The Making of Medical Decisions
Every day on our lives we make choices and decisions. And with these choices and decisions come consequences or results. For instance, when we wake up, we may get in the shower and get the day started by bathing and washing our hair. But in doing so, we may slip in the shower and fall and break an arm, or we may bend down to pick up the soap and hurt our back. Unlikely, but it happens! Then, we get dressed, get in our cars, and go to work, or run errands. But we may get in a wreck and get injured, or the car may malfunction, etc. So is it worth it to take that shower, to pick up that bar of soap, or to drive that car? Of course it is! We make our decisions about every day activities almost without thinking because the benefits outweigh the risks.
The same holds true in medicine, and every day I help my patients (and their parents) make those decisions. Do I take that antibiotic for the ear infection or do I wait? What are the potential risks of taking the antibiotic, and what are the potential benefits? My child has headaches, so does he need a CAT scan? Are there risks involved in a CAT scan? What are we likely to find? Dr. Karam, I want to give my newborn some “Grippe” water, because my friends have done it. Is it safe? Will it help?
These are just some of the many questions that I encounter on a daily basis. Some of them have easy answers, such as treating Strep throat with antibiotics. (If you don’t, you have a significant chance of acquiring Acute Rheumatic Fever, a potentially fatal disease, and if you do treat, the risk of getting this disease is almost zero. There is a risk to taking an antibiotic, but this risk pales in comparison to that of Acute Rheumatic Fever). But of course some questions are much harder. An example would be when to refer a patient for surgery to place tubes in the eardrums for recurrent infections. There are many variables in getting to an answer, and parents will have different thresholds for when this would occur, if ever. This is where the physician comes in, giving the latest information on recent scientific studies, his own personal experiences, and both the upside and downside to the procedure. Then it is up to the parents to decide what is in the best interest of their child and family.
One of the questions I want my parents to ask me is “What would you do if this was your child?” I have been through many, though certainly not all, medical problems with all of my six children. My wife and I have had to make many decisions about their medical care and therapy over the past 26 plus years. Fortunately, none of them have involved life threatening or extremely serious situations. But for many of the day to day problems that face children and their parents, I have “been there, done that”! So don’t hesitate to ask me what I would do for my own kids. I will be frank and honest.
There is one last thing for me to mention. For those who consistently ignore my advice on serious, potentially life threatening matters, I will ask them to leave my practice. There reaches a point where I do not want to be responsible for caring for ill children who become ill because of the neglect of their parents. There is a medico-legal basis for this, as well as a personal one. Fortunately, I have had to do this only a very few times in my career. Hopefully, I won’t have to again.
