Americans today are bombarded with medical information from a vast array of sources — family members, friends, neighbors, news outlets, TV ads, ads on buses and trains, flyers in your mail — not to mention the medical industry itself. Who should we trust, especially when doctors themselves don't always agree on treatments or protocols?
See also: Excerpt from Your Medical Mind.
Photo by Shelly Harrison; Photography courtesy Penguin Books
In this medical minefield, the all-important doctor-patient relationship needs to be maximized, especially when time is of the essence. Now, two doctors suggest a way to do it.
The husband-and-wife team of Jerome Groopman, M.D., and Pamela Hartzband, M.D. — he's a noted oncologist, she's a noted endocrinologist — offers a way through critical medical decision-making in their new book, Your Medical Mind: How to Decide What Is Right for You. The Boston-based physicians stress the importance of patients' beliefs, backgrounds and personalities when making medical decisions. They say this information should be shared with doctors early on, in an atmosphere of mutual respect and negotiation, so that the smartest medical decisions for each patient can be made.
In a nutshell: All medicine is personal.
To write the book, Groopman and Hartzband drew on more than three decades of experience in medicine. They both serve on the faculty of Harvard Medical School and the staff of Beth Israel Deaconess Medical Center. Together they've written for the Wall Street Journal, the New York Times, the New England Journal of Medicine and other publications, and Groopman is a longtime staff writer for the New Yorker.
AARP Bulletin spoke to them in a joint interview.
Q. You say it's vital that patients share who they are as people very early on in the relationship with the doctor. Why?
Pamela Hartzband: We hope that by beginning the process before you even step into the doctor's office, you'll be able to spend your time more efficiently with the doctor.
Jermone Groopman: We're all suffering, both patients and doctors, under the current 12-minute visits, the 15-minute visits. Everything feels rushed today. Doctors are pressured to check off boxes on the computer screen. Too often people feel as if they're on a factory assembly line. We'd like to help make people more effective patients. Before you even go in, you'll be able to think: Am I a minimalist or a maximalist?
Q. Let's discuss some of the language you've created for patients.
JG. When reflecting on your medical mind, the language and the concept behind it are important. Two of the terms we use are maximalist and minimalist. Maximalist says, "I'm proactive. I'm going to do everything, plus." Minimalist says, "I subscribe to the theory of less is more."
PH. For example, when they hear about a cholesterol-lowering statin, people may say, "Yes, I want that medicine. That sounds good, because to my mind I want to do everything I can for my issue." Other people might say, "Oh, there is not enough benefit for me."
Q. What other terms help capture and define the patient's personality and preference?
PH. Think about whether you're a believer or a doubter. Believers are those who feel that there is a good solution to their problem — they just have to find it and then they'll go ahead with it. Doubters are people who are very risk averse, always thinking about side effects, worried about side effects and risks.
Q. And these things may also change from time to time.
JG. Yes, they are dynamic. These preferences may change after he or she hears what the doctor thinks.
Q. Don't some patients want to be led by the hand — while others want more say in their treatment? How do you reconcile that?
PH. It's very important for patients to understand what they want and to share that with the doctor. If they don't know, they may say to the doctor, "Tell me what I should do." But when somebody says to a doctor, "Tell me what you would do for your mother," well, what we would do for one mother might be different from what we would recommend for another mother! Each patient is an individual.
JG. We're not saying the patient is left on their own. Rather, this shared decision-making, this relationship, has to be grounded in the patient's mind initially and then the doctor's goals. They work together from there.
Q. Is the concept of the patient's "medical mind" taught in medical school?
JG. It's definitely not taught to medical students or residents right now. It's not part of the training; it wasn't part of our medical training, which was extensive. Yet you'll often hear people say, "The preferences of the patient are very important." So how does a physician determine that and then help the patient understand it? That's why we wrote this book.
PH. Doctors have to be very careful not to superimpose their own medical mind-set on the patient.
Q. Given your stress on the personal, do you evoke your own experiences and feelings when talking with your patients?
PH. Absolutely. In my practice I'm often talking to patients about thyroid nodules — nodules within the thyroid gland. Once we've done a biopsy, it might come out equivocal. So when a patient says to me, "What would you do?" I'll often say, "If it were me, I would probably choose to wait a little while" — since I'm a minimalist. But if it were my husband, he would have had it out yesterday" — he's a maximalist. Patients see there are several approaches.
JG. It also shows that as a doctor, you step down from a pedestal and say, "There is no one perfect answer. Each of us must decide what's right for our own situation."
Q. As more and more boomers age, do you foresee changes for the better in palliative care?
JG. Palliative care is an important component of health care. A lot of people think that once someone puts out an advance directive, those choices are engraved in stone. But people change their minds a lot. Or they face critical situations not covered strictly by that directive.
PH. We give the example of someone with lung cancer who develops congestive heart failure and needs, very briefly, to be on a respirator. Is that covered in the directive? It's a different situation.
JG. Palliative care doctors are trained to really understand these choices in a changing, dynamic way. When you're healthy you may say, "Oh, I would never go on a ventilator. I never want to be resuscitated." Then people change and their needs and wishes change.
Q. How can patients' families keep up with these changes?
JG. It's important to just be aware that these preferences can, and do, change over time. And to remember to ask the patient, "How are you feeling about this now? Is this plan still making sense to you?"
Maureen Mackey is an editor and writer based in New York.