Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [46]
Steven then investigated radiation therapy, although he knew that the size of his gland made this approach less than optimal. The radiation therapist explained that first he could be treated with hormonal therapy that might reduce the size of the gland, and then he would potentially receive radiation. This approach seemed even more uncertain to him.
Steven then consulted a medical oncologist expert in prostate cancer. This doctor made the case for “watchful waiting.” “You have at least a 50 percent chance of the prostate cancer not killing you if you do nothing,” the medical oncologist told Baum. “And if you die of something else twenty years from now, never having suffered from the cancer, then I win and cancer loses, even though I didn’t do anything. This is a real option for you.” This plan appealed to Steven. Maybe he could get by without any treatment at all.
When we spoke with Steven, he said, “I feel like I’m at a crossroads with about four or five different paths in front of me.” His primary care doctor told him, “The hard thing is you are going to have lots of options and there is really not a clear best option.” Steven was familiar with the work of the psychologists Barry Schwartz and Sheena Iyengar, who have written extensively about the paradox of choice. Contrary to conventional thinking, having many options can be more distressing than having fewer options and can impede our ability to make a sound decision, or even any decision. Fewer choices can lessen the cognitive burden that comes with having to examine many options. But the wrong choice can lead not only to disappointment, but also to regret.
In his own practice, Steven Baum had listened to countless patients articulate their deep regret about events in their lives—a divorce that could have been avoided, a rift with family or a friend that might have been repaired, an investment chosen unwisely. Steven was determined to do his best to avoid regret. He told us that “I follow the same process in making every decision in my life, whether it’s to buy a certain car, sell my apartment, get married, or have a child. I get all the information and then sit with myself and think. Here,” he continued, “I need to know that I have seen into my own head and the heads of my doctors—my own feelings and their feelings. At some point, I ask myself, What can I live with? Which choice would be the one that I couldn’t live with, and which one would be the choice I could live with? And then I know that I’ve gone through my process and have achieved a clear understanding.
“What happens in the beginning is that I’m not sure, and I’m running all these different scenarios through my mind. And then I reach a point where I start to see what’s right and what’s wrong for me. It’s a deliberative process, and each person’s process is different based on who they are and their history. Somebody else clearly would want to have surgery right away, and that might be right for them, and I may end up there as well, but I’m not there yet. I have to answer the voice in my head that says, ‘You know, if you were smart enough or good enough or enough of a man, you would just make your choice now.’ But I have come to believe, having made mistakes by being impulsive, that for me decisions of this kind should not be made quickly. Dithering and obsessing and trawling over not only the information but the feelings is what I need to do.”
Several months later, still undecided, Steven Baum ran into an old friend at a coffee shop in Westwood. In short order, the conversation