I was asked to do a procedure on a patient taking aspirin. Aspirin helps prevent heart attacks and stroke but it also promotes bleeding - not good when a doctor is going to use a sharp object like a scalpel or needle on you. Although the data is not clear, my hospital has a policy to wait 5 days off aspirin if the reason for the procedure is not life threatening. but this can result in delayed care and patient inconvenience. Guidelines leave room for clinical judgement.
This is a relatively simplistic example of a broader care issue. There is no free lunch in healthcare. Almost everything providers do to patients have the potential to harm. This may be radiation exposure up through serious complications or death from a simple biopsy or surgery. How patient's view risk varies. It seems ironic that we spend more time asking people about their investment risk strategy, than their ideas about health risk. Ideally, providers would know their patients, and something about their willingness to accept risk relative to care options.
A provider's risk profile is also unknown. Some seem to be afraid of their own shadow, practicing as if there is a lawyer in the room. Others are less risk averse, willing to forgo even recommended tests if they feel there is limited value. In one practice I know of there was a 10 fold difference in mammography call backs comparing senior, more experienced and assured, radiologists and their junior partners. The art of medicine more than occasionally equates to provider preference. American healthcare is far from evidence based. Treatment decisions are strongly influenced by the risk tolerance of provide, what they are willing to miss both for the patient's benefit and (medical-legally) their own.
Ideally there would be time for patients and providers to know each other better. However, until there is a change in the financial pressures and fragmented care, perhaps healthcare can borrow from the finance industry. A shared assessment of risk tolerance for both patients and providers might allow a better care match. Although modern healthcare is often viewed contentiously, care decisions should represent a social contract between a patient and their provider, a willingness to try and move forward in partnership. There is no guarantees of good health, but at least decisions should align with personal choice.
