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Slow & Fast Health Decisions

Oliver Zolman MD

· Health Decisions

Like thoughts, health decisions can come in two types: fast and slow.

Fast decisions include those that

  • have no other option but a certain intervention, such as in an emergency situation for treating severe anaphylaxis (allergic reaction) where you can't breathe. In these situations there is typically no option of doing nothing. 
  • are trivial - such as should I brush my teeth this morning in those with no dental problems 
  • or habitual, for example taking vitamin supplements each day
  • or are 'outsourcable' to health professionals with good certainty of resolution - as is the case for minor medical problems that one is not that bothered by or medical problems that are resolving well with the medical care you are receiving

Slow health decisions on the other hand are those that require relatively slow, reasoned thought to more deeply assess risks and benefits of different options that one can proceed with

Slow decisions are those that have at least 2 options, with one of these options potentially being of 'doing nothing at all' - the treatment is no treatment.

For example, in serious diseases that have a risk of death or severe quality of life reduction like cancer, test and treatment options can become very complex. Here, slow decision questions can be asked: Are there new tests or therapies that have been developed which I am currently not being offered by my clinicians that can improve my quality of life or overall chance of disease free survival? How do I know the therapy recommended to me is the 'best one'? What are the outcomes of my healthcare professionals compared to others for people with this same condition?

 

Slow decisions can also be relevant to less serious conditions, with little or no risk of death or severe quality life reduction. For some, the small health annoyance they have been

If a slow decision is optimally made:

  • health outcomes can be enhanced (better health gained, side effects avoided)
  • financial costs may be able to be saved (although increased too if it leads to you undertaking more costly tests, therapies or services)
  • and peace of mind that there is less chance important information relevant to your health decision has been missed.
  • "Informed Consent" can more reliably said to have been achieved, which is ethically positive (respecting the medical ethical principle of autonomy - the ability for someone to make their own decisions to the best ability)

What is the best way to make slow health decisions?

The International Patient Decision Aid Standards were first published in 2005 - essentially this is a checklist for the information that should be provided to make a health decision that has more than 1 option.

Simplicity is the ultimate sophistication. - Leonardo da Vinci

Surprisingly, I have never seen anyone use the IPDAS checklist in medical practice or seen content that appears to be - or is stated to be - 'IPDAS compliant' on health information resources.

A link to the PDF checklist can be found here.

In light of no better standards, it appears IPDAS compliant content represents the gold-standard for 'slow' health decision making.

Given that very little IPDAS compliant content exists - I would encourage people to use the IPDAS checklists themselves to make their own health 'decision aids' (essentially, a document that helps you make a slow health decision), when making Slow health decisions.

Note that even for the relatively few (to the total number of types of medical problems in the world) IPDAS compliant decision aids that are out there already, these may be out of date; and given 1 million new medical papers are now published every year - even being a few months out of date might miss an important clinical trial or other study; meaning one could still potentially benefit from updating such a decision aid.

I would encourage people to use the IPDAS checklists themselves to make their own health 'decision aids' when making Slow health decisions

Medical disclaimer: Our services and guides do not provide medical advice. Do not make any changes to your health behaviours based on this article without consulting your licensed clinicians first. See our medical disclaimer.

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