Difficult Medical Choice? 3 Steps to Making the Right Decision

Among all the arguments about the pros and cons of healthcare reform, perhaps the most compelling issue for individuals concerns their freedom of choice: Will they still be able to choose their own doctor and healthcare plan? Will they be denied potentially lifesaving procedures? Americans have become accustomed to sitting in the driver's seat when it comes to making important medical decisions. And many doctors are happy to leave the ultimate choice in their patients' hands.

Case in point: Christine Henderson recently had to decide whether to have surgery to unclog a blocked carotid artery in her neck—a risky procedure that causes heart attacks, strokes, or death in up to 3 or 4 percent of patients. Her alternative was to do nothing and face a 3-to-4 percent chance of suffering a stroke in the next year and in every year thereafter. For advice, the 58-year-old grandmother of seven from Baltimore turned to Rajabrata Sarkar, the vascular surgeon at the University of Maryland Medical Center who was evaluating the ultrasound images of her artery. She asked, "What would you do?"

He told her he couldn't make the decision for her—it was her call. But, Sarkar explained, the medical evidence weighed in favor of surgery because the short-term increase in stroke risk would soon be offset by the long-term decrease. Henderson, who had a stroke 12 years ago, decided to go ahead with surgery in June. It was successful.

Some medical experts argue that our healthcare system can go even further than it has toward letting the patient call virtually all the shots, from allowing a friend to hold his hand during a cardiac catheterization to deciding whether she needs an MRI to ensure that a headache isn't caused by a brain tumor. "Doctors should promise choice in all matters that involve a patient," contends Donald Berwick, a pediatrician who is president and chief executive officer of the Institute for Healthcare Improvement, a nonprofit education and research institute in Cambridge, Mass. "There's a good case to be made that better patient experiences lead to better clinical outcomes, but beyond that, I think it's an ethical issue—treating people the way you wish to be treated."

Some say Berwick's patient-centered approach would lead to unnecessary procedures and higher healthcare costs. He answers that evidence shows just the opposite. A recent review of 55 clinical trials published in the journal Cochrane Database of Systematic Reviews shows that patients who participated in informed decision making were 20 percent less likely than other patients to choose costly surgery over medication. Women were less likely to take hormone therapy during menopause, and elderly men were more likely to skip unnecessary screening for prostate cancer.

How do you make the most informed medical decision? Do the following:

1. Be demanding of your doctor. "Ask for their performance rates and surgery outcomes," Berwick says. "See if you can read your medical chart at any time." Your doctor should be able to tell you what the studies show about the risks and benefits of treatment versus doing nothing. And find out if the studies included people like you, considering your age, gender and medical history.

2. Find out as much as you can about a procedure or new treatment. If you're having surgery, find out what it entails and how long it will take for full recuperation. (Doctors have a tendency to downplay the amount of discomfort patients experience after surgery.) Most of all, Berwick says, make sure your doctor communicates effectively to you, sans medical jargon, so you understand exactly what you're facing in terms of possible side effects.

3. Be prepared for trade-offs. When you're facing the toughest of decisions, you need to consider your goals, the medical uncertainties, and the trade-offs, says Alan Schwartz, an associate professor of medical education at the University of Illinois-Chicago College of Medicine and author of Medical Decision Making: A Physician's Guide. "Think about what you want most and communicate that to your doctor. Is it the longest life possible, the best life possible, or something in between?" In most cases, there isn't one perfect decision, and that can make choosing a course agonizing. Sometimes the solution lies in remaining indecisive. "If it won't make a difference in your health outcome," says Schwartz, "take a few months to really think about it."