Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, M.D.
27 June 2002

THE NATURE OF REGRET

     As a person comes of age and has experiences to learn from, the concept of regret begins to have meaning.  Regret can be thought of as the feelings or emotions of wishing that some past life experience had been acted upon differently.  Regret is not looked upon as a pleasant emotion and most people would just as soon avoid it.

       This column is dedicated to an unfortunate gentleman who had a major stroke and left him unable to move his right side or to speak.  Using a special typewriter that he can manipulate with his left hand, he is able to communicate.  His ability to think and to feel is still every bit intact but he spends his day in a wheelchair needing help with all of the activities of daily living such as meal preparation, bathrooming and personal hygiene.  Prior to his stroke, he had been a very active self sufficient individual with an attitude that he didn’t need medicines or medical attention because “they weren’t natural”.  At a time when he injured his foot, it was noted that his blood pressure was quite high at 220/120 mm Hg.  This is a very dangerous blood pressure and the healthcare provider attending him apprised him of this.  He did check the blood pressure several more times and on each occasion, the values were quite high.  Then at age 48, disaster struck and he had a major stroke.

     At a clinic visit one day, he communicated on his typewriter that he was very sorry for being such a burden to those around him and how he regretted what he had done.  He had a very loving family who were enthusiastic about caring for him in their home and was reassured that his presence was a pleasure and not a burden.

     I then asked him what he regretted.  He indicated that he wished he had listened to the advice to control his blood pressure so that he would not have had a stroke.  I inquired as to why he had never chosen to treat his blood pressure even though he knew it was quite high.  He said that he was afraid of medicines because they were “not natural”.  He indicated that by taking medications he might harm himself although he didn’t know what that harm might be.   I asked if he understood what the harm of high blood pressure represented and he indicated that he did.  He knew that strokes were devastating as his had been.

     He thought for a moment and then he said he felt that if he was going to have a stroke that would be his fate and not his fault.  But he felt if he took a medication and there were a side effects that caused harm, he felt that would be his fault and he didn’t want to be responsible for causing himself harm.  Therefore, he had never taken medication to treat his high blood pressure.

     This same thinking applied to many parents in the 1950’s when the Salk vaccine for polio first became available.  It was known that a very few children had developed polio when using the vaccine.  In a final analysis, it was noted that for every eight cases of polio had occurred in unvaccinated children, there was one case in a vaccinated child.  Therefore, the benefit to risk ratio was eight to one in favor of having the polio shot.  But many parents were unwilling to have their child vaccinated because of the thought that they may have caused the child’s polio case.  If the child got polio through natural community acquired infection, then it wasn’t their fault even though they had exposed their child to an eight time increased risk by not vaccinating the child

     These two stories provide a lesson and some profound advice.  The lesson is that the nature of regret depends upon which direction one is looking.  If one looks into the past, most people regret something that they did not do.  They look back and wish that they had taken the opportunity that they let go by. Relatively few people look back regretting something that they did do.

     Yet looking forward into the future, people act to avoid making their own making mistakes and being responsible for an adverse event.  Either they don’t consider the dangers of natural history or perhaps there is a feeling that natural history has to do with fate.  If fate strikes, they feel that is o.k. even though the risks and consequences maybe horrific.  As long as the person doesn’t feel responsible for the way fate intervenes,  many people are more willing to do nothing in the way of medical care rather than take the chance on making a mistake in choosing to initiate a medicine or a surgical procedure.

    The advice from this column has to do with making choices.  When looking into the future and making a choice on medical concerns the benefit to risk ratio by far favors well thought out sound medical protocols.  The healthcare professionals at your local clinic are aware of these considerations and can help in decision making on whether medications or surgery are going to be useful steps in long term medical care.  When allowing fate to control your health and the natural history of disease, the fear of making a bad choice is associated with a high incidence of regret.