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“But what would a stroke feel like?” my patient asked.

I didn’t quite know how to answer. I again explained that we could give him a blood thinner, which would lower his risk of having a stroke to 3 percent, but increase his risk of bleeding to 5 percent. I again told him that his abnormal heart rhythm, atrial fibrillation, made it more likely a blood clot could shoot off toward his brain, which in turn could lead to difficulty speaking or moving parts of his…

He interrupted me. “You already said that. Would I recover? Be the same person? And where exactly would I bleed from?”

Despite tremendous advances in health care, most medicine still occurs in agray zone: There aren’t right or wrong answers, but rather a continuum of risks and benefits. Circumstances exist in which diagnosis and treatment are clear — a ruptured appendix, for example, or a life-threatening heart attack. But for most conditions there are several reasonable options, important trade-offs among them, and uncertainty about how well each might work. It’s our job to help patients choose, but doing so can be surprisingly difficult.

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