Making health decisions: mindsets, numbers, and stories

Lloyd Resnick

Former Editor, Harvard Heart Letter

How do people make decisions about their health and medical treatment? It’s something I think about, and try to help with, as editor of the Harvard Heart Letter. So it was interesting to take a busman’s holiday to listen to two thoughtful physicians who have grappled with that very question.

Drs. Jerome Groopman and Pamela Hartzband, both faculty members at Harvard Medical School and physicians at Beth Israel Deaconess Medical Center, have written a new book called Your Medical Mind. Its main topic is how people make medical decisions. They spoke about their work in the inaugural Health Information Lunchtime Lecture Series in Consumer Health at Harvard Medical School’s Countway Library of Medicine.

The husband-and-wife team pointed to three basic influences that drive our medical decisions: our mindset or general approach to medical matters, numbers (medical data and how they are presented), and stories. Stories, say the authors, are often the most compelling force in making medical decisions. “Scientists in general hate stories,” joked Dr. Groopman. “But most of us understand our world through narratives.”

Groopman and Hartzband distilled interviews with scores of patients to arrive at general mindsets that shape medical decisions. Some people are maximalists, who are willing to undergo whatever test or treatment might help. Their opposites, the minimalists, prefer as little intervention as possible. Naturalists opt for an herbal preparation that is chemically identical to a drug produced in a lab, while technologists would prefer the synthetic formulation. (The speakers surmised that the recently deceased Steve Jobs was a curious combination: a naturalist-maximalist.)

There are also the believers, who take what their doctors say as gospel, and doubters, who search for any possible evidence that their doctors’ recommendations might be worse than the diseases they treat.

These mindsets, Drs. Groopman and Hartzband emphasized, can and do change in the face of new numbers, well-framed advice from physicians, compelling stories from friends and family, and, alas, stories of another kind: direct-to-consumer advertising. “If you regularly watch the evening news and a couple of hours of prime time TV, you’ll see about 16 hours of drug ads a year,” Dr. Hartzband noted. “That’s a lot more time than you probably spend with your doctor.”

In an ideal world, medical decisions would be based partly on incontrovertible and unambiguous numbers, but “evidence, data, numbers, and studies are imperfect and often flawed,” Dr. Groopman said. “There are no black and white answers.” Even the so-called expert panels, which have recently disagreed about high-stakes matters such as screening for breast and prostate cancer, layer subjective interpretations onto the hard numbers.

Both authors conceded that, during medical training, they weren’t taught how patient preferences are formed or how to elicit them. Today Dr. Hartzband does it this way: “After explaining the options as neutrally as possible, I ask, ‘Tell me what you’re thinking?’ I listen and make a special effort not to present my point of view until I’ve heard from my patient.”

This is a good reminder to let our doctors know what we’re thinking, whether we’re specifically asked or not.

Related Information: Harvard Heart Letter


  1. Dom Schwab

    Hello Ladies and Gentlemen, December 13, 2011

    I do so hope you are well, in good health! In my opinion, the shortfall we are facing in the Medical Care Arena. Is that the sheer numbers of population. Versus the available Medical Practitioners! Has caused so many shortfalls of effective time and fiduciary constraints. That many of our people are suffering without proper Medical Care. Why cannot we organize a Med-Teck Situation. Whereby, People who actually have Sincere Concern for People!Also of Good Character! Can recieve an Expedited course in Basic Diagnosis and Suggestions/(Limited Preschription writing ability(No Heavy Narchotics)Only Antibiotics and other preventative and condition alleviating Scripts, for Care. To alleviate the momentious work load faced by our present Highly Skilled Physicians. For Instance a short 2 Year Course of Rather Intense Dimensions. Military Schools have proven very effective. In what they can accomplish with Apt Students! Personally I prefer Air Force Or Navy Role Models. So a Similar Format Perhaps! They could then with time become highly accessable and cost effective. Also, i would suggest they be also Schooled in Basic, Life Saving Field Surgery. How many are being lost annually because no one was there. Available to provide effective, on the spot care? Looking to the future; Some care not because of population explosion! I believe we should care as much, if not more! We as a Species are on the brink of Colonizing other Worlds. If We Care about them all! The Challenges We Face, Are Not Insurmountable! Rather Perhaps, It may very well improve us as conscious beings. For the Challenge Faced and Accomplished! Just a Sugggestion, Sincerly, Dom Schwab.

  2. Dr.Subhash Dabir

    The mindset of people differ from patient to patient based on their past experiences with other doctors. Treatment approach change from doctor to doctor.This will puzzle patients.

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