198 Being a Doctor After Being a Patient
Accepting Versus‘‘ Defying’’ the Odds: Optimism Versus Pessimism in Framing and Interpreting Statistics
Ill doctors varied widely in defining, specifically,‘‘ good odds.’’ How should one interpret risks, especially those that are less than 50 percent( e. g., a 40 percent chance of death)— present, but not probable? Uncertainty affected these doctors differently. Overall, psychological tendencies toward‘‘ optimism’’ or‘‘ pessimism,’’ and over- or underestimation of odds shaped risk assessments. Often, tripartite views— as emotional human beings, as doctors, and as patients— interacted, combining or clashing. Again, these views underlined the inherently subjective nature of much of medical discourse and information.
A few tried calmly to‘‘ accept’’ the possibility of bad outcomes, seeking a variety of reasons to support their views. Brian, who had hepatitis, said,‘‘ I had a one-in-three chance of the medication clearing up my infection. It was a long shot. But those were the odds.’’ He felt he should not fret, since he had limited power to alter this fate. He thought he did what he could to shape the outcome.
I didn’ t think about it much. My biopsy showed I have mild disease. Presumably, it’ s been there twenty years. So I am good to live a whole bunch more. It could change, but why worry about something you have no control over? I have some control. I take care of myself, eat well, and don’ t drink much alcohol. But I don’ t fret.
In supporting this attitude, Brian thus cited five factors that he took into account( e. g., his disease was mild, and his prognosis was not bleak).
Others struggled to be optimistic. Jim, the drug company researcher with leukemia, wrestled with how to view the fact that his chance of a good prognosis was significantly less than 100 percent. He routinely assessed the odds of treatment effectiveness for other patients, but was unsure how to evaluate these for himself.
Even with a‘‘ favorable’’ prognosis, my chance of being alive five years later is between one third and one half. Maybe treatments and supportive care are a lot better than they were, but the odds of them being successful depend on a lot of factors, and are good, but not 100 percent. When you get a cold, you get better 100 percent of the time. There’ s no guide to thinking about how‘‘ good’’ odds are not always good.