Making good decisions begin with what you hear from your doctor in the first place.
“The way we frame illness and the treatment options is the most important factor driving what happens next,” he said. “And the cancer label is particularly profound.”
“Did you get a second opinion?” he asked me.
When I said that I hadn’t, he wasn’t surprised. According to a study by Dr. Katz and other researchers, more than 90 percent of patients newly diagnosed with early-stage breast cancer do not seek a second opinion. Like me, they’re operating on a toxic cocktail of panic and what Dr. Katz calls “anticipated regret” — the idea that you want to throw every possible solution at a problem so that, at the end of the day, you can think, “I tried everything.” Doctors, he said, need more training in addressing patients’ intuitions. Patients need to slow down and try to keep their emotions in check.
“There is time for just about any decision you make,” he said.
Four weeks after my lumpectomy, the purple-and-yellow bruises that made my breast look like a summer thunderstorm have faded and the stitches have dissolved. All that’s left are the occasional twinge, a U-shaped scar that looks like a smile, and questions. When I look back, I feel like Dorothy, scooped up by a hurricane, blown into a strange new land and just as quickly dumped back in Kansas.
It wasn’t until after my panic and my surgery that I began to read about doctors who think we’re testing too much and treating too aggressively, and to think about what the psychologists Daniel Kahneman and Amos Tversky called the anchoring effect, the way the first number you hear affects the decisions you make. When you’re told that a set of knives is valued at $59.99, $19.99 sounds like a bargain. Maybe when the first word you hear is “cancer,” surgery, as soon as possible, feels like the only possible move.
I know myself well enough to believe that there was no way I was going to live with something, whether it was cancer or pre-cancer or cancer’s second cousin once removed, hanging out in my chest, even if I’d been advised to watch and wait. I don’t regret my decision. But I have questions about the way I made it.
Humans crave certainty. We want to know that we married the right person, voted for the right candidate, made the right