Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Good decision making often depends on good communication

Peter Ubel, MD
Physician
November 19, 2012
Share
Tweet
Share

We live in an age of patient empowerment.  Medical students are now routinely taught that the “right choice” often depends on patient preferences—on how an individual patient weighs the pros and cons of her treatment alternatives.  That means medical decisions depend, more than ever, on good communication. Physicians need to help patients understand their choices so that they can partner with their patients in discovering the best alternatives, ones personalized to fit each patient’s individual preferences.

But helping patients understand their treatment choices is often no simple matter.

In my book Critical Decisions, I provide a word by word account of an earnestly communicative hematologist describing the risks and benefits of treating leukemia to his patient.  The hematologist tries to explain that there is a good chance the patient’s tumor will respond to chemotherapy.

“So if you look at complete cytogenetic response rates in the chronic phase,” the hematologist explains, “it’s about 80%, and if you look at the accelerated phase, it’s about 15%.  So, the drug doesn’t work in advanced disease very well. If you look at patients who get a complete cytogenetic response as their best response in the Iris trial, their risk of ever progressing in the next 4 years, so about 48 months roughly, is about 8% overall.”

“That’s good,” the patient replied.

“Yeah.  So, and this is divided into people who become Philadelphia chromosome positive but appear to be in chronic phase.  And half of these are people who go to accelerated phase or blast crisis.  If you look at people who had complete cytogenetic response, this is people who had complete cytogenetic remission at any time of the trial, … if you look at people who are at complete cytogenetic remission at 6 months like you are, this is probably less than 5%, so.”

“Over 4 years?”

“Yeah,” the doctor replied. “Now if you look at the curves, truth be known, there’s a steady decline.  It’s about a risk of losing progression overall in the study of somewhere between 2-4% per year.”

The patient is understandably confused.  In less than two minutes time, she has been deluged with numbers: 80%, 15%, 48 months, 4 years … whose head wouldn’t be spinning?

Later in this conversation, during an appointment that lasted more than an hour, the patient would learn that if she goes into complete remission (one of those numbers from above, I think), she would still face a 5% risk of cancer progression over the next 4 years, and a 4% risk (time-frame unspecified by the physician) of expressing new chromosomal changes.  If she has a recurrence, she can get a bone marrow transplant (which led to a 5 or 10 minute conversation laying out the odds of surviving such a treatment, plus the odds of experiencing graft versus host disease: “there’s about a 40-50% chance you’d need some therapy for that.  And then if you are an unrelated donor and a match, it goes up to about 70% …”), with the subsequent risk of chronic relapse of 5 to 8% depending on …well, does it really matter anymore?

We physicians are a highly numerate group of people.  To us, numbers are second nature.  In many doctor/patient encounters, in fact, physicians unwittingly flip back and forth between percentages (“3%”) and frequencies (“8 out of 100”).  After all, isn’t 3% the same thing as 3 out of 100?  But for many patients, this back and forth is incredibly confusing. Look what this back and forth did to Yogi Berra, who, when asked by reporters to explain the intricacies of baseball explained that: “90% of the game is half mental.”

Good decision making often depends on good communication.  The patient empowerment revolution succeeded in convincing most of us physicians that patients deserve an important role in making medical decisions.  Now we have to find better ways of helping doctors and patients talk with each other, in a language each party can understand.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Prev

What are the biggest issues with EMR today?

November 19, 2012 Kevin 12
…
Next

In defense of the terrible twos

November 19, 2012 Kevin 1
…

ADVERTISEMENT

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
What are the biggest issues with EMR today?
Next Post >
In defense of the terrible twos

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Physician

  • From rejection to resilience: my journey through emergency medicine residency

    Dr. Syed Hassan
  • What my first Match Day as a program director taught me about hope

    Ryan McCarthy, MD
  • Stop absorbing the chaos: How doctors can reclaim their well-being

    Jessie Mahoney, MD
  • Why no medical malpractice firm responded to my scientific protocol

    Howard Smith, MD
  • Doctors speak out: Why we’re saying no to burnout

    Aisha Quarles, MD
  • When doctors die in silence: Confronting the epidemic of violence against physicians

    Muhamad Aly Rifai, MD
  • Most Popular

  • Past Week

    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The hidden impact of denials on health care systems

      Diana Ortiz, JD | Finance
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • Misconceptions about food allergy safety in the skies [PODCAST]

      The Podcast by KevinMD | Podcast
    • C. Everett Koop’s defining stand against the tobacco industry [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • Doctors don’t need yoga, they need time to smoke

      Salim Afshar, MD, DMD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
    • Flatline: Our nation is dying, and we’re ignoring the signs

      Tomi Mitchell, MD | Physician
  • Recent Posts

    • Misconceptions about food allergy safety in the skies [PODCAST]

      The Podcast by KevinMD | Podcast
    • From rejection to resilience: my journey through emergency medicine residency

      Dr. Syed Hassan | Physician
    • Conflicts of interest are eroding trust in U.S. health agencies

      Martha Rosenberg | Policy
    • Why the words doctors use matter more than they think

      Erin Paterson | Conditions
    • What my first Match Day as a program director taught me about hope

      Ryan McCarthy, MD | Physician
    • Navigating the path from physician burnout to career balance [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The hidden impact of denials on health care systems

      Diana Ortiz, JD | Finance
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • Misconceptions about food allergy safety in the skies [PODCAST]

      The Podcast by KevinMD | Podcast
    • C. Everett Koop’s defining stand against the tobacco industry [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • Doctors don’t need yoga, they need time to smoke

      Salim Afshar, MD, DMD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
    • Flatline: Our nation is dying, and we’re ignoring the signs

      Tomi Mitchell, MD | Physician
  • Recent Posts

    • Misconceptions about food allergy safety in the skies [PODCAST]

      The Podcast by KevinMD | Podcast
    • From rejection to resilience: my journey through emergency medicine residency

      Dr. Syed Hassan | Physician
    • Conflicts of interest are eroding trust in U.S. health agencies

      Martha Rosenberg | Policy
    • Why the words doctors use matter more than they think

      Erin Paterson | Conditions
    • What my first Match Day as a program director taught me about hope

      Ryan McCarthy, MD | Physician
    • Navigating the path from physician burnout to career balance [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Good decision making often depends on good communication
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...