
low-grade discomfort in the foot may lead to a imbalance at the spine level and
create a discopathy creating symptoms of sciatica and more discomfort. Or a
chronic inflammation of the stomach treated with “Tums” may be a harbinger of a
Helicobacter Pylori infection that precedes a gastric (stomach) lymphoma or a
gastric cancer. Long-term acceptance of a low-grade chronic condition can and
will at times lead to a worse outcome. Such patients need to be counseled in
appropriateness of care and management. All minor complaints, even trivial ones
can lead to a profound discovery that can thwart the risk of greater harm down
the road of life.
Understanding
Lastly we arrive at the core of proper care; Understanding!
No truer knowledge than a reasoned understanding of the
ailment both by the patient and the physician will lead to the best outcomes.
A knowledgeable patient asks the right questions and a
knowledgeable physicians offers the correct answers to those questions.
We live in a world of fear and reprisal. We must learn the
art of managing these fears and by acknowledging their presence, learn to
educate against reprisals. The world is a conjugate of many reflections. A
proper understanding circumnavigates such a minefield. It is in the learning of
the known that measures of ultimate benefit reside, not in the mindless
guidelines and mandates that conform to a closed-loop thinking of the few.
Hey, I didn’t say this was going to be easy!
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