• Robert Danziger

What to Do When Facing the Trap Door Phenomenon

While trying to navigate the health care system and make the best possible medical decisions, the Determined Patient the trapdoor phenomenon: It’s possible that a particular treatment will be a trapdoor that opens, causing you to fall and crash to a lower floor, where you experience another physical ailment. I call this “the trap door phenomenon.”


Let’s say you have a fracture of your humerus that prevents you from lifting your arm high enough to serve a tennis ball. Naturally, you want to repair the bone, but this could result in avascular necrosis: a loss of blood flow to the bone altogether. Therefore, you might be better off accepting some restriction in your range of motion rather than have the bone in your arm begin to diet. It can be very disappointing and frustrating to think that you can fix a medical problem completely only to find out that it has you dealing with the trapdoor phenomenon. Surgery for your humerus might open a trap door and force you to address a new condition: the loss of your arm.


When looking at the risks to a medical procedure or treatment, you must do your best to see things in perspective. There may be a trap door, but when you fall through it and find yourself dealing with a second medical problem, things might be so bad.


In medical decision making, there will be times when you have to weigh the positive against the negative and accept that you are facing the trapdoor phenomenon and your situation can get worse. If you are a cancer patient whose oncologist has prescribed a particular chemotherapeutic regiment to destroy the tumor and improve your prognosis, you may not be able to avoid some of the more stressful side effects of chemotherapy, such as nausea and hair loss. Again, you may be able to manage it even if you can’t overcome it completely while undergoing your life-saving therapy.


When facing the trapdoor phenomenon, ask your doctors to assign probabilities to outcomes or series of outcomes. Are you at a 25 percent risk of developing a particular condition as a result of undergoing a medical procedure that is being recommended for you? Is that probability based on other patients that have a lot in common with you—for example, they’re of a similar age and the same gender and race, and they have similar comorbid conditions to yours?


There is a whole field of study of biases that can interfere with making decisions. This work called behavioral economics, and one of the major researchers in this field was awarded the Nobel Prize. You need to be aware of any biases that might be affecting you. Is the physician you are consulting with to help you make a decision biased in giving advice to you because you are obese or elderly and the physician isn’t? Is your race or gender triggering a hidden bias? We know that doctors are less likely to prescribe pain medications to women and African Americans, or to prescribe less, than they are to white men. Getting a second, third, or even fourth opinion and researching outcomes in patients similar to you can help you make the best decision about treatments and ask good questions about probabilities.


Your doctor may be overcautious or under-cautious about treating you because of his or her hidden biases. If you are potentially facing the trap door phenomenon, and the possible side effects or risks of treatment are not something you can easily accept, ask about the risks of delaying your decision while you do more research. You might be able to get in to see another specialist or two more quickly than you think, especially if your condition needs to be treated quickly and you explain that to the specialist’s receptionist.


Be a determined patient. Don’t let the possibility of the trapdoor phenomenon keep you from doing your research, getting more opinions, and slowing down your decision-making process when it is safe to do so.




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