Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [91]
Your preferences about treatment do matter. They provide a foundation so that you can choose the right treatment, the one that fits your values and way of living. Understanding your preferences begins with reflecting on your mind-set.
Studies show that some 60 percent of people in the United States pursue so-called alternative or natural therapies. This indicates a naturalism orientation, the notion that the body can often heal itself if given the proper environment, harnessing the mind-body connection and supplementing with herbs, vitamins, and other natural products. On the opposite end of this spectrum is the technology orientation, the belief that cutting-edge research yielding new medications and innovative procedures holds the answers.
Each of us also falls somewhere along a second spectrum, depending on whether we want maximal or minimal treatment. Some people are proudly proactive about their health, believing that more is usually better. Even in the absence of definitive clinical data, some patients and indeed some physicians believe that they will be healthier and live longer by tightly controlling their blood pressure or dramatically reducing their “bad” LDL cholesterol or achieving a body mass index below recommended levels; they are intent on being “ahead of the curve.” In contrast, those with a minimalist mind-set aim to avoid treatment if at all possible; and if that is not possible, they try to use the fewest medications at the lowest possible doses or to select the most conservative surgery or procedure. Minimalists hold to the notion that “less is more,” that risks and unintended consequences may overshadow apparent benefits.
Then there are believers and doubters. Believers approach their options with the sense that there is a successful solution for their problem somewhere. They generally have a well-defined orientation. Doubters approach all treatment options with profound skepticism. They are deeply risk-averse, acutely aware of the potential side effects and limitations of drugs and procedures. They question how much benefit a therapy really offers them and whether there might be deleterious consequences.
A believer can have a strong naturalism orientation, trusting in the healing power of nature and shunning high-tech interventions. Or a believer can have a technology orientation, relying on the promise of modern medicine. A believer who is a maximalist feels that more treatment is the best approach and doing less is shortsighted, whereas a believer who is a minimalist is certain of the opposite strategy. For example, one of our friends is a believer, a maximalist with a strong naturalism orientation; his cabinets and refrigerator are filled with nutritional supplements, he has regular acupuncture treatments to “stay healthy,” and he consults a homeopathic practitioner for any illnesses. Another friend, also a believer with a strong naturalism orientation, is a minimalist. She takes no supplements on a regular basis, but when treatment seems necessary, she prefers herbal remedies in the smallest amounts. Similarly, those believers with a technology orientation may be maximalists or minimalists.
Doubters are typically minimalists. They apply their skepticism without consideration to the origins of a therapy, whether it be prescribed medications or herbal supplements. Some people are doubters at the outset, drawing on the attitudes of their upbringing, while others arrive at this mind-set through hard experience after an incorrect diagnosis or a treatment that falls short of expectations.
Being a doubter is uncomfortable, because it results in intense decisional conflict. While doubt can prevent you from