Making
a decision requires you to compare tests/treatments that have been
contrasted in research studies to see if one over another results in
improved chances of good outcomes. In a sense, medical decision making
is a competition. To assess the competition, you compare the chances of
outcomes, or results from groups of people taking different options. The
comparison is a simple subtraction in the amounts of outcomes that
occur in each studied group.
Subtracting
results in a difference that is either a benefit (if better for you) or
a harm (if worse for you). For nearly all decisions, however, the
test/treatment that is better for disease outcomes (benefit) is worse
for complications (harm). Comparing, then, results in the following
possibilities:
The chances of outcomes associated with the condition you have and the tests/treatments available will be the same for all options. In this case, chose the cheapest option.
The chance of outcomes associated with the condition you have will be less with one option. That option provides added benefit
The chance of a complication caused by the test/treatment that adds benefit for the disease outcomes will be greater (harm).
Since
the test/treatment that is better for you in terms of the disease you
have will be, simultaneously, worse for you in terms of complications
caused by that test/treatment, a trade-off of benefit and harm is
required.
Hence, the definition of “works” is that:
A test/treatment works when
you feel there is more to gain from the greater chance of better
disease associated outcomes than there would be to lose from suffering
the complications caused by your chosen treatment.
So, medical-decision-making is a competition between options and there is always some good to be balanced against some bad.
The balance of good and bad from your perspective is what makes one treatment work over another.
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