Judging Patients' Decisions

Seems everyone’s an expert these days, which can add to patients’ distress.

A woman is found to have an abnormal finding on a screening study. After shared decision making with a highly qualified specialist, she undergoes an excisional biopsy. At home, she calls a friend who’s a survivor to share the glorious news: “I’m really sore. But the final pathology indicates all the abnormal tissue is removed. No need for further treatment!”

Instead of receiving congratulations for the news and/or sympathy for the ongoing pain, she gets scolded: “You may have had surgery you didn’t need. Why didn’t you get a second opinion?”

Now, still in pain, the patient is wondering if she should doubt her decision and her doctors.

Three pieces of advice for responding to a friend who shares a medical update with you:

  1. Please don’t offer your opinion about any decisions, unless asked for it.

  2. Please recognize the limits of what you can possibly know about the best decisions if you…

    1. are not a medical professional in that field

    2. have not taken a medical history, performed an examination, reviewed the test results, discussed with him or her the options in the context of the patient’s risk-taking preferences

I’m a strong proponent of getting second (and third) opinions. Patients don’t always need them, especially for decisions about which diagnostic tests to run or if a biopsy is indicated—including excisional biopsies and lumpectomies. At times, the benefits of proceeding outweigh the potential benefits of getting additional opinions.

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