Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [93]
But availability can also work to your detriment. It can cause you to distort the reality of what you face. To avoid this, it is best to integrate stories into the larger body of information, meaning the numbers about risk and benefit, particularly the number needed to treat and the number needed to harm.
As you go through this deliberate process of analyzing information, attentive to cognitive pitfalls, also consider how much autonomy or control you want in decision making. Some of the people we interviewed went to great lengths to exert control over every aspect of their medical care. Others did not. Just as there is no “one size fits all” in treatment, there is not a single choice about how much control you should want. Rather, try to find your starting place on the spectrum of autonomy, and then, as your trust and confidence in your doctors is confirmed or lost, consider again if that position makes sense.
We are often asked who is the “best doctor” to treat a particular condition. One criterion is a physician’s knowledge about your condition and its treatments, his or her command of the scientific data, so-called evidence-based medicine. But we believe the best doctors go one step further and practice “judgment-based medicine,” meaning they consider available evidence and then assess how it applies to the individual patient.
Some patients seek physicians who have a mind-set like their own: a maximalist patient may prefer a maximalist doctor, while a minimalist patient may want a doctor with that approach. Yet Dr. Jacques Carter cares for Susan Powell and Michelle Byrd and Alex Miller, each with a different mind-set. Although he doesn’t agree with all their choices, he tries to understand the orientation and values of each, and he shows respect even when his preferences differ from theirs. While you don’t want a doctor who superimposes his or her own preferences on you, you may not gain as much from a doctor who just rubber-stamps your decisions. A doctor who facilitates but also may challenge your decision process sometimes gives you more.
Writing this book changed us. It changed how we, as physicians, help our patients make decisions about treatment. Each day at work, as we speak with people facing different treatment options, we find ourselves using the terms that arose from this book: minimalists and maximalists; believers and doubters; naturalism or technology orientation. We find ourselves thinking more about autonomy and regret while helping patients make their decisions. As we introduced this vocabulary, patients have taken the words and concepts and expanded on them to better explain their point of view and mind-set. Writing this book also changed how we weigh options about our own health, defining and showing us the origins and evolution of our preferences.
Navigating a medical decision is a dynamic process. Your orientation and mind-set, the level of autonomy you desire, and the influences you are exposed to may change over the course of time. We hope that the insights provided in this book will help you to better understand your approach to health before entering the doctor’s office or hospital, to clearly explain your thinking to your physician, and then to continue the decision-making process after you leave. Then you will be on the path to choosing the right treatment for the right reasons.
Acknowledgments
We are deeply grateful to the many patients and their family members who shared their stories with us, opening their hearts and minds. Our debt to each is beyond words. We have worked hard to capture the thoughts, feelings, and lessons they wished to communicate. Any shortcomings in substance or style are ours.
Our agent, Suzanne Gluck