When talking to patients, how do
you weigh the risks vs. rewards?
By Stuart Foxman
magine you’re on the road and late
for work. The light ahead is about to
turn red. Leaving aside traffic laws (in
this hypothetical, tickets don’t exist),
should you run it?
You have a 50% chance of getting through
safely, a 50% chance of being broadsided.
Or make it 60-40. Logic dictates that you
hit the brakes. The enormous potential
harm (injury or death) far outweighs the
slight potential benefit (getting to work a bit
What if some variables changed? For in-
stance, your boss said that if you’re late again
you’ll be fired. Or you’re a doctor heading to
the hospital to perform emergency surgery.
And other approaching cars seem far enough
away. Would that change your decision?
For any decision, rank the possible loss
(how bad is the outcome with total fail-
ure?) and the possible gain (how good is
the outcome with complete success?). Some
decisions may be a coin flip. For others, the
reward has to far outweigh the risk to be
These are the conversations in our heads,
running through the considerations and
calculations. They’re also the sort of full and
open conversations that doctors should have
with patients around opioids – and may not
have enough, says Dr. David Juurlink, a staff
internist and head of Clinical Pharmacology
and Toxicology at Sunnybrook Health Sci-
ences Centre in Toronto.
ISSUE 3, 2017 DIALOGUE