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Excerpt From 'Your Medical Mind'

A patient's preference does matter

If medicine were an exact science, like mathematics, there would be one correct answer for each problem. Your preferences about treatment would be irrelevant to what is "right." But medicine is an uncertain science.

See also: Interview with Jerome Groopman and Pamela Hartzband.

Studies and statistics can tell us that one or two in a group of 100 women with high cholesterol will have a heart attack. But which ones? Similarly, we can't identify with certainty the one or two women out of 300 who will benefit by taking a statin drug. Even genetic information like BRCA testing provides only an estimate of cancer risk. No one can say which women will develop breast cancer or when.

Nor can we say with certainty what impact atrial fibrillation or prostate cancer or any other condition will have on an individual's life or how someone will experience the side effects from a particular treatment. Each of us is unique in the interplay of genetic makeup and environment. The path to maintaining or regaining health is not the same for everyone.

Choices made in this gray zone are frequently not simple or obvious. For that reason, medicine involves nuanced and personalized decision making by both the patient and the doctor.

This essential truth is often overlooked by experts who seek to standardize treatments rather than customize them to the individual. Although presented as scientific, formulas that reduce the experience of illness to numbers are flawed and artificial. Yet insurers and government officials are pressuring physicians and hospitals to standardize care using such formulas. Policy planners and even some doctors have declared that the art of medicine is passé, that care should be delivered in an industrialized fashion with doctors and nurses following operating manuals. They contend that doctors and patients can't be relied upon to decide what is best. While they insist that their aim is "patient-centered care," in fact it is "system-centered care." People need time to explore the roots of their preferences. Your preferences do matter. They provide a foundation so that you can choose the right treatment, the one that fits your values and your way of living.

Also of interest: The digital doctor will see you now. >>

Your Medical Mind, © 2011 by Jerome Groopman, M.D., and Pamela Hartzband, M.D., is published by The Penguin Press. Used by permission of the publisher.

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