Decision making and opportunity cost.

Opportunity cost is not typically spoken about when it comes to injuries. Classically it is referred to in the business, financial or investment fields. It refers to the loss of alternatives by committing to one alternative or option. This may not seem like something that affects injury management, however after reviewing the previous two blog posts it made me think that we as health professionals consciously choose an option when carrying out a rehabilitation plan. We select which type of exercise to prescribe for a patient with back pain and we choose when to initiate the rehabilitation following the onset of an injury. Patients decide when to seek out assessment and treatment and even who they get to complete the assessment and treatment. In this way both practitioner and patient effectively commits to an alternative and therefore loses the other possible alternatives. Even if they seek a second opinion they may have incurred an opportunity cost of time and money in selecting the first alternative.

This may seem trivial but as stated in the previous blog post on muscle strain injuries, if a practitioner advises a patient to start rehabilitation one week post injury they have lost the opportunity to make improvements that ultimately have been shown to reduce the time to return to sport.

From the patient perspective commonly held beliefs may influence them to seek out treatment after a certain period of time. Common ideas include the notion that you cannot start rehabilitation on a muscle strain if you still have pain. This presents a clear opportunity cost that many people may not be aware of.

The post on pilates highlights that by choosing a modality, method or technique we may be limiting other alternatives or approaches. This happens often when a patient may be informed that surgery is the primary option, when often conservative management presents similar if not better outcomes for these injuries. These examples highlight that by being conscious of the decision that we are making we may be able to select the most appropriate alternative, rather than the easiest, most accessible or simplest option.

This type of opportunity cost is not only limited to rehabilitation and injuries. As some of you may know, MAD is also heavily involved in sports performance, conditioning and coaching. The idea of opportunity cost in this arena is highly important also. Any coach or athlete across sports needs to be aware that by committing to a training plan or exercise scheme they are consciously selecting an alternative that may diminish or remove the opportunity to use another alternative. If it is the most beneficial option at that time it will lead to the biggest benefit, however if it is a minimally beneficial option it may lead to a period of non improvement and a significant opportunity cost of time.

This post is not to cause people to spend extended amounts of time researching every last option before selecting an alternative, but rather giving awareness to the decisions we make for patients we treat or the athletes we coach. Identifying that every action we take presents an opportunity, we must aim for it to be maximally effective, whether in isolation or in a multi-modal approach, so that we do not lose further opportunities due to that decision. The questions to ask ourselves include is this the best option? Are there other alternatives that may assist with achieving the best outcome if combined with this option? Is this the best time to implement this option? Will implementing this option eliminate my opportunity to utilise another alternative in the future? If you can answer those questions with some confidence then the decision becomes easier to make. It will never eliminate opportunity cost as that is impossible, but it will provide some clarity in our decision making process.