How to Choose the Best Medical Treatments

For generations, people dutifully obeyed medical authority-the doctor was always right. Then, medical consumers were urged to take control of their own treatment-to scour the Internet for information and seek additional medical opinions.

But does this approach ensure the best possible medical care? Many patients engage in extensive fact-finding missions that can be overwhelming, expensive and confusing. What's more, some patients feel they are unintentionally turning their doctors into adversaries to be challenged at every step.

Latest development: Experts who conduct research on decision making say that it's more helpful to bring your own personal values and preferences to the medical process than to spend your time exhaustively gathering information and/or seeking multiple opinions.

Albert G. Mulley, MD, cofounder of the Foundation for Informed Medical Decision Making, a nonprofit organization dedicated to helping people understand their medical choices, answers question about this approach.

• Why has the thinking changed on the best ways for patients to make medical decisions? There is an increasing recognition that few medical decisions are clear-cut. Most of the time, doctors and patients work in a gray zone. Two or more treatment options may be consistent with medical evidence and good medical practice. For example, for some women with breast cancer, a mastectomy (removal of the entire breast) or a lumpectomy (removal of the tumor and surrounding tissue) with radiation will yield the same chances of survival. Women who strongly prefer to save the breast will choose lumpectomy. They figure that if the cancer returns, they'll undergo a mastectomy then-but at least they will have a few more years with the breast. Other women feel that if their cancer comes back, they will regret not having removed more tissue, so they opt for mastectomy. Both treatments are equally effective, but the "best" choice is largely dictated by personal preference.
  

Doctors who have studied patients' decision-making processes recommend cooperation between the doctor and patient, recognizing that while doctors have technical, objective information, patients have subjective knowledge of their life priorities.

Imagine that you buy an airline ticket. Who controls the flight—you or the pilot? You could say the pilot, because he/she has the technical know-how to fly a plane. But you chose a plane that was going where you wanted to go.

It's the same with medical decisions. If you have doctors you trust and respect, then you'll want to make great use of their technical medical expertise. Once you know all treatment options and possible outcomes, you need to do the hard work of thinking about what is important to you...what outcomes you hope for and what consequences you are willing to live with.

• How do I ensure that I will know what all the options are? You ask. When faced with a new treatment option-whether it is surgery or a new prescription—you should always ask your doctor...
  

1. Why are you recommending this treatment? This will help you understand the doctor's reasoning.

2. What is the likely outcome of this treatment? Listen for the typical outcome as well as the best-case and worst-case scenarios.

3. What are the possible side effects or consequences, and what are the chances of these occurring? With this response, you will learn about the potentially negative physical and psychological effects of a proposed treatment.

4. What does the procedure involve? This will tell you what it feels like to experience a particular medical procedure or treatment.

5. What are my other options? For each option, ask why it wasn't the doctor's first choice. Keep asking about other options until the doctor has exhausted all possibilities.

6. What happens if I do nothing? This tells you the natural course of the disease. You always have the option to decline treatment.

The answers to these questions provide all the objective information you need-options, possible outcomes, risks and benefits.

• Shouldn't I get a second opinion? In some cases, another doctor might clearly have more expertise in one of the treatment options, and this may warrant getting a second opinion. But it doesn't make sense to go to one doctor, passively hear out his recommendation, then go to another doctor and get another recommendation. In general, it makes more sense to fully explore all the options with a well-trained doctor who is willing to work with you in sharing the decision-making responsibility. If you don't trust your doctor to give you all of your options, then you should look for another doctor.
  
• How do I know that my doctor is telling me everything I need to know? Although physicians may prefer one treatment over another, they usually know all of the possible options and are willing to share them with patients who ask. A doctor may have a bias toward treatments with which he is most familiar-patients should be mindful of this when deciding whether they have a balanced understanding of the options. If you are seeing a specialist, ask about his experience with each treatment option and whether it is advisable to speak to a different specialist.
  
• Isn't there value in doing Internet searches to learn more about my disorder? Of course, the Internet can be useful, but it of ten produces a lot of information that isn't necessarily relevant to your individual situation.
  

A good medical decision by a patient is not always Lased on knowing a lot of detail-It's often about knowing the gist of your problem, what your options are and what the outcomes may be. Then you can apply your own personal preferences.

Many people value data over feelings. But the subjective part of the decision-making process is at least as important as the objective information. If you don't factor in your needs and de sires, you leave a lot to chance...and the stakes are too high to rely on textbook knowledge and statistics alone.

• What is the best way to evaluate my needs so that I know I am making a sound decision? For each treatment option, write down the reasons you might choose it (the benefits) and the reasons to avoid it the risks). How much do those risks and benefits matter to you? How do you feel about the impact of each possible outcome?
  

If you find that you have unanswered questions or don't understand the possible outcomes, talk with your doctor again. Also, talk with other people who have been through similar treatments to discover how they feel about the experience. Ask your doctor if there is a support group you could attend or if there are counselors to consult.

There is an element of chance in any decision. You need to reduce uncertainty to its lowest possible point, then make a decision you can live with. That way, there can be no "wrong" decisions.