194 Being a Doctor After Being a Patient
Cold Hard Facts: The Roles of Cognitive and Emotional
Expectations in the Receipt of Information
‘‘The night before my surgery, I was told I had a 5 percent chance of
dying,’’ Herb said. ‘‘That night I couldn’t sleep. If I had been told instead
that I had a 95 percent chance of surviving, I would have slept better.’’
Many of these doctors became more aware of, and sensitive to, how
statistics were framed. Repeatedly, issues arose not only of what the
statistics were, but also of how they were presented. In particular, their
physicians provided medical knowledge in ways that often failed to ac-
knowledge or address patients’ emotional needs. These ill doctors now
realized both the degree to which providers did not present information
with a full sense of the patient as a person, and the elusiveness of re-
ceiving information ‘‘objectively.’’ Rather, they became more cognizant
of how inevitability data are subjectively framed.
These doctors saw colleagues as thinking that provision of medical
information in fact obviated the need to support patients emotionally.
Not uncommonly, practitioners conveyed diagnoses and other medi-
cal information with little sense of the patient’s consequent emotional
state. In fact, they sometimes provided medical information in ways that
not only lacked empathy, but were brutal and harsh. Herb was told he
had an MI without any sense of how he might respond emotionally to
the news.
A resident said, ‘‘I’m really sorry to say that you infarcted.’’ I didn’t
hear that from the cardiologist. Nobody said, ‘‘That’s a bum
break,’’ or ‘‘That’s a surprise—I wouldn’t have thought. . . .’’ No-
body sat down and said what the implications would be. The
cardiologist only said, ‘‘On the basis of this, we’re moving on to this
next procedure.’’
Against the emotional distress caused by disease, medical information
often did not shield as much as doctors had assumed. As Mark said, ‘‘I
was surprised that I was as shocked and numb as I was when I found out I
was HIV-positive.’’ Routinely, he had told patients who tested positive,
‘‘We don’t know what the test means, exactly, and many patients do well
for many years.’’ But now, having been diagnosed with HIV himself,
none of these approaches helped him. Previously, he had seen these
prognostic statements as beneficial in themselves. Now, he felt that many