Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [92]
After you consider your mind-set with regard to these categories, it is valuable to go through a deliberate process to become informed and to better understand the often hidden influences that can sway your thinking and distort your judgment.
The Institute of Medicine of the National Academy of Sciences places “informed patient choice” at the “pinnacle of quality medical care.” But this begs the question: What does it really mean to be informed? It means knowing the numbers about a particular medication or procedure, its likely benefits and side effects, but it also means being alert to how the presentation of these numbers can confuse or mislead you.
Stating that 35 percent of people with a serious illness are cured by a certain treatment has a hopeful resonance, while stating that 65 percent of people die despite that therapy has a pessimistic sound. But both statements are factually correct and describe the same data. For that reason, it is always valuable to “flip the frame” in your mind, to view information in both its positive and its negative forms.
Framing can be even more subtle, using words instead of numbers. For example, stating that a drug works “in the majority of patients” sounds quite different from specifying that 51 percent of people responded to the treatment, yet both are accurate. It is important to understand the numbers behind the words.
Finally, to most clearly understand the true benefit of a treatment, try to learn the “number needed to treat,” how many people with a condition similar to yours need to receive a therapy in order to improve or cure one person. Similarly, the “number needed to harm,” how many people typically must receive the treatment in order for one to suffer a side effect, more clearly reveals the risk of a therapy. Decision aids often contain these numbers, or your physician may give them to you. The number needed to treat contributed to Susan Powell’s decision not to take a statin drug. She discovered how the expected benefit of the drug applied to her as an individual and valued that result in light of her particular mind-set: a doubter and minimalist. Of course, for another person like Michelle Byrd, a believer and maximalist with a technology orientation, the same number needed to treat could reinforce her aim to be proactive, to do everything possible to avoid future illness.
It is vital when making a treatment choice that you remain alert to cognitive pitfalls beyond framing of numbers. By unmasking these hidden influences, you can gain a greater sense of confidence that your decision process was sound. For example, research from psychology shows that all of us generally experience loss more profoundly than gain. This aversion to loss may cause you to give undue weight to possible side effects compared with expected benefits.
Another powerful influence on thinking is the “focusing illusion.” In trying to forecast the future, all of us tend to focus on a particular aspect of our lives that would be negatively affected by a proposed treatment. This then becomes the overriding element in decision making. The focusing illusion neglects our extraordinary capacity to adapt, to enjoy life with less than “perfect” health. Imagining life with a colostomy, after a mastectomy, or following prostate surgery can all be skewed by the focusing illusion. We cannot see how the remaining parts of our lives expand to fill the gaps created by the illness and its treatment.
Seeing how those gaps may be filled can come from learning about the experiences of others with the same condition. This powerful influence of stories on thinking is termed “availability.” If a relative or friend was able to adapt successfully following a therapy, this may help you to see your own future with a wider focus. On the other hand, if your father or sister or a close friend had a severe side effect from a drug or operation, you will be unlikely to choose as they