Would You Rather?

Classic Would You Rather questions. Image from learnercentered.wordpress.com.

Remember the game “Would You Rather?”  The one where you give someone a choice between two seemingly equal awful or awesome options and see what they pick?

Patrick and I used to play it when we were dating.  Generally on our Facebook walls.  I am sure it was super annoying to our friends who kept getting our updates on their feeds.

We also played it a great deal at campfires around that time period.  One of our friends, K, had a favourite, somewhat inappropriate question that went like this… “Would you rather pee yourself and everyone know or poop yourself an nobody know?”  Every time.  Regardless of audience.  Actually, she resurrected the question over barbeque at the trailer last weekend.  Because she is good like that.

The catch with “Would You Rather” is that you can’t really ask clarification questions.  You need to take things at face value.  Without subtext.  At least that is how we play it.

At work, I have run into a “Would You Rather” type scenario at work.

Okay, really, much of medicine turns into a big game of “Would You Rather.”  Choosing between treatments is kind of like choosing between two evils.  Except you get informed of subtext (like side effects and cost) up front… At least theoretically.

For instance, some people with low-intermediate risk prostate cancer can choose between surveillance, surgery, external beam radiation with or without hormones in conjunction with a clinical trial or brachytherapy (radioactive seeds in the prostate).  A lot of choices to make.  Many factors to weigh.  Lots of subtext.

I find the way people make decisions interesting.  Some decide instantly, others debate for weeks or months.  Some people have things they are terrified of (like having surgery or foreign bodies in them) and that simplifies things.  There is no real wrong answer (well, some people aren’t eligible for certain options by merit of the size of their prostate or subtle disease features, to they may not have certain options offered).

Unlike the game, the decision has life long consequences and can influence quality of life and other things for years to come.

But, there are shorter term decisions too…

The men who are receiving hormones take these injections every three months to help suppress testosterone.  They are given by a doctor (like me) in a lovely preloaded syringe in the fat on the belly.  And the needles is big.

Some doctors I work with (interestingly, the men) give a dose of lidocaine just underneath the skin to help numb it before giving the big needles.  Others (mostly women), just give the needle.

The process when giving just the needle is faster and, honestly, I haven’t had anyone freak out or pass out or anything.  The lidocaine involves a second injection, and the injection of anesthetic stings and takes longer than just the one poke.

Where I have worked with people who have done it both ways, I have done it both ways.  I generally prefer to just give the needle.  Because it is faster and easier.  I don’t think I am cruel, but really, why go through the two pokes and the sting of the lidocaine?

Towards the end of this week, I was told to do whichever I preferred, so I started asking the men for their preference.  I was currently working with a pro-lidocaine doc.  The men were baffled by the choice.    To me, it seemed simple… One needle or two?  Quicker or slower?

Most of the men were hesitant to have the needle without the lidocaine, including those who hadn’t had it before.  They were scared of the pain from the big needle.  One opted to go without the lidocaine and was surprised that it was easier for him than getting both needles.  He asked why people would bother with the two pokes when they could just get it over with.  That was my thought too.

Like a game of “would you rather,” the choice between the injection or the anesthetic and injection is one with two undesirable options, however, there is some obvious subtext to it.  For me, the choice is simple both as a patient and as a practitioner.  But, everyone can make their own choice.  Especially when each is not desirable.

But, for future reference… One needles is always better than two in my books.  Despite me not being afraid of needles and regardless of the size of the bore.

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