How to make health decisions, a 3-step guide
Last week a very young relative, let’s call her Mia, aged 2, was scheduled to have an operation. A simple operation, but one that required a general anaesthetic. Mia’s parents were nervous, it was their first child, and the idea of the little one being knocked unconscious and operated on was not a pleasant thought. Health decisions can be really tough.
The general anaesthetic sounded potentially risky. What’s more Mia’s parents had heard plenty of opposing views saying the operation wasn’t even unnecessary.
What would you do in this situation? You have very little knowledge, no experience. You are relying on experts who don’t always agree, and the stakes are high.
A similar medical example is quoted in the excellent book Decisive by the Heath brothers, so I shared the Heaths’ advice with Mia’s parents. The advice was to “zoom in, and then zoom out”.
Zoom in and Zoom Out
Zoom In effectively means “go talk to some real people who’ve been through it” and see if it was worth it, whether there were any unexpected side effects and so on. Get up close and personal. The easiest way to do this is to look at online health forums. Sifting through the forums requires a healthy dose of cynicism, but where the entries report what their medical professionals tell them, or what happened in and after the operation, it can give you some valuable information.
Zoom Out means to go searching for the objective, helicopter view of the risks. In this instance Mia’s mum and dad were able to find, online, a review of all the deaths from general anaesthetic in Australia, and see that in that 3 year period no one under 20 died under general anaesthetic. Of the 53 people who did die (out of 900,000+ operations) the majority were over 60. This information was reassuring. The anaesthetic had gone from sounding risky, to sounding safe.
With this information to hand, Mia’s parents felt much more in control of the situation, and aware of the risks and benefits involved. Combining objective and subjective reports felt like a great way to make a decision. They went ahead and Mia had a successful operation.
This wasn’t a serious or long-term health issue. Those who have long term issues often report huge amounts of stress from having to make new decisions at every turn, in the absence of knowledge. The doctor is giving you their recommendation but asking you for the decision. What do you do? You’re hardly qualified to disagree with the doctor.
One way to reduce the stress
Decision-making expert, Professor Baba Shiv faced this very issue himself. He felt that having to make these life-or-death decisions while not being the expert himself was excruciatingly stressful. His solution? He decided not to decide, to put 100% faith in the doctor’s recommendation every time. There may be some sense in this, especially if you know the track record of your doctor.
Questions to ask your doctor
And yet, some estimates say that doctors misdiagnose 10-15% cases each year in Australia, and that between 2,000-4,000 people die as a result. Doctors are also subject to cognitive biases, just like the rest of us. They are prone to the availability bias, that is they are more likely to diagnose conditions that are heavily publicised. And also the confirmation bias, where when they form an initial hypothesis, they may test for this and miss other possible conditions. Some in the medical profession have begun to look into this and challenge doctors to improve their thinking around diagnosis and decision making.
The best approach to this situation is to be aware of the risks of misdiagnosis, and to challenge your doctor around their diagnosis (and/or the treatment) and ask them whether they have ruled out other options too quickly? Is there anything about your symptoms which doesn’t fit their diagnosis? Get a second opinion if necessary.
In summary, to make good decisions in medical situations…
- Zoom In
- Zoom Out
- Prompt your doctor to challenge his or her assumptions
Written by Rob Pyne