Medical Harm and Risk

Congratulations to Dr Rosenfeld for a very insightful discussion of the complex issues involved in the subject of medical harm and risk. ¹ One additional aspect implied but not overtly discussed is the issue of risk of harming patients by not treating them. It is very tempting to avoid even the possibility of harming a patient by extreme conservatism in even offering treatment. I observe this strategy in practice in my medical community every day. Patients with chronic facial pain have certainly been spared the risks of endoscopic sinus surgery by not being advised of its availability. The risks inherent in therapeutic nihilism often remain just as underappreciated as the risks inherent in medical or surgical intervention. Dr Rosenfeld has the issue precisely defined. Our challenge is not to avoid all risk at all cost but to clearly identify, weigh, and communicate the risks, both of intervention and of failing to intervene.