Emotions shape medical decision-making

As the Affordable Care Act helps drive industry momentum toward shared decision-making between patients and physicians, it's important for doctors to understand not only how much input patients want, but also about some of the counterintuitive ways information presented to patients may shape their thought process, according to a recent post in the New Yorker.

Fear and disgust are two key emotions that affect medical decisions, according to research cited by Lisa Rosenbaum, a fellow at the Philadelphia V.A. Medical Center and Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.

She wrote: "in the setting of fear, the possibility of recurrence, rather than its actual probability, fuels decisions that, over all, likely cause more harm than good." For example, in many cases, breast cancer patients who undergo a prophylactic mastectomy derive little survival benefit from the surgery, but are nonetheless "very worried" about breast cancer recurrence.

In other situations, the thought of suffering a complication, such as chronic diarrhea, wound infection, colostomy bag or intermittent bowel obstruction, can be more off-putting than an alternative that carries a higher risk of death. "For many people, the disgust of imagining life carrying around a bag of stool renders a lower absolute risk of death less resonant," Rosenbaum explained.

"We know that emotions influence the understanding of benefit and risk," Rosenbaum concluded. "But doctors haven't spent enough time trying to figure out the implications of this tendency for the actual decisions patients make."

To learn more:
- read the post from the New Yorker

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