Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [36]
Similarly, second opinions can be very helpful when patients face uncertain or serious medical diagnoses. But in Lisa’s case, the second surgeon seemed to be overly influenced by another prominent imperative in modern medical culture: patient autonomy. Lisa told us that the doctor said, “‘You can do it, or you can wait.’ He just wasn’t being helpful. He kept saying, ‘It’s all up to you.’” As the University of Michigan’s Carl Schneider has shown, the principle of autonomy may be taken too far in some instances and for certain patients, where the doctor exempts himself from his role as guide and puts the burden of choice entirely on the patient’s shoulders. This may have been the case with Lisa’s second opinion: Do whatever you want. Arizona’s Connolly notes that as patients achieve greater autonomy in decision making, they run a greater risk of regret; if the outcome is poor, the patient can end up blaming herself. Of course, this is a delicate balance, because in the face of a bad outcome, a person may also regret not exercising enough autonomy. And this, it appeared, was the case with Lisa.
Lisa Norton told us she hoped her story would help others making difficult decisions. She felt she had betrayed her own instincts and, in effect, failed to follow her normal process.
What about Carl Simpson? He was also deeply disappointed with the outcome of his operation. Marcel Zeelenberg distinguishes between regret and disappointment. Disappointment is an unavoidable aspect of making difficult choices: Sometimes the results fall short of what we had hoped for. But disappointment carries none of the self-blame that typically marks regret. Carl felt fully satisfied with how he had made his decision. “I’m a little bit of a pain in the rear end,” he said with a laugh. “I ask a lot of questions. My surgeon knows how my mind works, and he gave me answers.”
As Northeastern’s Judith Hall has observed, a doctor who successfully advises a patient facing uncertain choices must enter into the patient’s mind. “A doctor should encourage the patient, prompt him to explore his feelings and preferences,” Hall said. However, as we noted earlier, doctors usually aren’t formally trained in how to elicit a person’s preferences, either in medical school or during their residency. And as we have seen, doctors sometimes unwittingly project their own biases and preferences onto their patients.
“Do I regret what I did?” Carl asked rhetorically. “No.”
Carl had followed his way of approaching problems. And although he has persistent and limiting pain in his left knee, “I knew I did everything that could be done, and I did it right.” Researchers on regret would say Carl’s process was “normal.”
The optimal process has been termed “shared medical decision making” between doctor and patient. After together reviewing information about risks and benefits of treatment options, doctor and patient then customize the care according to the mind-set and orientation of the patient. Sharing the decision with a doctor who understands your preferences means sharing the burden of choice, so you lessen your risk for regret.
Five
Neighborly Advice
Prostate cancer is among the most commonly diagnosed malignancies. In 2010, more than two hundred thousand American men learned that they have the tumor. Making the diagnosis by a biopsy is relatively easy. But once the diagnosis is made, choosing treatment, if any, is hardly straightforward.
Matt Conlin, a venture capitalist in Chicago, glanced down and checked his BlackBerry. He had four new messages. Three were birthday greetings from friends—he had turned sixty-six that week. The fourth was a message from