By Jerome Groopman MD & Pamela Hartzband MD

I bought this book for from the Popular RM 5 fiesta last year. In a way it’s not directly related to psychology or mental health, but in fact anything about human behaviour – it is psychology. And this book is about how patients decide their treatments.

It doesn’t tell you how to decide, or what is right for you, but it shows you clearly how your past experience and up bringing influence your attitudes and decisions. I’d say this is important to know (I’m a minimalist, and a serious doubter), so I learnt how to communicate with my doctors, so that I see how the dr’s background may affect his/her approach on the patients, so I can help the dr to help me better. In addition to that, I also learnt how to understand those figures that drs or papers like to present us with, it is an important skill to gain (so when the dr tells you taking X drug will help 30% of the patients who are similar to you, you know what it really means).

Few things that I learnt from the book:

•  When you feel good, it’s difficult to imagine the choices and to forecast the decisions you will make when you are ill. Imagining that you have a disease, or that you have to live with X side effects, is not the same as actually experiencing them.
• All of us initially overestimate the ultimate impact of illness and its unpleasant side effects because we tend to focus on the negative and neglect the numerous positives in our lives.
• Many psychological studies show that we regularly underestimate our ability to adapt.
• Much of medicine is still an uncertain science, existing in gray zone — not clearly black or white. So there isn’t a clear “best” approach.
• Bernoulli’s Formula [(probability of outcome) x (utility of outcome) = expected utility]
• Three approaches that researchers have devised to come up with a number for the impact of living with a side effect: (1) rating scale; (2) time trade-off; (3) standard gamble. (please see the book for details, but they are not interchangeable, so I don’t consider them as practical.)
• A doctor’s good reputation can be built by … simply picking healthier patients, and avoiding patients with multiple medical problems (such as diabetes with kidney failure and heart disease), and thus will have better “outcomes”.
• A person’s wishes about treatment often fluctuate over the course of an illness. Completing a living will or advance directive had no effect on whether they maintained or shifted their initial thoughts about what therapies they wanted. It is difficult to imagine what they will want and how much they can endure when their condition shifts from healthy to sick and then to even sicker.
• Modern technology can support, at least temporarily, organs like lungs with a ventilator, the heart with a bypass apparatus, and the kidneys with dialysis. The liver cannot be supported by a machine but this vital organ can be transplanted.
• Research among patients in the ICU found that doctors are generally correct in giving a prognosis for moderately ill patients, but they aren’t very good at predicting the course of the sickest patients. They erred on both sides — too optimistic and too pessimistic.
• And many more…