I recently finished reading Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together by Peter Ubel, MD.  It should be required reading for all the following:  physicians and nurse practitioners, current patients, future patients, potential patients, family and friends of patients, patient advocates, health care policy makers, nurses, leaders and administrators in the medical industry, and anyone who writes or thinks about behavioral economics in health care. If you aren’t in any of those groups, don’t bother reading it.

First some basic comments: Dr. Ubel is a physician and ethicist with a humanities background. He has been a patient as well as the support-system for a family member with a serious illness. His qualifications are superb. The book is well organized and written clearly. He includes references and additional resources. And the topic is incredibly topical.  I’ve read it twice, taking notes, and will be reading it again. It remains on my shelf for ready reference.

Now, about the book itself.

He sets his discussion of patient choice within a historical perspective. Beginning with the distant era of Hippocrates where paternalistic comfort was the core of professionalism (and all that physicians of that era had to offer), he leads the reader through the advent of science, the rise of knowledge as a powerful tool wielded unilaterally by the authoritarian physician, the beginnings of the patient emancipation process with Karen Ann Quinlan and the struggle over who had the right to make decisions about end of life care, to patient empowerment and engagement in shared decision making. He concludes with a discussion of the needs for educational and cultural changes to support collaboration between patients and their clinicians.

Within this historical narrative he uses anecdotes (both his and others), medical science (with some nice discussions of screening, breast cancer, and prostate cancer), and behavioral economics (reflecting the work people like Amos Tversky  and Daniel KahnemanDan ArielyOri BrafmanMichael GazzanigaJerome Groopman, and others) to trace a path from what was through what is to what we should be striving to create.

It is rare that a book is so thoroughly enjoyable, readable and educational. Buy it and read it.




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