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Your Medical Mind: How to Decide What Is Right for You [Paperback]

Jerome Groopman , Pamela Hartzband

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Product details

  • Paperback: 308 pages
  • Publisher: Penguin Books; Reprint edition (28 Aug 2012)
  • Language: English
  • ISBN-10: 014312224X
  • ISBN-13: 978-0143122241
  • Product Dimensions: 21.5 x 14.1 x 2.7 cm
  • Amazon Bestsellers Rank: 1,007,737 in Books (See Top 100 in Books)

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Amazon.com: 4.1 out of 5 stars  47 reviews
80 of 87 people found the following review helpful
3.0 out of 5 stars Your Medical Mind - Book for Patients or Doctors? 11 Oct 2011
By Davis Liu - Published on Amazon.com
Format:Hardcover
I looked forward to reading Dr. Jerome Groopman's new book, Your Medical Mind - How to Decide What is Right For You, co-authored with Dr. Pamela Hartzband. His previous work, How Doctors Think, shaped my thinking as a practicing primary care doctor on the importance of language and the potential pitfalls we make in reaching decisions. I always recommend my medical students read that book.

Unfortunately, his latest work fell quite short of my expectations. In it, the authors try to understand and create a framework on how patients reach decisions about their medical care. In the end, this was a book about human psychology wrapped in the doctor patient relationship. Nothing particularly earth shattering here.

The real question I had is who is responsible for helping patients avoid these cognitive and psychological errors? Patients or doctors?

They note how the mindset of patients can be divided into the following categories - "believers and doubters; maximalists and minimalists; a naturalism orientation or a technology orientation." Specifically, some patients want maximal treatment and others believe "less is more". To avoid cognitive traps, the authors recommend that data be viewed in both positive and negative forms. Telling a patient that a therapy has side effects for 10 percent of patients is very different than saying 90 percent of patients have no side effects.

Other tips to good decision-making included minimizing emotion before deciding, bringing a friend or family member to an appointment to provide additional eyes and ears, and also getting second opinions. Finding a doctor who provides "shared medical decision making" might also decrease the chance of making a choice only to regret it later. In the book, many patients moved beyond decision paralysis upon hearing a story of another patient with a similar illness and predicament. Specifically, patients realized that instead of focusing on the negative, like the side effects, focusing on the positives and the ability to adapt made all the difference. There is both power and potential pitfall in hearing other patient's stories, which may be anecdotal.

Dr. Groopman and Dr. Hartzband noted that patient decision making and autonomy vary depending on circumstance. Sometimes patients want full control. Other times they wish to cede it to physicians, hence the reason many want to find the "best" physician. Surrogates, who act on behalf of patients when incapacitated, are ideally supposed to use "substituted judgment" and choose treatment based on what the patient would have wanted. Like patients, however, surrogates too will change their mind or relinquish or reclaim autonomy depending on the situation. As a result, sometimes doctors use the principles of "beneficence", the principle that physicians should act in the patient's best interest, and "nonmaleficence", to do no harm.

Physicians can also unwittingly bias a patient's decision by recommending a "best" treatment and downplaying others, which could be a better match for the patient's preference. Although there is a movement in health care to provide treatment which is evidence based, the authors conjecture that this focus would result in doctors recommending treatment not in preference of a patient. These seems rather ludicrous as already many current guidelines are not being followed.

The authors conclude that patients are best served if they find doctors who do not superimpose their preferences while at the same time don't simply rubberstamp what you want. "A doctor who facilitates but also may challenge your decision process sometimes gives you more."

Completely agree. Perhaps this book is best suited for doctors. While the book may be an enlightening read for patients, there isn't necessarily an easy practical framework which will help them make the right decisions.
78 of 87 people found the following review helpful
4.0 out of 5 stars Important Read For People Receiving Treatment 22 Sep 2011
By AKinderman - Published on Amazon.com
Format:Hardcover
I think this book did a great job of interviewing people in various stages of medical decision-making and using their choices to show the psychology behind it. The book shows you how doctors or drug companies can sometimes push their own agenda regardless of your feelings as well as the hard decisions people make to sometimes go against what their ailing loved one wants. If you ever need to receive treatment for anything in the future, this book will help you realize the psychological aspect of your decision and may help you make the right one.
52 of 58 people found the following review helpful
5.0 out of 5 stars A sensitive guide from remarkable physicians 25 Sep 2011
By William Boot - Published on Amazon.com
Format:Hardcover|Verified Purchase
This book has already helped me make decisions with my aging mother about her best medical options, while giving me a new perspective on taking care of myself.
The authors clearly know not only their own specialties, but the entire confusing state of today's medicine: insurance, choices, and standardized care. They're frank in their analysis and advice. I recommend this to anyone.
12 of 12 people found the following review helpful
4.0 out of 5 stars Pretty good, though rambling 4 Jan 2012
By Irfan A. Alvi - Published on Amazon.com
Format:Hardcover
This book explores medical decision-making and emphasizes the role of various biases that affect our decisions, usually unconsciously. Overall, it's a pretty good book and I can recommend it, but it's somewhat heavy on narratives of case histories and light on systematic presentation of the key findings - basically opposite of a textbook and apparently targeted more at the general reader.

I personally would have preferred a more systematic presentation, but I went ahead and compiled my own summary of the key findings:

(1) In general, the findings described in the book apply to everyone involved in making medical decisions: patients, patient advocates, physicians, nurses, researchers, administrators, etc.

(2) Our backgrounds predispose us towards taking varying general approaches to making decisions, such as being a minimalist (as little treatment as possible, letting the body primarily take care of itself), maximalist (treating aggressively, including treating preventively), naturalist (favoring natural CAM treatments rather than conventional allopathic medicine), technocrat (favoring modern high-tech medicine), and pragmatist (choosing from the whole range of treatment options as each particular situation warrants).

(3) The way information is framed can greatly influence our decisions. For example, "40% of patients are cured by this treatment" sounds more encouraging than "this treatment fails to cure 60% of patients." An implication is that statistics for treatment outcomes have to be looked at carefully, and looking at only summaries of statistics can be misleading.

(4) Anecdotal cases (as reported in this book) can be informative, but they can also excessively influence our decisions (availability bias).

(5) Serious illness and strong emotions can result in poorer decisions.

(6) Recommendations of doctors can vary considerably due to biases resulting from personal background, training, institution where they work, outcomes of the patients they've cared for (again, availability bias), and the treatments they're most familiar with. An implication is that it's often preferable for patients to seek multiple opinions, though that leaves patients having to make decisions when the provided opinions diverge.

(7) Ideally, patients and doctors should work together to make decisions, but patients vary widely in what role they want to take, ranging from wanting to be in primary control (and thus doing considerable work to investigate their condition and treatment options, and possibly seek multiple opinions) to delegating all decisions to their doctors.

(8) Advance directives for end of life decisions often don't work well because (a) people have difficulty anticipating how they'll feel when the time to decide comes, so they're prone to changing their minds and (b) even if directives aren't changed, it's often not clear what decisions will best comply with directives in particular circumstances.

(9) Advocates often have difficultly making decisions on our behalf. Part of the difficulty is the tension between trying to know what we would decide for ourselves versus deciding what they consider best for us.

(10) In general, following a systematic decision process tends to reduce regret if an outcome turns out to be disappointing (can at least say that the best possible effort was made). However, this doesn't mean that decision-making can be reduced to a formulaic "by the numbers" approach, for several key reasons: (a) there will always be uncertainty and complexity, so judgment inevitably will be required, (b) biological variability among patients means that treatments need to be individualized to patients, and (c) subjective values and goals are usually involved, so there may be no objectively "correct" decision.
10 of 10 people found the following review helpful
4.0 out of 5 stars Take the pill? Have the surgery? How to decide 25 Oct 2011
By N. B. Kennedy - Published on Amazon.com
Format:Hardcover
This book addresses the issue of how we make decisions about our medical care. Most of the book is comprised of case studies, actual patients who had to make decisions like whether to take cholesterol-lowering drugs, have knee surgery or sign do-not-resuscitate orders.

Drs. Groopman and Hartzband let the patients talk at length. Their stories are not simple tales with black-and-white answers or outcomes. The patients dither, they procrastinate, they clam up when they should talk frankly, they change their minds, they reject medical advice. Sometimes they do the right thing, sometimes they don't.

I appreciated this ambiguity. We often read medical horror stories and think, "Well, I wouldn't have made a mess of it like they did. I would have done the right thing." These stories show that the right course of action is often not clear or straightforward, and even when it is, it may be a difficult action to take, for many reasons.

Drs. Groopman and Hartzband do a fine job of identifying ways patients typically respond to medical advice, especially in the concluding chapter. You can skip right to that one, if you want: some people are believers, some doubters, some trust in natural therapies, some in technology, some people are minimalists, others maximalists. Most of us harbor some mix of these tendencies that guides our medical decision making.

I'm not sure the book addresses "how to decide what is right for you" as the subtitle suggests. I found the book to be more descriptive than prescriptive. And, I suspect that when most of us become patients we won't have the same luxury to weigh options and come to reasoned conclusions as the people in this book did. After a while, I just wanted to shout at some of these folks, "Take the pill! Have the surgery!"

But I really appreciated the End of Life chapter, in which the grey areas of treatment when nearing the end of life are fully explored. I think we tend to believe that if we just sign advance directives and health care proxies, we're covered. But the case study here shows that little by little, small step by small step, a family can be drawn into procedures and treatments they were certain they didn't want. If these case studies simply get people talking more honestly and openly to their doctors and their families, these authors will have done a great service with this book.
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