Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [20]
Over time, much of my clinical practice has focused on thyroid disease and thyroid cancer. I now serve as medical director of our hospital’s thyroid nodule clinic, where patients with growths in the thyroid gland come for evaluation and biopsy. Thyroid cancers are often found incidentally on examination or on imaging done for other reasons. Most of these thyroid cancers are small, slow growing, and easily cured. My minimalist mind-set fits well with a tempered approach appropriate to treating this kind of tumor. But some thyroid cancers are extremely aggressive and require equally aggressive treatment. Caring for such patients, I deliberately shift my mind-set and become a maximalist.
My parents, now in their eighties, continue to be active and in generally good health. My father enjoys discussing new developments in science and medicine with me. My mother still tells me what to eat, pointing out that salmon and blueberries are healthy and that I should be sure to get enough calcium. When I point out that I am a doctor, her response is, “Well, doctors don’t know everything.” And of course, she is correct.
[Joint Conclusion]
Despite working in medicine as physicians for more than thirty years, we were surprised to realize that we had had only a hazy understanding of our own mind-sets. Revisiting our family history, our prior medical history, and our social history opened our eyes to the origin and nature of our preferences about our own health. We were struck by similarities to the patients we’d spoken to. Like Michelle Byrd, one of us was a believer in maximizing treatment and had a strong technology orientation; the other, like Susan Powell, was a doubter, risk-averse, and in favor of minimal treatment.
In our role as doctors, our aim is to help our patients understand what makes sense for them, what treatments are right given their individual values and goals. We are especially mindful not to impose our preferences about our own health on our patients.
Three
But Is It Best for Me?
Patrick Baptiste, a thirty-six-year-old personal trainer at a popular health club in Houston, Texas, typically bench-pressed 310 to 320 pounds. Standing just shy of six feet three inches, with broad shoulders and a neatly trimmed goatee, Patrick had a warm and relaxed manner that made him one of the favorite instructors among patrons of the gym. One day shortly before Thanksgiving, when he positioned himself squarely on the bench to show a new member how to press properly, the weight seemed unusually heavy. Over the ensuing months, his strength seemed to decline, until he strained to press 225 pounds. Patrick had been eating more than usual to boost his strength and was surprised when he got on the scale and saw that he had lost seven pounds. He looked at himself in the mirror and noticed that the prominent curves of his biceps seemed a little flatter. Even more perplexing were several episodes of rapid heartbeat and trembling in his hands. These episodes occurred not only after he worked out at the gym, but once when he was driving to visit his family on a day off and another time when he was stretched out on his couch watching football. Patrick often felt on edge and several times was impatient with clients at the gym. Finally, when he realized that it took effort even to walk up a flight of stairs, he went to see his primary care doctor.
Patrick’s physician had cared for him for several years and noted that his pulse, normally in the low 60s typical for an athlete, was now 90. As the doctor examined him, he