Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [43]
This disconnect between the truth and what Matt would say coincides with the results from studies that compared how men reported side effects after prostate surgery to their surgeons with their statements to a neutral interviewer obtaining answers in the privacy of their home. What accounts for this discrepancy? Reports of side effects are often colored by the desire to please the physician and express thanks for removing the cancer. Other times, men may want to minimize their distress by compartmentalizing it, a common coping mechanism. One patient said to us, “I tell everyone I feel better than I do, and that makes me feel better.”
Even when physicians receive accurate reports of side effects, research has shown that doctors assess the impact of side effects after prostate surgery very differently from the men who have had the operation. The same disconnect between physician and patient is true for radiation treatments as well. What seems minor to many doctors is often a major source of frustration and unhappiness for the patient. Studies also show that when doctors advise patients about which treatment to choose, they project their own biases with regard to the impact of side effects on quality of life. Surgeons focus on unacceptable side effects of radiation, while radiation therapists emphasize the unacceptable side effects of surgery. We saw this phenomenon of “projection bias” with the doctor who advised Patrick Baptiste to have radioactive iodine rather than surgery. The physician’s advice was framed to minimize the side effects of the treatment he’d recommended and accentuate the side effects of the other possible treatments.
We wondered, after all his research and deliberation, if Matt Conlin regretted his decision to have robotic surgery.
“Well, I’m thrilled that my PSA is zero,” he said. “There is no better number as far as I am concerned.” Indeed, studies show that if Matt stays at zero, his cancer won’t recur. “There is nothing more that I could have done—no point in looking back. In fact, a few weeks after the surgery, I threw out my files on prostate cancer. It’s time to move forward.”
While Matt Conlin was recovering from his operation in Chicago, some two thousand miles away in West Los Angeles, Steven Baum, a sixty-two-year-old clinical psychologist, received a message to call his urologist. Steven had known for several years that he had a large prostate gland, and the urologist who cared for him had reassured him that his apparently high PSA level, when corrected for the size of the prostate, was not actually high at all. He had seen the urologist two weeks earlier because routine blood work showed the PSA had risen by a full point. “He examined me and said everything was fine.” As before, the doctor felt that the large prostate explained the increase in the PSA level. Although he said there was no cause for concern, the urologist recommended a biopsy “to be sure.” “I don’t think you’re going to have any problem. Don’t worry about it.”
Steven Baum returned the call. “Well, we found some growths—the pathologist classified most of this as a 6, but there was a very small amount of 7,” the urologist said, “and I’m concerned about the 7.”
Steven had no idea what the numbers meant. The urologist elaborated: “Most of this is run-of-the-mill stuff, we don’t worry too much about it. But come in and we’ll talk.” Later, Steven told us, “I’m listening to him, trying to figure out what he is really saying. Do I have cancer? And what is 6 and 7?”
He said that he was able to block out the conversation with the doctor from his mind until he finished seeing his last patient, shortly before seven