New Review of Critical Decisions

My heart was warmed by a new, and very positive, review of a Critical Decisions. I always find myself agreeing with people who liked my book. Funny thing. Anyway, here is the review:

“This is a very belated review. And I mean that as a compliment.

As soon as I finished reading Peter Ubel’s Critical Decisions, I immediately leant it out to a colleague as a very enjoyable “must-read.” She devoured it and passed it along to yet another colleague – and that was literally the last I saw of my copy, which I hope to eventually get back in some kind of battered but well-read condition.

Yes, we’ve ordered more copies. But I think everyone keeps passing it on because Critical Decisions provides a wealth of history and information about medical decision making, and how doctors and patients each think about decisions. Perhaps most importantly, it shows the author confronting the reality of how medical decision making actually plays out in the real world.

It starts by tracing the history of medical decisions. Yes, we’ve come a long way from the days where even a U.S. president wouldn’t question a physician’s recommendation for his wife to get something as life-changing as a mastectomy without even discussing the biopsy results, to a world where individuals and families have more opportunity to participate in and make decisions about their care.
But on both the patient and the clinician side, so many factors influence and bias us, and we’re often unaware of it.

First, as Ubel points out, decisions are also a burden. And when decisions get even a little tough we often look for ways not to decide. Yep, we defer. A common instinct is to ask our doctor what they would do if they were the patient. But it’s a problematic request, because our judgment changes when we’re actually responsible for the decision.

Even if we don’t defer, we often base decisions on a friend or family member’s good or bad experience with a drug or treatment, which may or may not be the norm. We also underestimate our own resilience and can’t imagine getting used to things like self-injecting insulin. And when words like “cancer” are introduced, we inflate risks, thinking they’re more likely. Clearly, it’s hard to give our brains space for calm deliberation. And, as Ubel writes:

Good decision making is not merely a matter of comprehension. Understanding doesn’t necessarily lead people toward making rational choices. Decision making is often as much about feeling as it is about thinking. And the way people use risk information… is often influenced less by their understanding of the magnitude of these risks than by subtle psychological cues that change the way these risks feel. (p. 137)… (Read more)”

 

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