Treatment Side-Effect Pairing
Compare the costs of treatment with the costs of leaving a condition untreated
- Difficulty
- Moderate
- Time to result
- ~days to results
- Steps
- 5
- Confidence
- 96%
When Steven says he avoids medication, Amen argues that asking only about a medicine's side effects leaves the decision incomplete. His paired question is: what are the side effects of not taking it? The patient and clinician should compare possible treatment harms with the condition's effects on work, money, relationships, health, sleep, and stress. They should also discuss non-drug approaches, alternative medicines, and whether intervention is needed at all. Amen frames the doctor's role as giving options, explaining the pros and cons of each, and allowing the patient to choose through informed consent. The method structures a conversation; it does not determine which option is medically appropriate.
Origin
Extracted from The Diary of a CEO
Core principles
- 01Treatment risks are only one side of a clinical decision
- 02Doing nothing can also carry costs
- 03The right option depends on the individual
- 04Pros, cons, and alternatives should be made explicit
- 05The informed patient chooses with a qualified clinician
How to run it
- 1
Define the decision
State the symptom, impairment, or desired outcome and the option currently under consideration. Clarify whether the goal is treatment, optimization, or further assessment.
Pro tip Use concrete examples of impact rather than a label alone.
Watch out A podcast discussion cannot establish your diagnosis or treatment indication.
- 2
List action risks
Ask the clinician about common and serious adverse effects, uncertainty, interactions, and monitoring for the proposed option. Note which risks are personally relevant.
Pro tip Ask for absolute risks when reliable figures are available.
Watch out Do not assume the brief stimulant examples in the episode are exhaustive.
- 3
List inaction risks
Describe what may continue or worsen without treatment, including effects on daily functioning and health. Distinguish observed impairment from hypothetical fear.
Pro tip Compare against your actual baseline.
Watch out Untreated outcomes vary; they are not guaranteed.
- 4
Map the alternatives
Discuss behavioral, environmental, therapeutic, medical, and watchful-waiting options that fit the condition. Include combinations and staged trials when clinically appropriate.
Pro tip Ask what the least invasive reasonable first step is.
Watch out Natural does not automatically mean safe or effective.
- 5
Choose and monitor
Make the decision with the qualified clinician, define what improvement and harm would look like, and set a review point. Adjust through the same shared process.
Pro tip Record the agreed measures before beginning.
Watch out Do not stop prescribed medication abruptly unless directed to do so.
In the wild
Steven worries about taking ADHD medication and asks why he would need it if disorganization is simply part of who he is. Amen mentions appetite and sleep as possible stimulant side effects, then asks him to compare those risks with the possible costs of untreated impairment before considering options in stages.
→ The discussion shifts from “medication or no medication” to an individualized comparison of options and consequences.
Common mistakes
Counting only medicine harms
This omits the observed or likely costs of the untreated condition.
Assuming treatment is mandatory
Amen says the role is to present options and trade-offs, then let the patient choose.
Using a generic risk list
A useful decision must account for the person's diagnosis, health, other treatments, and goals.
Is it for you?
Best for
It is best for a patient preparing for a shared decision with an appropriately qualified healthcare professional.
Not ideal for
It is not a formula for prescribing, stopping, or changing medication without the clinician responsible for care.
From the transcript
“What are the side effects of not taking the medicine?”
“giving people options. And then telling them the pros and cons of each option”
“It's called informed consent.”
From the episode
The ADHD Doctor: “I’ve Scanned 250,000 Brains” You (Steven Bartlett) Have ADHD! & Coffee Is Damaging Your Brain!!! Dr Daniel Amen