Risk Averse

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Inspired by a post on Risk Taking and Failure written by a friend.

One of the most important skills everyone should learn is how to take risks. I’m not talking about foolish or rash decision making but of calculated and beneficial risks. For the most part, I credit a lot of my success to my willingness to take action in the face of uncertainty. Winning scholarships, getting job positions, finding opportunities, getting into medical school are all things I have benefited from taking good risks.

In many careers, calculated risk taking has many benefits. Business opportunities if coupled with entrepreneurial spirit and hard work can result in large financial gain. New artistic direction can be what separates you from the crowd. Having the courage to start a conversation with someone you don’t know may blossom into an important relationship. However, medicine often discourages risk taking, often to the point that erring on the side of caution is preferred.

Any risk will always have a chance of failure. You should only take risks if the odds are in your favor or if the reward far outweighs the cost. And that is exactly the problem in taking risks when it comes to medicine – the cost of failure is high.

A wrong mistake can lead to crippling disability.  An erroneous slip can lead to a malpractice lawsuit or a license suspension. One lab test missed or improper history can mean life or death. For example, even if the benefits of immediate treatment means a speedy recover, if a diagnosis is made and treatment started without confirming the diagnosis, the results may be disastrous.

That is why we are taught to be thorough in our history taking and physical examinations. That is why checking up on patients is so important, so that no alarm signs  slip go unmissed. That is why a differential diagnosis should be long and comprehensive, even if some items are highly unlikely. That is why extensive lab tests, imaging and consults are required. Don’t jump to conclusions. Be thorough even if it is going to cost you time and money. As a generalized rule, doctors err on the side of caution.

I think that is something I quite miss from my life before medical school. The chance to take risks and face the outcomes and consequences. I could aimed for all sorts of goals because I knew had the ability to rebound from my failures. I could push myself to my limits, be committed in several activities and try new endeavors. But now, I have a duty and a privilege to my future patients. To do well in my studies and become a good doctor. Instead of pursuing other interests, I have a job that I should do to the best of my abilities.

Perhaps I am over-exaggerating my situation to prove a point. It’s a bit like growing up. In yours twenties, you don’t have much to lose. If someone offered you one chance to win a million dollars on a 10:1 coin flip, would you take it? If you win, you get $1,000,000 but if you lose, you have to shell up $100,000. Mathematically, agreeing to the bet would be a no brainer. Now add twenty years to the same scenario, a house, a mortgage to pay, a car, a spouse, kids and bills that you are just scraping by with, your decision to take that bet drastically changes. If you win, a million dollars that could result in retirement but if you lose that money, how are you going to pay next month’s rent? Provide for your family? Would you still take that risk?

[I realize that the possibility of going into $100,000 of debt in your twenties is a great setback. You could even argue that when you’re 40 and you have a stable job, you are more in a position to lose $100,000 than when you are just starting your career, but these numbers are just an arbitrary scenario and I hope you got the main point I was trying to make]

Possibility is traded away in return for stability. Predictable outcomes are favored when what you risk losing is  greater than the gain. When you become responsible for other people, especially in a job like medicine where a doctor-patient relationship is so important, I would feel really bad if I made a risky decision that negatively affected someone else.

So although risk-taking is a valuable trait to have, I often think being risk averse is also an equally important trait to have especially in medicine. Being paranoid and nit-picky, which is excessive at times, may one day save a life. Someone’s obsessive need for perfection or his insecure fear of failure can make a positive difference.

What are your thoughts on risk taking and risk aversion?

2 Responses to Risk Averse

  1. Joshua says:

    Nice post.

    I agree, your tolerance for risk is going to change a lot depending on your circumstances. You need to be more careful about your decision making and managing risk the more that your decisions affect those other than yourself.

    I think it’s also important to recognize that tough decisions are often going to necessarily involve some element of risk and the best we can do is manage risk. When you’re faced with a patient who will die without surgery but can’t be guaranteed to live with surgery, the fact is some percentage of the time, the outcome isn’t going to be good no matter how good of a decision maker you are.

    Not just as doctors but as people, we need to learn to accept that we can only do our best, and there are often factors our of our control. But as future doctors, we need to learn to be content with being able to help and save as many patients as we should, even though that likely means not being able to save them all.

  2. Joe says:

    To medaholic and Josh:
    Very educated posts (I read the medchatter one was well), I especially enjoyed your fake scenarios, which was a refresher from my Cognitive Psychology class.

    I used to be risk aversive, ESPECIALLY in highschool. Looking back, I have huge regrets… and that is exactly why I am no longer risk aversive. Being afraid to take risks means that you will never know what COULD have happened. This lead to my many regrets.

    I am know more open to taking a swim in the deep end, mainly because I don’t want to have that regretful feeling of what could have been.

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