Trim, athletic and recently retired, Dave Simon enjoyed playing tennis and was working hard to take his game to a new level. During a match, as he lunged to return a ball, he collapsed onto the court; though he tried to get up, he could not move his right arm or leg, and he couldn't speak to answer his tennis partner's questions. Just as he was struggling to find his voice, the door to the examining room snapped open and his doctor's voice greeted him, shaking Simon out of his daydream of being stricken by a stroke. When the doctor asked Simon about his decision to begin drug therapy for atrial fibrillation, the patient—vacillating between his terror of a stroke and the adverse side effects of such drugs on a good friend—simply replied that he had not yet decided to commence treatment.
In Your Medical Mind, a compelling study of the ways we make our decisions about personal health care, Dr. Jerome Groopman and Dr. Pamela Hartzband show that Simon is hardly alone in his ambivalence in seeking a course of treatment whose benefits must be balanced against its drawbacks. Drawing on interviews with a range of patients who have had to make decisions regarding cancer, heart disease and the end of life, the two doctors provide a useful chart of the approaches that individuals take to medical decision-making.
Some patients are maximalists who believe that they are making the best medical choices for themselves by embracing the full range of recommendations—tests, drug therapies, surgery—their physicians make in order to preserve health. Others are minimalists who often avoid treatment, try to use the fewest medications and the lowest dosages of those drugs, and select conservative procedures. Then there are believers who approach each situation with the optimism that there will be a successful solution; doubters approach treatment with profound skepticism and are often unwilling to take risks when the adverse consequences might outweigh the benefits of a procedure or therapy. While believers are most often maximalists and doubters most often minimalists, the authors point out that there are always exceptions to this characterization. Some patients have an orientation toward naturalism and seek out natural remedies or homeopathic treatments and even then partake of those quite sparingly.
With the advent of medical sites and patient blogs on the Internet, television and radio commercials about the promising benefits and the chilling side effects of drugs, conflicting advice from personal doctors and specialists, and the promise of natural remedies and therapies, patients now have more difficulty than ever before in making decisions about how to proceed after a difficult diagnosis or which procedures or treatments might be best for them in a certain situation. Groopman and Hartzband masterfully help us all navigate these choppy medical waters.
