Decoding the Conundrum: Who Decides the Most Conservative Path in Medicine?

The Intrigue of the Term “Conservative” in Medical Decision-Making

In medicine, we are always faced with management decisions. I have been intrigued by the term “conservative”, when it comes to describing management plans. The term conservative implies taking the safest road in a medical decision-making journey. But, who decides what is the most conservative path?

Over my career, I’ve encountered medical conditions that have required risky management and less risky management. The decision to follow one decision path versus another really seems to depend upon the comfort level of the physician managing the patient and the integration of multiple other variables. One physician’s conservative plan may be another physician’s perilous plan. The decision-making can be quite complex and there may not be a single correct answer.

Medical Decision-Making Complexities

The complexity of the decision-making doesn’t always involve data and literature. It often involves personal clinical experience, specialty or subspecialty perspective, clinician age, and other variables that make each physician unique. Medical decision-making is not only about the data, but also the context of the patients and those who are caring for them. Everyone is just trying to make the best decision possible under the circumstances and information that they are given. Yet, while some medical scenarios involve low risk, there are others with higher stakes where we wish that we could predict the outcome without uncertainty.

We often want to look into a crystal ball to see the future, so that we can know the outcome of what was decided. But, alas, we can’t predict the outcome of our decisions with 100% certainty. So, we must bundle our decisions with varying risk stratifications. Depending upon what is at stake, a high-risk decision may be acceptable. However, for most medical decision-making, clinicians would prefer to limit risk and take the safest path possible.

Engaging All Stakeholders

This brings us back to the beginning about thinking who decides what is the most conservative path. The term, “conservative”, seems to have a relative connotation and not a fixed definition when it comes to medical decision-making. With this in mind, it is reasonable to assume that the decision about what is conservative and what is not really depends upon those involved as the decision makers and those who are the recipients of the decisions. Recognizing the subjectivity of defining the most conservative path, input and collaborative engagements from both the medical professionals and the individuals affected by the decisions are critical to settling on a meaning that is acceptable for all stakeholders involved.

How do you personally define the term “conservative” in the context of medical decision-making? What factors do you consider when determining the safest medical decisions?