Using Your BRAIN: How to Make Informed Decisions About Your Medical Care
In the UK, five million people visit their GP surgery every week and up to 90% of healthcare is delivered by primary care. According to the report on the future of General Practice overworked GPs are dealing with complex cases one after another and are suffering from burnout. Their high workload is making them worry that will make mistakes or not be able to practise safely. That means that there is a chance that you or I might be one of the patients that slip through the gaps in our fifteen minute appointment slot. It is important that we know how to advocate for ourselves
I really like this infographic:
But a framework that I really like when facing a medical decision without much time to process or think is the B.R.A.I.N informed decision making tool.
“B” stands for benefits and asks what good will come from this procedure? When compared with sham/placebo surgery how has this one fared?
“R” stands for risks and requires a conversation about present and hypothetical risks as well as side effects and long term safety.
“A” asks about alternatives and complementary therapies that can be followed alongside a treatment regime.
“I” asks what your intuition tells you and asks what decision feels right to you.
“N” asks what will happen if I do nothing? What if we take a pause on this course of treatment?
Initially the benefits to a course of action may seem obvious and though Google can be a harmful rabbit hole, a useful site that I use is “StatPearls” in google scholar which is a free library of medical information. Here someone can find out about their medication or surgery without the background noise of opinion and bias.
The side effects of a treatment must always be weighed up, if you knew that your treatment had a twenty one to fifty six percent chance of success but could also damage your retina - would you still proceed?
What about the side effects and risks of alternative treatments or medications? What would the risk be if we did nothing?
This is a number needed to treat table (NNT) for analgesics. It shows the number of people, with moderate to severe pain, that need to receive a treatment before ONE person felt at least 50% pain relief over 4-6 hours. What the concept of number needed to treat (NNT) shows is that not all analgesics work on everyone, and they do not need to eliminate pain entirely to be seen to work. It is useful to know the NNT for the medication that you might be taking.
This is where alternatives and complementary services can help someone. Yes, they need to see a doctor but they may also need to see people who can help them with movement, meditation, visualisation, breath work, mindset training and pain education. They might see a therapist, a sleep expert, a nutritionist, an in person pain support group, online pain support and a specialist pain clinic.
This image here shows natural remedies for pain that people have used for centuries. They may not have strong scientific backing behind their efficacy but with what we know of the power of the brain and the placebo effect in its role in pain reduction - that may not matter.
At the heart of the Hippocratic ideal is the concept of “doing no harm.” A doctor must surely feel that in doing nothing they are failing to intervene and they are not doing their job properly. It is through weighing up side effects, complications and long term effects of a treatment with their patients that they come to the right decision. However, it is the patient’s right to decline treatment. As long as they have the capacity and understand the risks incurred through not having the treatment their choice must be respected.
I hope that you always have amazing service from your GP. I feel that I do. We know that they are overworked people who are doing their best. We also know that we owe it to ourselves, and our loved ones to advocate for our rights.
Kia Kaha friends