Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [3]
But isn’t there a single indisputable right answer about treatment for each of them?
Despite many scientific advances, the unsettling reality is that much of medicine still exists within a gray zone where there is no black or white answer about when to treat and how to treat. Often, there are several differing approaches to treatment, each with its own risks and benefits. The best choice for an individual may be anything but simple or obvious.
People often explain their treatment choices by saying they do or don’t feel “comfortable” taking a medication or undergoing a procedure. The discussion usually stops there. But what makes them “comfortable” or “uncomfortable” with one treatment or another, or no treatment at all? Where do these views about therapy come from? What are the forces inside and outside a patient’s mind that shape that person’s views? And will understanding those forces help patients to make better decisions?
After more than three decades of clinical practice, we did not have ready answers to these fundamental questions for our patients or for ourselves. Despite a rigorous education in medical school and residency training, then working in academic medical centers, we had never been taught how and why a patient might come to choose one treatment or another.
For answers, we turned first to medical decision analysis. This approach, drawn from economics and used by health care policy makers and insurance companies, contends that the experience of illness can be readily distilled into a number. These numbers should then be used to calculate the one “best” and therefore “rational” treatment choice. Difficult decisions become a matter of simple arithmetic. This kind of approach holds understandable appeal, but we found considerable research that shows it is based on false assumptions and fails to fulfill its promise.
As we continued to search for answers, the words of Sir William Osler, an eminent physician of the last century, came to mind. He famously said that when trying to unravel a complex medical diagnosis, you should listen carefully to the patient, because he is telling you the answer. So we turned for insight to people making choices about treatment.
We spoke at length with scores of patients of different ages, in different parts of the country, of different economic status, with different medical conditions, from various ethnic, racial, and religious groups. We asked them to tell their stories: when they first fell ill, how the diagnosis was made, what their physicians advised, and other information they considered when choosing their treatment. Often, we went back and spoke to them again, delving deeply into not only the clinical aspects of their experience, but the details of their lives—their families’ attitudes about health and disease, whether friends or acquaintances had conditions that showed them the kinds of choices they might one day face, what knowledge they gained from their relationships, or their jobs, or their faith, that served them as guideposts. That journey into the minds of patients became this book. At each step along the way, as we listened to patients reflect, we gained more understanding. We then applied new research in psychology and cognitive science about decision making to their stories and began to answer the questions we raised.
It would be impossible to recount all the stories we heard, so we selected the ones that best illustrated specific influences on the medical decisions all of us make as patients. You will meet a teacher, a business consultant, a fitness trainer, an art dealer, a homemaker, a psychologist, a librarian, and many more. We’re grateful to all these people for their openness and candor and their desire to share both their successes and failures in making their choices.
The book begins with decisions about problems that are not urgent and are often found on a routine checkup, like a high cholesterol level or a small rise in blood pressure, and then proceeds to conditions of greater urgency, like surgery, heart disease, and