Don’t dazzle me with choices- what do I do?

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Yesterday, I talked about a visit to your doctor.  Today, about a visit to the web or the library.

We want to know more about our health.  So, we run a web search.  And, only 14,234 pages show up.  With the first page almost totally filled with advertisements for one miracle therapy after another.  Really?  Is this to what things have come?

Drs. Groopman and Hartzband (oncologist and endocrinologist, respectively, plus they are also husband and wife) have written a book we need to own: Your Medical Mind.  And, this is not Dr. Groopman’s first book for lay people. How Doctors Think is another book that you should consider reading.)

Why do I recommend this new book?   YMM is an analysis of how patients consider their options, how to discern the various options, how to navigate the ocean of conflicting advice and therapies.    The authors understand that much of modern medicine is filled with shades of grays, with an occasional black and white choice poking through the options.

This book is based upon the Dartmouth (lead hospital) shared medical decision process.  As I wrote yesterday, this process unites the doctor and the patient in determining the risks and benefits for any treatment, with care optimized to achieve the best results- and adhere to the values and preferences of the patient.  [By the way, now is the time to consider my other recommendation to have a medical directive and medical power of attorney in place.]

These choices include whether the patient is firmly in the camp of intervention or more of a skeptic.  Do they opt for the maximum care or the minimum amount to effect the desired change?  Are they technology prone- or more desirous of a natural therapy?  Yet, all this is well and good- but not when the strongest medical evidence is to the contrary.  But, the physician should not place the entire burden on the patient, either.

The authors also recognize that having too many options is usually more stressful to the patient than having few, if any, choices.  We freeze, unable to make a choice.

The approach Groopman and Hartzband propose is similar in concept to the frailty guide (assessment of health prospects) I discussed earlier.  Basically, we determine the probability of a desired outcome and the state of health that said outcome would produce.  Using the probability (the product percentage of outcome success and the numerical value), one can array the various treatments.  And, we can objectively arrive at the most rational, optimum therapy for our situation.

It does not help that many people do not understand statistics.  As an example, let’s assume you were found the 10 year heart attack risk calculator on the web.  And, your risk was 1%.  That means 1 of 100 people in your condition could have a heart attack in 10 years.  But, your doctor also told you need to take a statin pill, which will reduce your risk by 30%.  What both these facts mean if no one likes you takes the pill, then 297 people would never have a heart attack in ten years and if EVERYONE took the pill, then 299 people would never have a heart attack.  Now, how would you evaluate the side effects of this pill?   Would you risk not taking the pill, which really means your odds of succumbing to a heart attack (which still may not be fatal) is at best 3 out of 300- but still 1 of 300 if you do?

Roy A. Ackerman, Ph.D., E.A.

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7 thoughts on “Don’t dazzle me with choices- what do I do?”

  1. I think this is a wonderful series you are writing Roy. I loved yesterdays post!
    The majority are very ignorant when it comes to their doctor visits. Thank you very much for educating us. Thank you for empowering the patients.

    1. Thanks for dropping in and adding your comments, Elise.
      I am so glad you enjoyed the posts and added to the discussion- there is no need to be ignorant- it may make the difference between the outcome we want and the outcome we get.
      Roy

  2. Roy, thanks for the recommendations. It is so difficult to get people engaged in their health decisions when it literally can mean your life. I am definitely going to check out the book. Thanks, Roy.

  3. Great post, Dr. Roy! I think that there are far too many medical decisions that get wrapped around the emotional impact vs. honestly looking at the facts on the ground. I think that, to me, the most important thing is to look at whether something works, how effective it is, and what are the possible consequences. Once I know these things, I can then tell you whether something is the best option, or whether it is truly not worth it.

    One example: on a smaller scale, when I was in high school, the orthodontist wanted to recommend me for veneers. There’s nothing wrong with my teeth physically [I turn 32 next month and I’ve never had a cavity], but the shape is irregular, and I’m one of those people who only had two adult incisors on the top. They told me what it would do, and what foods I would have to give up, and I ultimately decided that my teeth were perfectly fine, and it wasn’t worth the hassle for something that was purely cosmetic.

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