Buckle Up

Rob Lamberts, MDLipitor can destroy your liver.

Back surgery can leave you paralyzed.

People who take Chantix might kill themselves.

You may never wake up from a simple surgery.

These statements are all true.  They also are very confusing to many of my patients when I am prescribing drugs or recommending surgery.  What should they do when they hear such bad things about drugs, surgeries, or procedures?  How much do they risk when they follow my advice?

It’s a hard world out there, with the attorneys advertising on TV about drugs my patients have taken, with the websites devoted to the harms brought on by a drug or an immunization, with Dr. Oz and other seemingly smart people telling them things that are contrary to my advice, and with friends and neighbors who give dire warnings about the dangers of following my advice.

There are so many voices out there competing with mine, that I sometimes spend more time reassuring than I do anything else.  A doctor in our practice believes that Dr. Oz ought to issue a statement to doctors whenever he voices another controversial opinion as gospel fact so that we can be ready with our counter-arguments.

What can doctors do?  We can’t quiet the other voices that speak against us.  In truth, those voices have an important role in preventing us from becoming comfortable and dogmatic in our beliefs.  So how do I combat such a heavy current against our advice?

By talking about seat belts.

Seat belts can kill you, you know.  You can be trapped inside your car by your seat belt and not be able to get out before your car explodes.  It’s not a fable; it can really happen.

You may be sealing your fate to die terribly every time you buckle your seat belt.

When I say this to my patients they instantly get what I am saying.  Sure, there is risk putting on a seat belt, but that is overwhelmed with the risk of not wearing it.  EMT’s will tell you that they rarely unbuckle a dead person.

I love using illustrations like this.  I can, with a good illustration, explain a highly complex subject in very little time.  They give the patient something they understand as a basis on which to consider their options.  In the case of the seat belt, the analogy gives them perspective.  It shows them that the people who talk about the bad stuff aren’t lying (seat belts really can kill), but they aren’t considering the risk of not having the surgery, taking the medicine, or getting the procedure done (seat belts save lives).

There is the risk of over-simplifying something, or leading patients to believe something is lower risk than it really is.  That’s why I always follow this by talking about how I feel the risk of taking the medicine compares with that of not taking it.  I don’t argue against those who say Lipitor can destroy your liver, doing so would undermine my credibility because Lipitor can kill your liver; I just simply put that risk in perspective.  Analogies alone don’t explain things, but they do take difficult to understand concepts and bring them into a world the patient understands.  From that point on, the explanation is much easier.

I used the analogy this morning explaining to a mother who was worried about the risk of ear tubes in her baby.  I explained that the risk of surgery (wearing the seat belt) was much less than the risk of antibiotic over-use (not wearing the seat belt).  She visibly relaxed when I said this.  I am not belittling her fear, I am just putting it in perspective.

I use seat belt analogies in other ways too.  Today someone told me that they never get flu shots and haven’t ever gotten sick.  I told them that I could have never worn a seat belt in my life (which is almost 50 years) and I would still be alive talking to them.  I’ve never gotten into a serious accident, so seat belts have been a complete waste of time, right?  The patient smiled when I said this.  No, I told him, I think it was a good idea to wear them and will continue to do so.  People who wear seat belts are more likely to be alive in a year than those who don’t.  The exact same thing is true for high-risk people and flu shots.

He still didn’t get one.

I also talk about the warning labels that seat belts would have if they had to list all of the ways you could be harmed by them.  Imagine a seat belt commercial done like a pharmaceutical ad: “Seat belts could choke young children, could trap you in the car and kill you, could cause bruising to the shoulder, pinching to the fingers, lacerations, and abrasions.  Seat belts also could be used maliciously by older brothers to torture their younger sister.  Call your mechanic if you cannot unfasten your seat belt for more than four hours.”

You get the picture.  So do my patients.

Buckle up.

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