Newsletter – October 2013

Book Club Notes

“Your Medical Mind: How to Decide What Is Right for You” by Jerome Groopman, MD, and Pamela Hartzband, MD
By Paul W. Mamula, PhD

On September 30, 2013, the North Central Chapter book club met and discussed Your Medical Mind: How to Decide What is Right for You by Jerome Groopman, MD, and Pamela Hartzband, MD. The book focuses on steps patients need to take in deciding health care treatment options. It also addresses legitimate questions about the process of selecting the most suitable treatment option and how much remains unknown about existing treatments. Groopman and Hartzband are a husband-and-wife team that has collaborated on other books. In some ways, this book serves as a follow-up to their book How Physicians Think.

At 281 pages, Your Medical Mind is a fast read. Notes and bibliography add an additional 90 pages. The notes provide useful examples, explanations of studies cited, and explanations of terms such as “number needed to treat” (number of patients that need to be treated to prevent 1 event such as a heart attack) and “number needed to harm” (number of patients treated that produce 1 additional adverse effect). The book presents even complicated cases in a reader-friendly way.

The opening quote by E.O. Wilson sets the book’s philosophical tone: “We are drowning in information, while starving for wisdom.” Groopman and Hartzband draw on cases from their practices that involve common ailments such as elevated cholesterol levels, hypertension, and thyroid hormone disorders, as well as more complicated cases involving therapies for breast and prostate cancer and issues concerning the end of life.

Your Medical Mind does a nice job of interweaving stories about selecting particular treatment options, analyzing the outcomes, and reviewing other potential treatments. The authors present multiple patient types and health problems to describe the process by which patients and their physicians decide on therapy. Some patients are minimalists—refusing treatment until absolutely necessary. Others are maximalists—requesting all possible treatment, until all options are exhausted. This characterization applies to physicians as well. The personality and process combine to offer a thought-provoking window into patient and physician decision-making. 

Book Club attendee George Kline said, “A strength of this book is that the authors are consistently conscientious about taking care of the reader. There was neither condescension in the stories of others nor in explanations to the reader of why the answers to the ‘What is the best decision?’ often lie within us. A second strength was the stories about themselves and their not-so-good medical decisions. Their candor was refreshing.”

Attendee Mary Knatterud stressed that “the wife-and-husband writing team made for a pair of diverse backgrounds and differing perspectives right off the bat.  Though both Hartzband and Groopman are practicing MDs at Harvard and BethIsraelDeaconessMedicalCenter, their viewpoints on medical decisions have been disparately shaped by their own childhoods, their own families of origin, their own psyches. Yet they are both amazingly receptive to what they keep learning from their own medical challenges and from their own unique patients (she’s an endocrinologist, he’s an oncologist).”

The authors also emphasize how much still remains unknown about optimal treatment regimens and how these options differ among populations. For example, in their story about a patient with diabetes who discovers that he has Graves disease (a disorder arising from an overactive thyroid gland), his physician recommends radioiodine therapy (treatment that addresses the condition but results in permanent hypothyroidism) over other potential therapies. The physician tells his patient that he would have to “take a pill for the rest of his life.” The physician considered this option as the “best,” even though other options are equally effective. The patient, however, disagreed, stating that he didn’t want to take another medication in addition to that for his diabetes and opted for a different therapy. The authors note that the treatment for Graves disease varies among countries. In Japan and several European countries, radioiodine therapy is the least-preferred therapy. For this disorder, no one standard treatment exists, and decisions about which therapy that is “best” has to be determined by the individual patient and the physician.

Other stories make for fascinating and insightful reading for anyone who faces medical decisions for themselves or as the health advocate for a spouse, parent, or other relative. What Knatterud appreciated most from this book was “the humble empathy that the authors, experts in their ever-changing fields, continually display in their discussions with and about their patients, experts in their own complex lives.  Clearly, they understand the deep need—and absolute right—of patients to (1) hear from experienced, respectful doctors the latest science and the real-world statistics pertinent to a given set of treatment choices but then (2) weigh the pluses and minuses and balance them in the way that best fits their own life situation and their own mindset.”

As an aside, the book club’s first attempt at an alternative venue was foiled by the remodeling of the meeting place, so we adjourned to another nearby restaurant and had our discussion outside on a beautiful evening. Wearing her hat as coordinator of the book club, Knatterud noted, “The evening time that we tried tonight doesn’t seem to be ideal for any of us, although our trio certainly made it work.” She was grateful “to be able to sit outside, savoring a fun and substantive conversation, on such a gorgeous autumn night.”

The next book club will be held on January 27th at The Egg & I (The Emperor of All Maladies: A Biography of Cancer). Then, the book club will try meeting at the Caribou near Lake Nokomis on April 26th (The End of Illness). Details will be announced in upcoming newsletters. We hope to meet you there.

 

Final call for the AMWA Annual Conference

There’s still time to register for AMWA’s 73rd Annual Conference November 6-9, 2013, in Columbus. You can view the full registration brochure and then go to Register Now to be a part of this not-to-miss opportunity. 

If you go….On Thursday evening, November 7, join fellow members of the North Central Chapter who are attending the conference. Meet at the Chapter Greet & Go in the Delaware Foyer at 6:15 and head out for dinner together at a nearby restaurant.

 

Chapter holds successful networking happy hour

A group of seven chapter members and potential members (plus one supportive spouse) met Wednesday evening, Oct. 9, at McCoy’s in St. Louis Park. The diverse group of employees and freelancers/business owners exchanged employment information and business cards, as well as sharing personal histories, happy hour treats and of course, a drink or two. 

One topic of discussion was volunteer opportunities with the chapter. As a result, the finance committee gained a new member, and there is potential interest in the president-elect position. 

We enjoyed meeting new colleagues and learning about their work, and look forward to seeing you at our next get-together.