What Risks Can You Live With?

There's a Risk to “Yes.” There's a Risk to “No.”

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What Risks Can You Live With?

A patient with pre-diabetes recently asked me, “Can I start taking a GLP-1 medication?”

She had read about the side effects—the nausea, the muscle loss, the “Ozempic face.” The way she asked the question sounded like she was asking whether or not she was allowed to take this medication. Like she wanted my permission.

So here’s what I told her: let’s start by reframing your question. Not because the risks of GLP-1s aren’t real. But because the question carries two assumptions—that my job is to grant permission or withhold it, and that one choice is safe and the other risky.

But that’s not how this works.

There is a risk to the “Yes” There is also a risk to the “No.” Neither answer removes risk. Each just hands her a different list of them

So the real question—the one that’s actually answerable—isn’t “Can I?” It’s “Which of these risks can I live with?”

I wrote about risk and risk management for Maria Shriver’s Sunday Paper this week. It was a reaction to the NYT’s recent article about all the women who have been told “NO” to hormone therapy—that the door is closed to them—when so often what they were really handed wasn’t a contraindication but the absence of a conversation. I talk about a patient of mine with a clotting disorder, the kind of woman who usually gets a fast, firm “absolutely not,” for whom I ended up prescribing HRT:

“I didn’t do that because I decided her risk was acceptable. I did it because her risk was never mine to accept or refuse. It was hers to weigh.”

That’s the whole thing, really. Your tolerance for risk is yours. It was never mine to assume.

Take my patient with pre-diabetes. We discussed the potential risks of taking a GLP-1, such as constipation, heartburn, muscle loss, fatigue. We also discussed how we would mitigate these risks, for example by adding more fiber, dietary protein, and strength exercises, and following up with me for lab work and dosing adjustments.

We also discussed the risks of not starting a GLP-1 medication and of pre-diabetes itself—such as heart disease, weight gain, the progression to frank diabetes. We discussed how to mitigate these risks with dietary changes, exercise, medications like metformin, and using a continuous glucose monitor for added insight on how her body reacts to fueling it.

My point is that risk is everywhere. It sits on both sides of every medical decision. The question isn’t how to escape it. It’s which side of the decision you’re better off living on.

This is the spine of nearly everything I believe about taking care of people. There are no solutions in health, only trade-offs that reflect what matters to you. My job was never to decide which risks you should accept. It’s to hand you the data, the real trade-offs, and the tools to mitigate both sides.

So the next time someone hands you a flat “No,” I hope you’ll ask a better question—to yourself and to the people responsible for your care.

Not “Can I?”

But: “What are the risks on each side—and which one can I live with?”

Weighing risks and benefits and making decisions like this thoughtfully is a topic I cover in my forthcoming book, Beyond the Prescription! It comes out on August 11, and I hope you’ll read it. I wrote it with you in mind ❤️

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