Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [38]
It’s easy to acknowledge the truth of physician fallibility in the abstract; it’s much more difficult to accept it when you actually experience it, when your own doctor’s soothing words turn out to be wrong. It can shake the foundations of your confidence like an earthquake; the ground you stand on can no longer support you. The experience of how a diagnosis is made, what doctors thought and said, can have a profound impact on how you apply their advice about treatment. Indeed, both of us as patients had this experience where our physicians proved fallible. Someone who is already a doubter is reinforced in that mind-set. A believer struggles to maintain his or her sense of belief as the seeds of doubt are planted.
Matt Conlin never had any reason to doubt a physician’s advice before. He had never been seriously ill and prided himself on his youthful physique and energy. Medically, everything had always gone according to plan for him. He had had an EKG and colonoscopy, both normal. His blood pressure and cholesterol were checked regularly, and when his doctor noted a slightly elevated cholesterol, he prescribed a statin. The physician assured him he would tolerate it well, and he did; soon his cholesterol had dropped as predicted. But now the world of medicine looked very different. The stark reality of uncertainty was in the foreground of his vision.
Matt Conlin designated one of his senior analysts to sit in for him on the meeting about the investment in India. Then he told his secretary to hold all calls and closed his office door. When an investment turned sour, Matt went back and looked at the numbers himself, to understand the problem and try to solve it. Now he told himself that he needed to find the numbers, to rely on his own information. He began a Google search on prostate cancer.
“If you Google ‘prostate cancer,’” he told us, “you get millions of hits.” Using the same methodical strategy that he applied to investments, he started with general background information before delving into the specifics. He went to the Web sites of mainstream organizations like the National Cancer Institute and the American Cancer Society. All presented three options: surgery, radiation, or no immediate treatment but close monitoring, so-called watchful waiting. Each approach was outlined in broad language without indicating which was superior. He wanted more details on treatment, so he began to read medical articles. “I was looking for differences that might be important for me,” Matt told us. After a few hours in front of the screen, he was overwhelmed. “The technical terms were confusing and there was too much information. I didn’t know how to interpret what I was reading. Where did my case fit? I was looking for more guidance. So I went to Barnes and Noble and bought an armful of books on prostate cancer.”
One of the books was written by a prominent urologist in another city who stated that he had one of the highest rates of cure and lowest incidence of complications in the United States.
Matt called this urologist’s office. The receptionist began to take down his information, but after getting his name and date of birth, she abruptly halted the conversation. “I’m sorry, but we have a cutoff of sixty-five years old,” she said. “You’re sixty-six.”
Matt was taken aback. How could there be such a rigid age cutoff? “Last week, I was sixty-five,” he replied. “So if I had called last week before my sixty-sixth birthday, then I could have gotten an appointment?”
“Yes, that’s our rule.”
Matt had accumulated not only considerable wealth over the course of decades, but also