It may seem counterintuitive, but there are instances when less is best in the world of medicine. When you consider the fact that nearly all medical tests, surgical procedures and medications carry some risk of adverse effects, this idea — that less of something could offer more benefit — begins to make sense.
Doctors at Rush University Medical Center do their best to balance the benefits of treatment with the potential of complications. Read on to learn about situations where, when it comes to medicine, less is often more.
Prostate cancer: Less intervention may be more beneficial
Most men diagnosed with prostate cancer begin treatment immediately, either with surgery or radiation therapy. However, for some men a plan called active surveillance is a better option.
"Each patient's treatment options need to be individualized," says Ajay Nehra, MD, a urologist at Rush. "But for older men with other health conditions and early stage disease, prostate cancer may be addressed through observation."
Also known as watchful waiting, active surveillance involves monitoring the cancer closely with tests and exams but holding off on treatment. Several particulars of prostate cancer make it possible, and wise, to consider this watch-and-wait approach. First, prostate cancer is often a slow-growing cancer. Many men will pass away long before the cancer grows large enough to be life-threatening. Second, treatment can have serious side effects, such as incontinence and erectile dysfunction.
Watchful waiting may preserve a man’s quality of life without endangering his life. If the cancer progresses, though, he still has all of the other treatment options available.
Heart disease: Stenting chosen wisely
For many heart attack patients, a stent can be lifesaving. That's because this small mesh tube can be placed inside a blocked artery during a heart attack to restore blood flow and limit heart damage. The stent then remains in the artery to keep it open and ensure continued blood flow.
Knowing this, it might seem logical that a stent would also help a patient with stable chronic coronary artery disease (CAD) — the most common type of heart disease, in which the arteries supplying blood to the heart are partially blocked due to atherosclerosis (fatty plaques in the lining of blood vessels). That is not always true.
"When we talk about selective stenting, we now have data that shows for many patients with stable CAD, who have mild or no symptoms, the benefits of stenting don't outweigh potential risks," says Gary Schaer, MD, an interventional cardiologist at Rush. Stents have not been shown to reduce the risk of heart attack or improve survival in these patients.
That said, for patients with severe narrowing of the major coronary arteries (or in patients with frequent or worsening symptoms), stenting is usually beneficial. "At Rush we always weigh the potential benefits of a procedure against the possible risks," Schaer says. "We consider each patient's situation carefully to determine if a stent is necessary."
Neonatology: Little 'lesses’ add up to more
All babies are precious, but some are especially fragile. They may come into the world too early or at a low birth weight. Whatever struggles a newborn may face, the staff at Rush's neonatal intensive care unit (NICU) work to provide the many services that will ease their arrival. These babies may need more care, but sometimes having less helps too.
"Fewer disruptions and less noise means better care," says Jean Silvestri, MD, a neonatologist at Rush.
These benefits will come into play when the new NICU opens in the Tower this year. In the new NICU, each baby will have an individual room. These single rooms mean less noise and fewer bright lights, which result in more privacy and better developmental outcomes for these fragile patients. Individual rooms also limit infection risks and decrease caregiver disruption, allowing for more focused care.
These changes have been shown to result in a calming, healing and supportive environment for babies and their families at a very difficult and stressful time. "In the past, neonatal units were large, open wards," Silvestri says. "That's why the staff designed this new unit with the idea of making it more family friendly and better overall for the babies."
Heart attack: Less time to treatment means more heart muscle saved
A heart attack happens when the blood flow in the arteries to the heart becomes blocked, causing heart muscle to die. The faster a heart attack patient gets through the emergency department and into the catheterization lab to open up the artery and get the blood flowing (called door-to-balloon time), the more muscle is preserved. The national door-to-balloon time goal is 120 minutes or less. In 2011 the median door-to-balloon time at Rush was 85 minutes.
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