North Star Conversations Transcript: The Art of Watchful Waiting—Rebecca Cho, M.D.
Dr. Rebecca Cho outlines how she balances patience and progress in child psychiatry through careful cost-benefit analysis.
Brandon Gimbel (00:00)
A parent asks: How do you decide when watchful waiting is appropriate rather than making a change?
Rebecca Cho (00:04)
That is a good question. A few different factors I take into consideration are: how long has the child or teen been on the medicine and how long does it take for that medication to take effect? Are we seeing movement forward? If we're starting to see some movement forward and improvements, I may say, let's keep waiting and see whether we can see further improvements. If there has been improvements or if there have been no changes, what is the cost-benefit analysis of keeping things steady versus going up? For example, if there's been a little movement forward, but there's still a lot further that can be improved upon, I may say, let's move up a little bit more quickly and aggressively, especially if the symptoms are very distressing or interfering with day-to-day functioning, as long as the person is tolerating the medications without concerns for side effects. However, if the person is in a place with the medicine where they're starting to feel better and function better and they're working on some of the details with their therapist, then I may say, wait to see whether the synergistic effect between medication and therapy can get us to that finish line without having to make any adjustments. The goal always is figuring out that minimal effective dose.
Brandon Gimbel (01:40)
That's fantastic. I talk about with my patients cost benefit analysis all the time— does the benefit outweigh the cost? Or is the benefit worth the cost? And what you're saying is when the symptoms are loud and disruptive, the benefit potentially really does outweigh the cost. But as symptoms are more and more under control over time, whether that's because of medication or therapy, the calculation starts to change. And given that we're always dealing with uncertainty, we have to consider that equation in a regular way so as to minimize disruption and lessen harm.
Rebecca Cho (02:15)
What's the cost benefit of medications and what's the costs versus benefits of not treating the underlying psychiatric disorders?