Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [4]
In each instance, we examine the powerful and often hidden influences outside and inside the patient’s mind that can sway thinking and distort judgment. We saw that by unmasking these influences, it is possible to gain greater confidence and control over your medical decisions. That way, you can chart a clear path through all the conflicting advice and arrive at the right treatment for the right reasons.
One
Where Am I in the Numbers?
Susan Powell was one of the first patients we spoke with. We thought that starting with a common and seemingly simple choice—whether or not to take a statin drug for high cholesterol—would give us a simple answer about how people process information and arrive at their decisions. But Susan’s decision was anything but simple.
Susan was up as usual at dawn. She made breakfast for her husband and her children and then checked the list of patients she would care for that day as a nurse’s assistant. Late that afternoon she had a follow-up appointment with her new primary care doctor.
Susan had been healthy all her life. Like many women, her only contact with a doctor had been with the obstetrician/gynecologist who delivered her daughters and performed a yearly examination. But when Susan turned forty-five, she told us, “I decided the time had come for me to see a primary care doctor.” Her gynecologist agreed and referred Susan to a young physician who practiced at a teaching hospital in Boston.
At her first appointment several weeks earlier, the doctor noted that while Susan ate healthy foods and led a physically active life, she was a bit overweight. Susan agreed to try to shed a few pounds. At the end of that first meeting, Susan had blood tests and at today’s visit she would get the results.
“Everything looks good,” the physician said, “except for a high cholesterol.” The doctor paused. “You know there are two kinds of cholesterol, often called ‘good’ and ‘bad.’”
Susan nodded.
“Your total cholesterol is 240, well above the cutoff of normal. Your good cholesterol, or HDL, is too low, only 37. And your bad cholesterol, or LDL, is too high at 179.”
The doctor handed Susan a printout of her laboratory tests. “Since you’re active and already follow a healthy diet, I think it’s time for medication. Fortunately, we have good treatment for this. Here’s a prescription,” the doctor said, handing Susan a small green piece of paper with the name of a statin drug. “I’ll see you again in a month, and we’ll do blood tests then. I don’t expect that you’ll have any problems, but if you do, please let me know right away.”
Susan took the prescription and put it in her purse.
Statins are among the most commonly prescribed medications in the world. In the United States alone, more than twenty-five million people take the drugs to lower their cholesterol. Cholesterol is a key factor in developing atherosclerosis, fatty deposits in arteries that can lead to heart attack and stroke. The first statin was discovered in 1972 by scientists in Japan. There are now more than a dozen varieties on the market. The drugs work by blocking an enzyme in the liver that makes cholesterol. Expert panels in the United States, Europe, and other countries have developed guidelines for prescribing statins based on the data from epidemiological studies as well as clinical trials assessing their effectiveness in preventing a heart attack.
Susan was familiar with the particular statin that the doctor had prescribed; many of her patients took the white pill that reminded her of a tiny football. Over the ensuing days, the doctor’s prescription sat in her purse. On her way to church she passed the local pharmacy, but she didn’t stop in to fill her new prescription.
At church that Sunday, Susan spotted an acquaintance of hers a few rows away. When the service was over, the woman, a little older than Susan, struggled to stand up. Her