Recently I received an email from someone I have never met, who asked me the following:
“Could you refer me to any current study results on Arimidex (Anastrozole)? My oncologist is not helpful. My oncotype dx said I have 9% chance of recurrence and with Arimidex for 5 years that is reduced to 4.5 %. Not sure it is worth it?
I remember being mocked because I wouldn’t take HRT in 1996. He chided me that after my uterus was removed I needed it for my heart. Turns out that was not true. Makes me wonder.
Any current info would be helpful.”
One of the joys of writing for broad audiences is that I get to interact with people outside the worlds of academia and medical practice. And since writing Critical Decisions, I have received an increasing number of emails from people who say the book has helped them through their own medical journeys. On the other hand, that sometimes puts me in the awkward position of trying to figure out how to handle anonymous requests for medical advice.
From this person’s brief email, it is clear that this woman had breast cancer and was trying to decide whether to take Arimidex to reduce her chance of recurrence. Now I could answer with a strong medical recommendation: “Of course you should take this medicine. It cuts your risk by 4.5%.” Even if I thought that was the right decision for every patient to make, however, I would never dole out medical advice over email to someone I don’t know. (For that matter, I wouldn’t have ever handled my own patients’ requests that way, when I could talk to them instead about their values, their fears and concerns.) I wouldn’t give her advice over email in part because I am not sure of the legal ramifications—what would happen if she took my advice and something bad happened? Putting legal concerns aside, I wouldn’t want to give a clinical answer to her because I don’t know her well enough, both medically and personally.
Instead, I gave her a different bit of advice. I’m not even sure this was the right thing to do. (I’m eager for your thoughts.) But here is what I wrote:
“I am very very far from an expert on this topic. I am sorry you are facing this tough diagnosis and tough decision.
If you can afford to, I suggest getting a second opinion from another oncologist, if for no other reason than peace of mind. If you get the same advice, that will make you feel better. If you get different advice, but have a better relationship with that doctor, you will be better off too. I hope you find an oncologist who is able to talk to you in the way you expect, someone you feel is helpful.”
What do you think? Did I do the right thing?
**Previously posted on Forbes**