DECIDING WHAT KIND OF PATIENT YOU ARE.

DECIDING WHAT KIND OF PATIENT YOU ARE. Jerome Groopman (an oncologist) and Pamela Hartzband (an endocrinologist) have written YOUR MEDICAL MIND, which analyzes the role of patient choices in medical decisions. (I have relied on this review by Daniel J. Levitin and this review by Laura Landro.) The premise of the book is that for many medical decisions, there is no black and white answer so that often patients will have to make decisions based on probabilities. The doctor and the patient should work together in doing this. The authors (husband and wife) propose two useful dichotomies: first, patients tend to be maximalists or minimalists. Dr. Groopman was a maximalist until a bad experience with back surgery made him more risk averse. Dr. Hartzband identifies herself as a minimalist, using medicines only when absolutely necessary. Second, a patient can be biased either for or against new technology. Is a patient willing to try a new medical treatment before it has been “proved”? Is a patient willing to let nature take its course perhaps with the aid of “alternative medicine”. The two dichotomies result in four classifications. Mary Jane and I tend to be maximalists who are open to new technology.

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One Response to DECIDING WHAT KIND OF PATIENT YOU ARE.

  1. Dick Weisfelder says:

    One can be very open to new technology, but also risk averse. The recent debates about how to diagnose and treat prostate cancer are a case in point. Despite new surgical techniques, the risks of post-operative incontinence, impotence, etc. are still substantial. These are compounded even more by the considerable risks of infection in hospitals. These make me a minimalist willing to postpone any surgery that is not immediately needed, but a maximalist when the alternatives are few.

    A doctor I know describes a successful hospital outcome as having the patient discharged with no more problems than when he/she was admitted.

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