Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [42]
Matt began to think about his family. His mother died at ninetythree in her sleep. His father died at ninety-seven in an accident, slipping off the roof of his house while repairing shingles. His paternal grandfather, he was told, lived to one hundred five. “I thought that if I am destined to live to ninety-plus, like others in my family—then I need to treat this cancer. Watchful waiting is not for me. I am not likely to die of something else, like a heart attack or stroke, before the cancer could grow and spread.” Matt’s effort to place his life into the time frame of his parents and grandparents was, in a sense, an availability bias. Their dramatic longevity had been a touchstone all his life. “Furthermore, I have to think long and hard about side effects, because I will have a long time to develop them and live with them.” For Matt, that was the problem with radiation, even proton beam. No one could give him the kinds of assurances that he wanted, that he would not develop late side effects. “So,” Matt told us, “it should be surgery, because with an operation you could take out all the cancer, and complications occur pretty much immediately. And robotics seemed to make to most sense to me, with my engineering background.” Matt was aware that studies did not show a significant difference between robotic surgery and open surgery by an experienced surgeon. “But,” he said, “it seemed to me that this robotic technology could eliminate a lot of potential human error. I thought about how any surgeon can have a bad day, and make a mistake on me. A robot would make a mistake less likely.” Matt showed what we call a “technology orientation,” the view that new science and technology are automatically superior to older approaches, a view that reflected his training as an engineer and his temperament as a venture capitalist investing in new developments. In contrast, those with a naturalism orientation would view the latest technology with suspicion, as being overhyped and not able to deliver on its promise.
With a technology orientation in mind, Matt did “due diligence” on urological surgeons who used robotic methods to remove the prostate gland. He studied the backgrounds of each surgeon the way an investor looks at the pedigree of the CEO before investing in a company. Matt called the surgeon who seemed to have the most experience and best reputation in Chicago and set up an appointment. “When I entered the waiting room, a patient was cheerfully chatting with the nurses. He told me he was back to thank the doctor after the operation.” This made a deep impression on Matt. He fantasized that one day he would be the one coming in to thank the surgeon. At the end of his appointment, the doctor suggested that he speak with some of his patients, other men who’d had the surgery. Matt contacted two of them. They seemed satisfied with the results and said they were “fine” within a year. But Matt confessed to us that he didn’t push as far as he might in a business investment. He was reluctant to invade their privacy to ask hard questions about their sex lives or whether they leaked urine.
It was some six months after the operation when we spoke again with Matt. “I still drip urine,” he said, “particularly when I exercise. Sometimes when I cough or sneeze or twist around quickly to reach something behind me, I go, Oops, there are a few drops. It’s really aggravating. And I can’t wear khaki trousers. I have a business trip to Switzerland next week, and I like to wear khakis on the flight. But dark stains show up from the urine. So the khakis are retired for the time being.”
Matt Conlin was very open with us. “And on the sexual function side, the erections are not strong enough.” He tried Viagra,