Review: Your Medical Mind

Best of Groopman’s books, IMO

I’ve read Groopman’s other books, and while it’s useful to know about how my doctors make up their minds, it’s much more important to me to understand the factors going on in my conscious and unconscious mind. This also applies to the people-as-patients who are close to me as they make decisions about medical treatment.

Some people are unhappy because Groopman & Hartzband fail to make the case for how to convince patients to follow the statistically best course of treatment, while missing the point that for most of our medical decisions, there may not be a “best” treatment. OK, colonoscopy is the gold standard for intestinal cancer screening. Fine. But there simply aren’t all that many “best” options, and almost any medical intervention varies hugely according to patient expectations, willingness, acceptance, income, etc. etc. and so forth.

The statistics about how many “best” treatments changed every year were the most interesting to me. HRT, no HRT; vitamins or not, drugs that work and then get yanked; surgeries that are found to be less than ideal. It rather strikes me that the act of believing in a “best” is possibly as irrational as any factor patients bring into the examining room.

Perhaps, if all patients truly understood statistics, we would make different decisions. Perhaps, if more doctors understood the reality of a patient’s experience with a treatment protocol and how it fits into a life, they would make different recommendations. Hard to say.

My best friend is evaluating a serious, expensive, and necessary but not urgent surgery. Her family medical “story” is vastly different from mine. Reading about other people’s backstories helps me get a handle on why she processes information one way, and I take similar data and go a different direction. This surgery is too new for there to be any useful “best” statistics, not unlike the chapter about making transplant decisions. Her processing is simply her way of thinking, not necessarily “full of cognitive errors.” This surgery could involve input from four different specialists, at least two of whom will need to be in the OR at the same time. They make a plausible case for why each is the better expert for her problem. They have stats. However, statistics fail in an N = 1 decision, when every 1 who faces this situation is significantly different from every other 1.

Your Medical Mind is NOT a checklist, or step-by-step, or even a deliberate guide to making the “right” medical decision, primarily because there is no such thing as the “right” decision, most of the time. It’s all a series of trade-offs, bartering an expected but unknown future outcome against a very present-day option. The best any of us can really do is understand what we bring to the table. I happen to think reading other people’s stories as examples of their decision-making process is a pretty good way to help me think about mine.

The book is also useful for directing conversation with the people in your life for whom you may be asked to make medical decisions, such as parents, partners, and children. I had not recognized how nearly completely useless my own medical directive documents are in the event of a near-death experience, and I’m (statistically) ahead of most in that I have the documents at all.

Every time I step into a medical practice, I sign a paper that says I will be, in the end, responsible for the charges if/when my insurance company is done. In the long run, I am also responsible for the outcome. Should it turn out “wrong,” I may have recourse and get money, but it’s still my body that’s broken, and my life to rebuild after. As such, understanding my side of the decision is totally my responsibility. IMO, Groopman and Hartzband could have gone a bit farther down this path.

Your Medical Mind

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