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Making Decisions

Posted 6/17/2014

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  We may decry the old culture of "doctor as god" and paternalistic medicine. However, it was a lot easier back in the days when we just did what our doctor suggested. Please do not misunderstand: I know that our era of partnership and empowerment and advocating for ourselves is a major improvement, but I also know that it brings a lot of stress and uncertainty. No matter how motivated we may be, we are not going to be able to learn as much about cancer and cancer treatment in the weeks after diagnosis, or in the years after diagnosis, as our doctors know. At some level, we need to sit back and trust them.

  This comes up in many ways and at many times for women with breast cancr. The beginning is choosing a doctor or an institution for care. Most of us are referred by our PCP or GYN or take the advice of family and friends or have no choice because of geography or insurance constraints. Many of us do have options, and surely in the Boston area, we have many wonderful options. I tell women daily that there likely is no difference in the  excellent treatment they will receive at any of the big Boston teaching hospitals, but that the cultures are slightly different, and each of us probably will feel most comfortable in one or another place. Of course, the relationship with your doctor (s) matters most of all. When you choose a medical oncologist, you are beginning a years, if not life, long relationship. It matters that you like, respect, and trust her/him.

  Choices and confusion continue with surgical options (especially for women who are considering a mastectomy or mastectomies and wondering about reconstruction) and then with chemo and, later, perhaps, with clinical trials or ongoing treatments. It is important to be true to yourself at each of these junctures. By this I mean that some of us want to know as much as possible, and others want to know only what is necessary. Don't try to become someone you're not; that will only increase the stress level. See the closing sentence in the paragraph above for the fall back position: trust your doctor.

  This is all an introduction to an excellent piece by Heather Millar in WebMD:

At a Cancer Treatment Crossroad? What to Consider
By Heather Millar

I’ve always loved the Robert Frost poem “The Road Not Taken,” which starts:
“Two roads diverged in a yellow wood,
And sorry I could not travel both.
And be one traveler, long I stood. …”
During my journey through cancer, those lines became even more profoundly meaningful – it felt
like I was constantly faced with the question, “Which road should I choose?” As cancer patients,
we stand at crossroads all the time. Should we opt for this treatment or that treatment? Have
chemo or not? Decide on hospice? Or fight a while longer? Change doctors, or not? Exploratory
surgery, or a PET scan? And once we make a decision, it feels like we can’t “un-make” it. And the
stakes are so high: life and death.
I’ve been thinking about this a lot in the last week. I’ve had several conversations with both cancer patients and survivors in which they lament the lack of clarity when you have cancer. What if one doctor tells you that this is the best treatment, and then another doctor tells you the opposite? How do
you know which one is correct? Is one incompetent, or do these doctors just have a professional disagreement? How do you know you’re doing the right thing?
I think that in cancer, as in the rest of life, there are times when you just can’t know if you’re choosing the right path. But here are some things I’ve learned about health crossroads, and I hope they may help you when “two roads diverge” in a cancer clinic

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