As consumers we are required to make choices. Every trip to Starbucks involves multiple decisions - The kind, the size, single or double shot, regular, soy or skim milk. It's usually fun exercising control over our beverage, but sometimes we just can't handle all these options. And, because choice making now prevails, even in the medical arena, sometimes we feel ill equipped to choose. Especially when the stakes are way higher than having too much foam.
Like coffee lovers, patients nowadays are increasingly granted the active role in medical decisions. This dovetails with an emphasis on patient autonomy. Just like the guy behind the coffee bar won't tell you what's best for you, the emancipated patient is assigned the reigns, and the doctor is only there to advise. Is that a good thing? Well, depends who you ask. And depends when you ask them. Because, when wriggling in the patient's seat, even the most devout advocate of patient autonomy may lament being robbed of the soothing certainty of having someone tell them what they should do to get better.
If anyone is well equipped for the patient role, it's C. A leading economist at a research institute, he spends his days writing acerbic reports, reading papers coming out of the National Bureau of Economic Research, going over endless tables displaying the logarithmic transformation of income and God knows what else, poring over numbers and highlighting columns with a yellow marker. The numbers, he says, speak to him. He wished to remain anonymous in case his heart fails again, and his doctors do not appreciate the way they are portrayed here. I will call him Clint, like Eastwood. Clint is in his fifties, smart as a whip; a cynic if ever there was one. Whereas other offices in his institute have a breathtaking view of the city, Clint's window overlooks a grim brick edifice. As though someone knew that such a man, perpetually enraged at fiscal policy, would not benefit from a more slightly vista.
Fifteen years ago Clint had a heart attack, and he's been having heart problems ever since. He has learned to live with the follow-up examinations and the daily aspirin. And he is not easily scared. Guys named Clint, who wear broad-rimmed hats seldom are. So it did not scare Clint when he came in for an exam and his cardiologist said things weren't looking too good, and he should get a bypass.
When national deficit data is presented, Clint is the first one to question the figures. But when the doctor who's been treating him for years told Clint he should get a bypass, an invasive procedure, he obediently signed up for it. "Then I went home," Clint tells me, "and my wife and daughters told me I was an idiot." They did not just call him an idiot, they suggested he seek a second opinion and, when he did, he got called an idiot a second time, by the second cardiologist. "Why would you agree to a risky procedure when there are no clear clinical indications that you need it? All in all, you're doing well. If your condition worsens, you should consider a bypass. But not now. You shouldn't volunteer to have your chest cut open."
Clint, who does not qualify as an idiot, was a bewildered man. He canceled the bypass surgery, but lost his peace of mind. Did he do the right thing? One doctor said he should have a major operation. The other said he shouldn't. And it up to him to decide. Clint is a smart man, educated, skeptical, seeking information. So when he met the director of the largest medical center in town, he couldn't help but blurt "what kind of jackass doctors do you have anyway? They can't make up their minds over anything."
The medical sheriff did not flinch. Instead, he sent Clint to yet another cardiologist. He swore by him.
As the famed cardiologist examined Clint, Clint was feeling serenity take over him. He would finally know what to do. But when the cardiologist gave his verdict, he did not say "do the bypass!" or "don't do the bypass!" Instead, he told Clint "you have three options."
Clint's sickly heart sank. Three options? He came in with two - to bypass or not to bypass, but now the doctor added another. "How about we use a stent? We won't touch the clogged artery, which was the candidate for the bypass. Instead, we'll insert a stent in another artery, which isn't as clogged."
Once again, Clint was required to decide. Once again, he wasn't sure. "What would you do?" he asked the doctor.
"I would go for the stent," doc replied, immediately qualifying, "but it's up to you."
