Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [32]
But after two months of conservative measures, Carl’s misery index had hardly budged. He returned to the surgeon, who ordered an MRI of the knee, and then they met again to discuss options.
“I can’t even climb the steps in my house without severe pain,” Carl said. “I want it fixed, as best as you can.”
But Carl told us that before he makes any final decision, he wants to see the numbers. He asked the surgeon for statistics about the risks and benefits of different treatments. And he said that one of the reasons he trusted this surgeon was that the doctor gave him those numbers, providing printouts of clinical studies that compared conservative measures with invasive procedures.
“I just couldn’t see how more physical therapy was going to help,” he said. “The cartilage was pretty badly frayed. I heard that crunching sound every time I extended my leg. All the physical therapy in the world wasn’t going to do anything for that as far as I was concerned. I had tried it for two months and it didn’t work.”
“There is just so much I can do here,” the surgeon told Carl. “At the point when there is bone on bone, we are limited in what we can offer.” Carl appreciated his surgeon’s honesty but felt that he had arrived at his only option. He didn’t hesitate or seek “natural remedies”; he went ahead with the surgery.
“My days as a runner are finished,” he told us some months after the operation. “My surgery was not successful. I’m still having significant pain in my knee.” The surgeon suggested injections with a new treatment, a resurfacing material that was being tried in cases like Carl’s but was still unproven. To date, two such injections had failed to improve Carl’s condition. But despite the poor outcome, Carl told us that he had nothing to regret.
In surgery, less than perfect results are hardly rare. Sometimes, falling short of perfection has only a minor impact on a person’s life: mild residual discomfort or a keloid scar that detracts from an otherwise successful procedure. At other times, the imperfect result is more problematic. Even with a highly skilled surgeon and outstanding nursing in an excellent hospital, a patient is not guaranteed a good outcome. “I can do everything right,” one orthopedist told us, “and the patient can be left with pain and limited use of the joint.” You explicitly acknowledge this when you sign a consent form before an operation, verifying that you have read, understood, and asked about the many possible negative outcomes, both minor and major, that fill the document. In effect, you are signing on to uncertainty.
Both Lisa and Carl signed such documents, and both were left in pain after their operations. What, then, might account for deep regret in one case and not the other?
Regret is painful and can be long-lasting, draining a sense of happiness from life. Early studies in the field of regret were conducted by Amos Tversky and Daniel Kahneman, researchers at the Hebrew University in Jerusalem, whose seminal work has informed much of modern cognitive psychology. They examined this issue with regard to money. In one experiment, they asked their research subjects to imagine the feelings of two different investors. The scenario went as follows: A stock falls in price after an “active” investor had recently purchased shares, while another “passive” investor had simply retained the stock in his portfolio. The vast majority of people, more than 90 percent, judged that the active investor would experience more regret because of his recent