When faced with a consequential decision, there is one question that we don’t ask often enough: “What if we waited?”

The question is especially important when the decision is about our health.

Doctors sometimes recommend interventions because they see it as the safest option in the short term, even though there may be long-term negative risks.

The do-nothing option is always available and doesn’t have to mean forever. It gives you time to gather more information without challenging the expert, as you’re clearly just trying to evaluate the landscape of options based on the outcomes. Delays may be minutes, hours, days, or even years

Reading about informed consent online, it looks like this kind of temporary delay is not a standard thing patients are taught to ask for. So often we live in a fictional world where decisions are one-and-done rather than the real world where a choice now sets us down a path which we can change later – though with some residual impacts from that initial choice.

In fact, informed consent is always a series of decisions. You decide if you’ll get a test. Then you decide what to do with the results of that test. Then maybe the treatment / doing nothing doesn’t work and you need to consider other options, and so on.

We don’t always talk about these decisions and the path they set you down as much as we should. In the AMA guidelines for informed consent, they note the obligation to provide patients knowledge “of all options” This kind of vague exploration of the future requires judgement to navigate.  

Figuring out how much of the future to explore is hard even for experts, and we frequently don’t give people adequate tools to chart their own course. So, we focus on a single decision and leave the rest of the future as an exercise for the patient. That is a shame, because people don’t always guess the right path.

The PSA prostate cancer screening test is an interesting example where a lot of people who get tested receive a false positive result. This raises the concern that if you get the test and it shows elevated levels, you could end up on a path to invasive and unnecessary additional testing.

On the other hand, the research shows the test is worth taking for men aged 45 – 70, though the recommendations to patients may not be clear. When you are in that age range, the odds slide in favor of testing. “Wait and see” then is on a scale of years as we decide the right time to start doing those tests.

Another version of wait and see is trying a less-invasive treatment option to see if it works. The FDA page on informed consent for example is focused on experimental treatments and sharing with the patient that there are no other options (often because they’ve already tried and not found success with approved treatments).

Doctors typically are weighing all these options and making a recommendation. Even when we ultimately follow the doctor’s advice, it can be nice to feel like we had a choice in the matter and got to the alternative that fits our values.

As always, the question comes down to “how do you feel about your options?” If there’s a $1 drug that will cure all your ills with no negative side effects, we’re ready to be signed up immediately. It’s when we have trade-offs and uncertainty that we need to think harder about which option is best.