Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [52]
Julie went to see the oncologist her gynecologist suggested. “It felt like he had all the time in the world to talk to me. And he seemed to be focused on me as an individual. But he made it clear there are always risks and uncertainties in cancer treatment.” That made her anxious. Maybe she should choose the doctor who was the “best of the best.” “I really had to think about which oncologist to choose. But finally I realized there would still be risks even with the best of the best.” She decided she would begin her treatment with the second specialist. “It was a difficult decision. But it really helped that a doctor I knew and trusted validated that this oncologist was a good choice.
“Dr. Best of the Best—when I called and told him that I’d be seeing this other oncologist—replied, ‘Of course, I’m great, he’s great. Whatever.’ ”
Almost immediately after choosing her oncologist, Julie Brody was faced with a difficult decision. After her lumpectomy, the surgeon told her that she would be getting chemotherapy and that she wouldn’t need radiation. But the oncologist she had chosen disagreed; he felt that radiation would reduce the risk that the cancer would return. They told her the final decision would be hers. This is the type of “decisional conflict” that Duke’s Mary Frances Luce highlights as a major source of stress for patients.
“My oncologist gave me strong advice,” Julie told us. “But he didn’t dictate. Not only did he explain the benefits of radiation with regard to treatment of the cancer, but also how radiation has downsides, increasing the risk of long-term complications, like other malignancies, and how it changes the tissue that is radiated, making reconstructive surgery after a mastectomy more challenging.”
Julie said it was a lot to absorb, and she had to think about the conflicting opinions. A few days after the appointment, the oncologist called Julie on her cell phone. She walked into her office behind the gallery, a quiet place where she could speak privately. “He told me that he had presented my case to a clinical conference at the hospital,” Julie said. “There were other oncologists, as well as my surgeon and other surgeons, and radiation specialists.”
The oncologist told her that during the discussion of her case, “there were some people who thought I didn’t need radiation, and some who did.” Her oncologist once again reviewed the pros and cons of the treatment. “And then he said, ‘I just didn’t hear anything that convinced me that you do not need radiation. But in the end, this is your decision—I will support you either way.’”
That made a deep impression on Julie. “He definitely had to talk me through it four or five times. It wasn’t as though he presented his point of view to me and I said, ‘Okay! Great, radiate me.’
“My doctor was saying, ‘Here, you can look behind the curtain. You can see.’ It’s not like he said there are no other points of view. For some people, telling them might have resulted in doubt about his ability or lack of confidence in his judgment. I felt that he was showing me everything. But I still had to make the choice.”
Mary Frances Luce found that some patients seek to mitigate the “emotional costs” of making difficult decisions by directly and repeatedly “attacking” the complexity of the choices they face. Luce terms this “vigilant decision making.” Matt Conlin embodied this approach. Constantly crunching the numbers, contacting more than twenty different doctors, trying to delve deeply into research studies culled from Internet searches, Matt was trying to reduce decisional conflict by finding small but significant differences that would tip the scales toward one treatment or another. But for many patients this is simply too difficult, both technically and emotionally. They believe they don’t have the capacity to critically assess the vast sea of conflicting information.
Julie didn’t feel confident to interpret what she found on the Internet. “I’m not going to become a doctor, like some certified specialist, in a few months. So finding that right doctor was so