by JEROME GROOPMAN, M.D. AND PAMELA HARTZBAND, M.D.
Jerome Groopman, is an oncologist who guides his patients through life-or-death decisions. His wife, Pamela Hartzband is a noted endocrinologist and educator at Harvard Medical School who helps patients make critical decisions about their long-term health.
The authors wrote:
- In our role as doctors, our aim is to help our patients understand what makes sense for them, what treatment are right given their individual values and goals. We are especially mindful not to impose our preferences about our own health on our patients.
We are drowning in information, while starving for wisdom ~ E.O. Wilson
Making the right medical choices is harder than ever. Whether we’re deciding to take a cholesterol drug or choosing a cancer treatment, we are overwhelmed by information from all sides: our doctors’ recommendations, dissenting expert opinions, confusing statistics, conflicting media reports, the advice of friends, claims on the Internet, and a never ending stream of drug company ads.
Some assert that you need more — more tests and more treatment. Others insist that you need less.
There are many facets of human nature.
Naturalism vs Technology
- Some are naturalism orientated believing 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 the this spectrum is the technology orientated believing that cutting-edge research yielding new medications and innovative procedures holds the answers.
Maximal vs Minimal Treatment
- Some people are profoundly proactive about their health, believing that more is usually better.
- In contrast, those with a minimalist mind-set aim to avoid treatment if at all possible, and if 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.
Believers vs Doubters
- Believers approach their options with the sense that there is a successful solution for their problem somewhere.
- 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.
Understand the numbers behind the words
- 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.
- 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.
- To 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.
The authors related a patient who used his scientific analytical knowledge to make decisions about his medical treatment. I am a scientist. I understand how research is conducted, what statistics show and don’t show. I was well aware of all the garbage that’s out there on the Internet. So I decided to go with top-tier journal, well-accredited papers, authored by specialists who are at recognized institutions.
After experiencing the medical system himself this patient suddenly came to this conclusion.
- Clinical medicine is an area that moves away from clarity, an area that I think of as having higher uncertainty. You can’t really make rational decisions in this world. Doctors like to have what I call a “badge of rationality,” because it gives them authority, and they try to appear competent for the patients … even if the situation is highly uncertain, they go out of their way to appear certain, to ooze rationality?
- They told me I had a 50 percent chance of getting graft-versus-host disease, with a 10 percent change of it affecting my liver, a 40 percent chance hurting my intestine, a 30 percent change involving my skin. I have no way to understand what all that means.
Who is the best doctor
- 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-base medicine,” meaning they consider available evidence and then assess how it applies to the individual patient.
|If medicine were an exact science like mathematics, there would be one correct answer for each problem …. But medicine is an uncertain science.
How do you know what is right for you? The answer often lies not with the experts, but within you.
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.
Dr. Groopman’ Experience
…the culture of my upbringing and the trauma of my father’s death made me a believer in modern medicine, is power and is promise …. My mentors at UCLA were maximalists in treatment, firmly committed to doing everything all the time.
And it was that maximalist mind-set that resulted in the signature medical mistake of my life. One Sunday morning in Los Angeles, feeling fine, I stood up from a chair and nearly collapsed from excruciating back pain. The pain persisted for weeks, and the doctors I consulted had no ready explanation for it.
But I was sure that medical science could pinpoint the cause of my pain. There had to be a fix somewhere in the universe of physicians and procedures.
I lacked the patience to wait. I was headstrong, intolerant of the lack of explanation for my misery. And I didn’t believe that my body would heal itself …. I underwent the most aggressive operation, a spinal fusion …..disastrous consequences: worsening pain and increased debility.
The aggressive and unsuccessful surgery was a hard lesson …. it now seems self-evident … mistakes are often necessary to bring insights. I learned to pay more attention to risk, to take time to consider side effects.