Submitted by Dr. Robert F. Lane on
“Rational Choice Theory assumes that people make decisions by multiplying the probability of getting what they want by the amount of pleasure (utility) that getting it will bring."*9. This presupposes that one really knows what he/she wants, can tell the doctor and then can reliably extract the probability of getting it from their doctor. If you can’t communicate realistic goals, he has no chance of giving you realistic probabilities. Only you can figure this out and tell him.
In real life, many people haven’t really resolved what is both most important and actually possible. Even if they have, they often lack the eloquence to express it or the courage to insist their physician provide a fair estimate of achieving it with any treatment program. You must have this figured out by the end of the backstretch. Odds are that you don’t really know when that is - so get on with it. Peace will follow.
A study of cancer patients with less than 4 months to live revealed that in less than one third of the patients did a doctor ask “What are your fears, goals and priorities when your time is short? What outcome for you would be unacceptable?” So if you can’t count on the doctor to ask, you have to ask yourself. This is huge. Studies also show that those who have this conversation suffer less, stop chemotherapy more readily and accept Hospice sooner. They also spend less time in the hospital and in the case of lung cancer, live 25% longer!*10.
Compromised communications with physicians can have both a gender and generational component. Women, more often than men, have not found their voice or the empowerment to use it, either out of temerity, misguided respect or fear; in any case, silence does not serve them well. Older patients belong to a generation that was conditioned to never question the doctor, believing he is the expert and is therefore always right. Often they are just not prepared.
A loss aversion proclivity can sabotage rational choices on two levels. Fear of losing hope can prevent one asking the tough questions that would provide the information necessary to make a rational choice. Fear of losing one’s life can compel one to irrationally choose a treatment that offers more toxicity than benefit . Chalk another one up for the Dragon!
It's like a batter at the plate with a three and two count taking a wild swing at a pitch that is way outside the strike zone in the hopes of scoring a home run. If he had only let it go by, he would have at least gotten a walk to first base. If a cancer patient will let the futile therapy pass by, they would at least be toxicity free on first base.
One has to drive down hard on what really matters and focus on both the upside and downside of the treatment decision. To be rational you need to know what the chances are that the new treatment will actually deliver on your hopes and recognize there is a chance that more treatment will take away something you already have, i.e., time without treatment side effects. Rational decisions deliver more quality life.
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