Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [50]
The oncologist “at the top of everyone’s list,” Julie told us, “was the one I wanted.” An art collector she knew was a trustee of the doctor’s hospital and contacted him on her behalf. The specialist was expecting Julie’s call. “I would love to come in and talk to you about my situation and understand what the options are and what you recommend,” she said.
“There’s really no need for a lot of discussion, I’ll know what is best for you. You’re going to get great care here.” He paused. “I guarantee you’re going to love us.”
I don’t know that I’m going to love you, Julie thought.
“I’m speaking at a cancer conference in Europe this coming week, but I’ll see you as soon as I get back next week.”
“Can I really wait a week?” she asked.
“I assure you, a week will not be a problem.”
Julie told us that “he seemed to be saying he knows what I like and what I need before even sitting down with me or hearing my story, or finding out who I am. It felt like a one-way street—with no input from my end. This really bothered me.” Her intuition made her feel that perhaps this was not the right doctor for her. But powerfully pulling on Julie were the opinions of the people on her Rolodex, who viewed this doctor as the “best of the best.” It seemed self-defeating to not be under his care. What benefit might he offer that, in the end, could make all the difference ? Would not choosing him hurt her chance to be cured?
“It was one of those really difficult pivot points,” Julie recalled. She didn’t want to decide impulsively. She imagined one day regretting her decision either way—whether she chose him or another oncologist. She was caught between two visions of future regret.
We saw the negative effect of regret with Lisa Norton after her failed foot surgery. This was regret felt in retrospect. Here, Julie Brody was anticipating regret. Her “pathologically positive” attitude had evaporated. Her mantra that “it’s going to be okay” had vanished. Instead of the steady calm she felt in tackling problems at work, Julie was gripped by a sense of fear and anxiety, feeling she had to act quickly. Her gynecologist had made her clear her calendar and go right in for the mammogram and biopsy. Her mammogram was normal two months ago, but now she had cancer not only in the breast, but in a lymph node. She felt time was of the essence. In the paradigm of “hot/ cold” decision making, she was poised to make a feverish decision. Anticipation of regret helped her to cool down. But Julie still had a decision to make. Should she choose this doctor or look for someone else? She realized that she had to reach out to someone who understood her dilemma, someone she trusted who knew her personally, and someone on the inside, someone with medical knowledge.
Julie called her gynecologist. She listened carefully to Julie’s story. “It is true, he’s an outstanding oncologist. But there isn’t just one ‘best’ doctor—there are many excellent oncologists who can provide superb care for you.”
We are often asked by patients, family, and friends who is “the best” surgeon, “the best” dermatologist, “the best” pediatrician. We respond similarly that there is no one “best doctor.” There are many physicians in each field with deep experience, excellent clinical judgment, and strong communication skills.
“Let me suggest another oncologist that I’ve worked closely with,” the gynecologist said. “This is a doctor whose judgment I respect, and several of my patients have worked well with him. I’ll help get you an appointment right away, and then you can see the other oncologist when he gets back from his trip.”
How do people pick their doctors? According to data from the nonprofit Center for Studying Health System Change, in 2007 an estimated twenty-five million adult Americans sought a new primary care doctor, and more than sixty million looked for a new specialist. Of those adults who found a new primary care physician, fully half relied on recommendations from friends and relatives, and more than a third also drew on recommendations from doctors, nurses, and other medical