What do patients want? Help in making effective choices.

Usually, I want to be a rational patient. To do that, my physicians need to help me understand the probability and magnitude of the good and bad things that can happen to me, as a result of taking—or rejecting—possible treatments. By “understand,” I mean having cognitive control over the issues that are so important to me. I want not only to hear the facts, but also to be able to integrate them into what I already know about the topic (recognizing that some of what I know is wrong and will have to be replaced by better knowledge). I want to be fluent enough to explain my decision to myself and my family. To tell the truth, I’d also like to have emotional control over the decision. As hard as it might be, I’d like to be at peace with the decision. I want to be able to live with my choice—and its consequences. If things turn out badly, I don’t want to add the insult of second guessing to the injury of what has already occurred. I realize that this can be a tall order. So let me reflect on it now, when I’m not mired in the tensions of an actual choice, and I can be more sympathetic to the constraints on my physician’s reality. I do know, in principle, that my physician does not have unlimited time, unlimited knowledge, or unlimited patience for me, especially when decisions have to be made and I might not be at my most reasonable.