Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [2]
When Michelle Byrd began treatment, the first medication did not improve her blood pressure and a second drug caused side effects. She didn’t hesitate to switch to yet another antihypertensive medication, and she’s had no problem with this one.
Every morning and evening, Michelle checks her blood pressure at home and updates a chart of the results. “When there’s a problem, I’ll do everything I can to get as perfect a resolution as possible,” she said. When we asked whether she was satisfied with her current systolic blood pressure in the low 120s, she paused and then answered, “I’m borderline okay with that.” Then, after another pause: “Not really.” She knows that 120 is viewed as a normal cutoff, but, she said, “I’d much rather be at 110.” So she’s asked her doctor to increase the dose of her current medication or add another treatment. He told her this wasn’t necessary, but she still presses him for more. Michelle seeks to do the maximum. “That’s the way I am. When I set a goal, that’s it.” Michelle is a “believer,” certain that maximizing treatment is the best way to stay healthy.
Soon after we spoke with Susan Powell and Michelle Byrd, we met Alex Miller, who’s also in his fifties. Alex is an accountant, a precise and organized man who spends his days crunching numbers. He has both high cholesterol (like Susan) and mild high blood pressure (like Michelle). While Susan Powell is convinced that taking a statin pill for her high cholesterol makes no sense, Alex Miller takes this medication every day, believing that it will help keep him healthy. So you might predict that Alex would be like Michelle Byrd in his approach to blood pressure readings above the normal range. But he decided that it doesn’t make sense for him to take medication for high blood pressure.
Alex’s cholesterol levels were consistent at each visit. But his blood pressure varied and was only somewhat elevated. After more than a year of discussion with his doctor, Alex reluctantly agreed to take a medication for his blood pressure. The pill had significant side effects. “I felt lousy, not myself at all,” he said. His doctor tried to reassure him that the side effects would soon pass, and if they didn’t, there were many other medications he could try. Unlike Michelle Byrd, who enthusiastically embraced a new drug after experiencing a side effect from a prior one, Alex Miller refused any more treatment.
Alex does not suffer from what some doctors call “health illiteracy”—a lack of understanding of the risks and benefits of treatment. His fluency with numbers allowed him to grasp the statistics his doctor showed him about high blood pressure and its potential consequences. But Alex had read on the Internet that some experts over the years had revised the definition of the normal range for blood pressure readings, designating what was once acceptable as now risky. “It’s like they keep changing the goalposts,” he said.
Alex knew not only about the consequences of hypertension itself, but about the many potential risks of treatment. “I wonder how many people actually look at the list of drug side effects, because if they did, they might not take any medication.”
We asked him, “Does being so fully informed give you confidence in your decision or make you more worried?”
“Both,” he replied.
Susan Powell and Michelle Byrd approach treatment choices quite differently. Susan is deeply doubtful about treatment and wants the minimum necessary, certain that “less is more.” Michelle seeks maximal medical therapy, believing that by being “proactive,” she is “ahead of the curve” in dealing with health issues. Alex Miller has elements