When I feel that the benefits outweigh the risks for the patient, I continue writing. Often, with God's help and blessing, I have been helpful to the patients who have come my way.
But, I have not always been helpful. I will never forget the pair of kidneys that I harmed with gentamicin. This patient understood something that I did not understand then, and what I am now trying to explain.
My patient did not expect that I could cause no harm. He expected me to try to help. When he had acute renal failure from the medication that we used, he understood that bad things happen. We tried something, we failed. After three months, he finally was able to stop dialysis. Most physicians understand this subtlety and practice accordingly. In that line of logic, if a physician gives a prescription and harm is done, and the patient is hurt, then the prescription should never have been given.
If surgery is performed and the patient dies, then the surgery should never have been done. It is only in not doing that we can give a percent assurance that we will not harm. I propose that the medical community continue to uphold the same high standard of excellence in caring for patients. I propose that the medical community continue to use therapies only when the potential risks are outweighed by the potential benefits.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. LeCroy makes an interesting point that I think bears emphasis. In the s and s and previously, this was in fact the case. The bank that originated a mortgage usually held it long term and derived income from interest and from repayment of the principal.
So banks would allow only those mortgages that were likely to be repaid, otherwise they lost money. However, once the focus was changed to loaning to those less likely to be able to repay the loan, various financial innovations were permitted to not only enable, but encourage banks, to make these loans.
For example with sub prime mortgages, the mortgage could be broken into component parts so that the principal could be separated from the interest, and then the components packaged into securities by common characteristics such as maturity or perceived risk that could be sold separately in financial markets.
These various plans caused a number of results which should have been foreseen as potentially harmful, but were not. High yields in a time of low interest rates were very attractive to Wall Street and these mortgage-backed securities developed quickly into a large market. Nothing wrong with that except that many banks and specialized mortgage companies no longer held the mortgages they originated. The main source of revenue for the bank was the origination fee, not the repayment of mortgage principal or interest as had been true in the past.
As a result, they were no longer concerned about repayment, but rather to make as many of these loans possible under the much more lenient lending laws. So these very good intentions created a toxic mix of incentives which sooner or later would lead to real harm when "the bubble burst. On one side borrowers were encouraged to borrow and to purchase far more than they could afford. It seemed that they would forever make money on these deals as housing prices rose higher and higher. The lenders were encouraged to approve as many mortgages as possible since the market was so heated that they would be able to sell the mortgages in these packages before any repayment problems arose, even those of clearly risky borrowers.
Increasingly less regulated and easy financial controls made it easy for borrowers, lenders and financial investment institutions to profit—at least on paper—until everything came crashing down when the bubble burst. But remember, this all started with a very good intention: to enable more Americans to own their own homes.
Beware of unintentional results and analyze bad things that could happen. Like, the BP disaster in the Gulf, they probably will. Look before you leap, especially with new concepts and untested ideas.
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