Thursday, October 13, 2011

Ask the doctor what's right for you

The always interesting Jerome Groopman, Harvard Med School oncologist, is at it again, with a new book, Your Medical Mind: How To Decide What Is Right For You, co-authored by endrocrinologist Pamela Hartzband.

I know of Groopman through his New Yorker essays -- literate, incisive, balanced, wise.

In this new book, Groopman and Hartzband describe two sets of biases that affect patient decisions. The New York Times Book Review describes them this way:
We can be minimalists, preferring to do as little as possible, or maximalists who aggressively pursue treatment. We can be technology enthusiasts, seeking the newest drugs or procedures, or naturalists who believe the body can cure itself, perhaps with the aid of spiritual or plant-based remedies.
I would describe myself as a minimalist/technology enthusiast. For example, I'm not at all fond of the drugs I'm taking for cholesterol and blood pressure, especially since my readings are only marginally high. On the other hand, if push came to shove, I'd want access to the best modern medicine has to offer. I'll leave the spiritual and plant-based remedies to Anne.

In general -- like most of us, I suspect -- I trust my doctor more than I trust my own instincts, and meekly follow his leads. After all, he has the medical degree and a lifetime of patient experience. I'm confident he has my best interests at heart. At the same time, I've read enough articles in the New York Review by Marcia Angel and her like to have a deep distrust of Big Pharm and their pill-pushing prowess. And who knows how Medicare, the insurance industry, and procedure providers are skewing treatment?

I suppose I'll read Groopman's new book, with his counsel on how to know what's right for me, and then I'll go right on following my doctor's recommendations. I've been with him long enough to like and respect him. I mean, what's a guy to do? Spend hours on the internet second-guessing his doctor's advice? No thanks.

All his is brought to mind by the current controversy over PSA screening for prostate cancer, a disease that killed my father at age 64 because he missed early detection. So far, my doctor has advised screening. Will he follow the new no-test guidelines when I have my annual physical in a few weeks? And what will I decide -- a 75-year-old minimalist/technology enthusiast -- is best for me?