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Making intelligent decisions - a guide for patients

Posted Nov 18 2008 12:13am

Patients need to weigh multiple factors when making a decision as to which treatment to select. These include : costs, risks, medical expertise, personal beliefs, social pressures. This is why medical decision making can be so hard. This is especially true for infertile couples, because treatment is elective - and there are so many choices.

Unfortunately, many get confused and don't know what to do next. They either get analysis-paralysis; or allow their doctor to make all the decisions, since he is the "expert".

Both these options are not optimal, because a doctor cannot read your mind ! I find that the following guide helps many of my patients to think through their options, so they can make a decision which gives them peace of mind.

The first step is to use your head. You need to do your research and find information so you can make a list of all your options . This list should be mutually exclusive and completely exhaustive. This should be done objectively , so don't make any judgments at this stage. It can help to pretend that you a compiling a list for a friend; and your only criterion is that the list should be as complete as possible. The doctor can be very helpful at this stage, in providing more information about the options; and their costs, risks and benefits.

There are quite a few problems with this step of gathering information. You may have too little - for example, if your doctor does not provide you with a copy of your medical records, so you don't have the data you need. Conversely, you may have too much - for example, if you do an uncritical google search. The information quality may be poor - and a lot of it maybe unreliable or outdated. Sometimes the information you unearth maybe contradictory - leading to even more confusion ! The good news is that it's possible to get good quality information if you are willing to be paitient ; are willing to learn; and to be critical.

The second step is to then use your heart. If you had no limitations, then which option would you select as the best choice ? The second best ? You need to rank your options, according to your personal preferences. Remember that you are using your heart, and you do not need to justify any of your choices - just follow your gut feelings !

I have often seen that two patients, when presented with exactly the same information, come to diametrically opposite conclusions ! This is because they have followed their heart - and everyone's heart is unique. It's fine to use prayer - or even tools such as astrology ( which defy logic) in this step.

The final step is to then combine both logic and emotions, and work out the logistics of what is practical, possible and feasible.

This decision making matrix will allow you to explore all options systematically, so you don't get confused and can follow the "path of least regret". This way you have peace of mind you did your best, no matter what the outcome ( which will always be uncertain in medicine !)

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