General Discussion and Conclusion

Abstract

A treatment programme is the result of deliberation in which the therapist weighs a number of different factors against one another. In his efforts to exert maximum control over the course of the disease, he assesses not only the relevant facts as they present themselves at that moment but also the likely future course. Each symptom or item of information is thus assigned both spatial and temporal dimensions. Different factors (symptoms or data) are assigned differing importance, depending on their relative magnitude and rate of change with time. Certain factors are directly related to the disease itself, while others are related to the patient who has the disease. There are also other factors which are not directly related to the patient or to the disease. All these factors may influence the decisionmaker, including the latter factors, which may be termed “external circumstances” and include such factors as the patient’s attitude to his disease and to different types of treatment. A patient with AVM may be unable to face the thought of living with this threat and may insist on having an operation even if the surgeon is doubtful, while another patient may refuse surgery and nullify the surgeon’s decision to operate. The surgeon himself is, of course, another variable and fluctuations of mood may influence his decision.