bestpractPaHarM

Patients visit clinicians because they want to become better. What patients really want is treatment or some kind of solution to relieve their chief complaint or health problem.

Any treatment, whether drugs or a change in lifestyle, has three possible results: benefit, harm, or improvement.

Antibiotics reduce symptoms and mortality for those with pneumococcal pneumonia. However, antibiotics, like other medications, have "harm" or side effects – such as diarrhea, rashes, or, in rare occasions, anaphylactic reactions -- when they're given to a patient with bacterial infection and a patient who is actually healthy.

Each “sick-visit” between a patient and a clinician is a “diagnosis-treatment” encounter with two important considerations: how much harm the treatment will cause if the patient was not sick, and how much disease improvement the treatment will bring if the patient was really sick.

We would, therefore, define "harm" as: the adverse or negative outcome of treatment that would occur in a patient without disease (in other words, the side effects in healthy individuals).

"Improvement" is defined as how much better a patient with disease becomes as a result of the medication or treatment, compared with what her condition would be without the treatment, disregarding the side effects of the treatment.

"Benefit" is how much better a patient with disease becomes as a result of the treatment, compared with what her condition would be without the treatment, after taking into account the side effects of the treatment.

You might be wondering why a physician would give antibiotics to a person who is without disease. They wouldn't if they knew that the person does not have a disease. However, many patients with colds, fever, and cough are often diagnosed to have bacterial pneumonia, when in reality, what they have is a viral infection. Sometimes also, a chest X-ray shows “pneumonia” but the cause of the pneumonia is not bacterial but viral.

Here's an example illustrating harm, benefit, and improvement:

Bestbiotic (fictional drug) is given to patients with serious bone infection, and it reduces mortality from 50% to 20%. This means 30 fewer deaths from bone infection for every 100 patients treated. Unfortunately, Bestbiotic causes severe anemia resulting in death in 10% of the patients who take it, meaning it kills 10 patients for every 100 patients treated. In this example, the "improvement" is 30 fewer deaths, the "harm" is 10 Bestbiotic-related deaths, and the resulting "benefit" is 30 minus 10, or 20 fewer deaths.

CONCEPT OF UTILITY

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