[2021-09-13] Decisions
I've faced a number of big decisions in the past year: whether to proceed with genetic testing, whether to start a tumour-suppressing drug, whether to retire, whether to have a prophylactic bilateral mastectomy and, if so, whether to get breast implants.
I find that for some decisions, I can lay out in my mind the various options and their respective pros and cons and can come to a conclusion I'm happy with. But for other decisions, the variables and risks are too considerable for me to simply think about the question. I need to write down the information I have so that I can step back and look at it.
Blogging has proven to be a helpful way to articulate what I know, to identify gaps in my knowledge, and to come to a sound decision. When I'm missing information, I'll do research, or seek the counsel of an expert, such as a doctor or coach, or talk with someone who has already made the decision I'm contemplating.
Once I have the information I need, I may use a pros-and-cons list, writing down all the possible positive effects and negative consequences of a given choice. Or I may employ a decision tree, which is a diagram that requires me to make a series of decisions, eliminating certain choices as I go. Or I may go for a long walk and think through the considerations.
Whatever method I use, I usually find that one or two reasons emerge as the most compelling. In the case of the prophylactic bilateral mastectomy, the most forceful argument to proceed with surgery is to reduce my risk of breast cancer. The alternative approach—annual screening via mammogram and breast MRI—would not reduce my risk. It would simply identify cancer after it had already developed. Once the screening option was ruled out and the surgery option was chosen, the next question was whether to get implants. Again, one argument was most convincing: as Dr. Cordeiro said, with implants, you go to sleep with breasts and you wake up with breasts.
I got thinking about decision-making after talking to someone I care about who is struggling with a health-related decision. I understand how hard it can be to make a decision, especially one related to our health or the health of a loved one. It's easy to become paralyzed, and thereby make no decision. In fact, not making a decision is making a decision. For example, if the question is "should I take this drug with potential side effects," and I can't decide, I've effectively chosen no.
It's also easy to focus on only one or two considerations and to ignore other arguments that are more important. When we create a list of the pros and cons of a given choice, we are more likely to acknowledge all the considerations and not just some of them.
I've had my share of health-related decisions to make in the past year (even my decision to retire when I did was motivated by a desire to protect my health). For every single decision, there were potential negative consequences to the choices I made, including chemotherapy, genetic testing, taking a drug, mastectomy and breast implants. In all cases, I've concluded that the benefits of my choice outweigh the risks and that my selected option is the best of the alternatives.
My advice to my friend was to talk to an expert she trusts, such as her family doctor, to ask all her questions and to get all the information she needs to make an informed choice.
When making a decision, consider all the pros and cons as well as the benefits and the risks. If numerous, write them down so that you can step back and look at them. Highlight the reasons that are most compelling. Consider whether you still have questions that need answers before you can land on a decision. Talk to experts. Once you've made a decision, keep your reasons uppermost in your mind so that you don't second-guess yourself. Above all, be kind to yourself. Health decisions are among the most difficult we will make.
