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arrhythmia?‘‘ I tend to show images to patients,’’ Albert said, referring to radiographic photos. He explained:
It creates an image of candor, which is good. But as a patient, I didn’ t say,‘‘ Show me exactly where the lesions are.’’ If I went through it again, I would tell my doctor:‘‘ I don’ t know anything about coronary circulation. My big concern is: How bad is my heart disease?... I know certain segments are not at all good, but what’ s the more general impression?’’ Radiologists should say,‘‘ The left anterior descending is clear, it’ s great. Unfortunately, on the periphery there are a couple of lesions.’’ But instead, radiologists say,‘‘ sixty percent occlusion of your left marginal.’’ I have to ask specifically,‘‘ How likely is a sudden arrhythmia? Is this an area of the heart where lethal arrhythmias are likely to occur? What about sudden death on the treadmill? Is everything downstream from these lesions nonviable?’’ They should have anticipated questions of that nature. You expect them to say,‘‘ Most of your circulation is good.’’ They could have told me,‘‘ An area about the size of a half dollar doesn’ t contract the rest of the heart. We assume it’ s dead or injured....’’ But instead, they just said,‘‘ You’ ve got these two lesions we’ re going to treat medically, and follow in six months.’’
Albert’ s doctors sought to avoid committing themselves to specific meanings of statistics.
Hence, physicians use an argot, a coded form of language with which they feel comfortable and that serves several functions, giving them senses of certitude, of providing an answer, and of‘‘ covering themselves’’ against error due to misinterpretation. At times, doctors‘‘ hid behind’’ the numbers, in part reflecting the reality that unknown factors may play key roles in treatment. Ultimately, ambiguity still haunted these statistical pronouncements.
Researching One’ s Own Disease
‘‘ We know very little,’’ Roxanne, the gastroenterologist, said, referring to the medical literature on the causes of cancer. As suggested above, once ill, many of these physicians came to reassess the role of research in individual medical decisions, and became more critical in their evaluations of research as a whole. Roxanne, for example, became more sensitive to the