Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Doing what’s best for patients may be worse for populations

Ira Nash, MD
Physician
December 24, 2016
Share
Tweet
Share

Every clinician knows that “framing” — how we present information to patients — has a big impact on decisions they make about their care. Even something as simple and apparently transparent as talking about survival versus mortality is important, with “a 90 percent chance of living” sounding a lot better than “a 10 percent chance of dying” even if both phrases convey the same estimate of risk.

Things get even dicier when doctors start talking to patients about more subtle concepts like risk-reduction or number needed to treat. The clinical impact of a big relative risk reduction operating on a low absolute risk can be hard for doctors to explain and patients to understand.

The impact of that complexity was the subject of a recent editorial in Circulation. In it, Diprose and Verster speculate that doing a better job of explaining these things to patients, which certainly seems like a good idea, may paradoxically lead to worse population health outcomes. Here’s how it could happen.

They cite several sources that suggest that as patients gain a better understanding of the modest impact of most preventive measures (e.g., statins for primary prevention), they are less inclined to accept the prescribed therapy. This is presumably based on their weighing the small benefit against the disutility of taking medications that may produce side effects or just having to take a pill that makes them feel like a “sick person.” The rub is that if lower utilization were to become widespread in the population, then measures of population health would decline. This is because even modest improvements in disease incidence in a large population can lead to a large number of averted adverse events. Of course, those population measures don’t account for the side effects and general reluctance to taking pills, which is why things look different at the individual and population level.

I feel strongly that a clinician’s primary responsibility is to the patient in front of him, not to the population as a whole, so I don’t see an easy way out of this.

Ira Nash is a cardiologist who blogs at Auscultation.

Image credit: Shutterstock.com

Prev

Connecting the lines between father and child

December 24, 2016 Kevin 0
…
Next

Navigate the X-ray seas with this radiological compass

December 25, 2016 Kevin 0
…

Tagged as: Primary Care

Post navigation

< Previous Post
Connecting the lines between father and child
Next Post >
Navigate the X-ray seas with this radiological compass

ADVERTISEMENT

More by Ira Nash, MD

  • Let’s stop trying to change what doctors do

    Ira Nash, MD
  • Keeping up with the rapid developments in mobile health technology

    Ira Nash, MD
  • Not all doctors are physicians

    Ira Nash, MD

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The National Guideline Clearinghouse will go offline. Patients will be worse off.

    Kenneth Lin, MD
  • You are abandoning your patients if you are not active on social media

    Pat Rich
  • Chronic disease is making medical education worse

    Jason J. Han, MD
  • Physician Suicide Awareness Day: Where are the patients? 

    Jennifer M. Sweeney
  • Is physician shadowing immoral?

    David Penner

More in Physician

  • When medicine surrenders to ideology

    Anonymous
  • How just culture can reduce burnout and boost health care staff retention

    Olumuyiwa Bamgbade, MD
  • Why embracing imperfection makes you truly unforgettable

    Osmund Agbo, MD
  • The unseen burden patients carry between appointments

    Ryan Nadelson, MD
  • My journey to loving primary care again

    Jerina Gani, MD, MPH
  • Why doctors striking may be the most ethical choice

    Patrick Hudson, MD
  • Most Popular

  • Past Week

    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • When medicine surrenders to ideology

      Anonymous | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • When medicine surrenders to ideology

      Anonymous | Physician
    • How just culture can reduce burnout and boost health care staff retention

      Olumuyiwa Bamgbade, MD | Physician
    • Why embracing imperfection makes you truly unforgettable

      Osmund Agbo, MD | Physician
    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • When medicine surrenders to ideology

      Anonymous | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • When medicine surrenders to ideology

      Anonymous | Physician
    • How just culture can reduce burnout and boost health care staff retention

      Olumuyiwa Bamgbade, MD | Physician
    • Why embracing imperfection makes you truly unforgettable

      Osmund Agbo, MD | Physician
    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Doing what’s best for patients may be worse for populations
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...