REPLY
Individualizing Therapy
Michael H. Alderman, MD
15 January 1994 | Volume 120 Issue 2 | Pages 170-171
IN RESPONSE:
Dr. Gerber has raised an important issue. Patient preconceptions and physician presentations are the context in which therapeutic decisions are made. Far too little is known about the processes that inform these phenomena. Although I no longer practice personal encounter medicine, I believe that it is incumbent on the physician, when contemplating preventive interventions, to know the actual probabilities (in each direction) associated with the available choices and to present this information meaningfully to the patient.
Dr. Gerber has cited a recent Annals article that identifies the medical care issue I have attempted to address [1]. It seems that the case made there is that intervention recommendations based exclusively on the level of a particular risk factor can be inappropriate. The individualization of risk assessment that I advocate offers the clinician a way to replace practice "by the numbers" with a strategy that depends on defining absolute risk as the basis for therapeutic decisions. The efficiency and effectiveness of preventive intervention will be enhanced as our capacity to assess risk improves.
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Author and Article Information
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Albert Einstein College of Medicine; Bronx, NY 10461
1. Brown EY, Viscoli CM, Horowitz RI. Preventive health strategies and the policy makers' paradox. Ann Intern Med. 1992; 116:593-7.
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