Medical decisions can seem overwhelming, especially when you’re sick and scared. In their new book, “Your Medical Mind: How to Decide What Is Right for You,” oncologist and New Yorker writer Jerome Groopman and his wife, endocrinologist Pamela Hartzband, team up to help readers recognize the many influences on their medical decisions and encourage them to chart their own path. They recently discussed their book with me.
Q You say that the most agonizing truth of medical care is its uncertainty. How can knowing their own “medical mind” help people cope with that?
Groopman: I think a lot of people don’t realize how uncertain medicine is. In the book, we quote an orthopedic surgeon who says, “I can do everything right, and the outcome still isn’t good.” Or you can take a statin and still have a heart attack. But in order to make a decision, not blindly but cleareyed, it’s important for the patient to understand the uncertainty. How you value the risks and benefits is really central so you choose what’s right for you as an individual.
You say that in many cases, determining the “right” medical decision depends on different personality orientations. What are these distinctions and how do they affect decision-making?
Hartzband: First, there’s the maximalist/minimalist orientation. Maximalists are the people who want to do everything possible and more to take care of the health issues they have. Minimalists believe less is more and want to do just what is absolutely necessary. Then there’s the naturalist vs. someone with a technology bias. The naturalist wants to use natural remedies while the technologist wants the latest, greatest, cutting-edge technology. Finally, there’s the believer/doubter orientation. The believer believes there’s a good treatment for whatever they have and is going to go for it. The doubter is risk-averse: He’s focused on unintended consequences and believes the treatment might be worse than the disease. And those three orientations all interact with one another.
The U.S. Preventive Services Task Force now recommends against routine prostate cancer screening for healthy men, because it doesn’t seem to improve mortality. Describe how different people might evaluate the decision to be screened.
Hartzband: The doubters are going to be the people who are reluctant to be tested. They’re going to see it going down a path they don’t want to follow . . .
Groopman: . . . of complications where the treatment is worse than the disease. Then you have the believers. They say, “The side effects [of treatment, such as impotence and incontinence] generally get better, and people adapt and cope.”
Hartzband: You can apply the same issue to the mammogram. It’s been suggested that when women have mammograms, they end up having a biopsy, with complications and scarring. The doubters don’t want to do it. The believers say, “[Detecting cancer] is so much more important than a little scarring.”
What role should doctors play in helping people make decisions?
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