“Benefit” of the doubting and the “risk” of doubting in cardiac care !
Posted Jun 19 2009 4:15pm
When a doctor is confronted by serious doubt , what will be the outcome for the patient ?
Can doubting be beneficial for a patient ? . It seems so , according to EBM which stresses about statistical outcome at every turn of events in a patient who is critically ill .
Is something , always better than nothing ? Our limbic system tends to think so . It may not be true. But in dire situations , anything has to be tried however doubtful it may be , like an emergency in an air plane. Even here there need to be a logic.
Then , this question arises . How do we make sure , we have a dire situation on hand ?
This is the central issue in clinical decision making .That needs experience , only experience. Though the principle of uncertainty is the fundamental rule , EBM aims to bring some degree of certainty in medical therapeutics.
Benefits of doubting in coronary care unit.
In a sinking patient with cardiogenic shock try the maximum treatment .Even if the patient is in severe shock , take him to the cath lab , try open the coronary artery . Give the benefit of dobut to him even though the chances of reviving him is less than 20%.
Risk of doubting in Coronary care unit.
A.Elderly STEMI with SHT,(Arriving late , with an unknown time window after an MI ) To thrombolyse or not ? . There is no benefit of doubt here. Do not thrombolyse.
B. Chest pain with LBBB (Thought to be new onset LBBB ) don’t ever rush to thrombolyse your doubts ! wait for the enzyme result .
C. Patient with persistent ST elevation following thrombolysis ,in an otherwise asymptomatic and stable patient. Don’t pass on ” your doubt ” of salvaging at least some myocardium by an rescue PCI .
The concept of giving the benefits of doubt to the patient is a widely prevalent practice in medicine .This concept is alive and popular , not because it has proved effective, but because of the primitive human perception and cognition , namely “Something is better than nothing ” !
Common sense and logic would suggest , whenever there is a benefit for doubting there would be a equal or more hazards and unmeasured risks . This becomes especially true , when the physician makes a therapeutic move based on doubting than on conviction .