Dialogue Volume 13 Issue 3 2017 - Page 37

SECTION TK PRACTICE PARTNER Opining on Opioids When talking to patients, how do you weigh the risks vs. rewards? DOC TALK By Stuart Foxman I 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 quicker). 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 worth it. 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 37