At my yearly check-up my family doctor found that I had a high PSA (prostate specific antigen) reading: 133. Anything over 5 is a serious warning of prostate cancer. So she sent me to a urologist to check for cancer, though it took 2.5 months to get an appointment. I wasn’t worried because I have no symptoms. Still, I thought about what I would do if there is cancer. If it’s metastasized, no treatment, certainly not chemotherapy since I’ve seen friends suffer and die from that before the cancer got them. I figured my best treatment plan would be spontaneous remission. I really wasn’t worried, though I did make some plans for what to do with a last year of life: I went out and bought lottery tickets and a bottle of good scotch.
So I go to the urology clinic. They take my vitals and have me fill out some questionnaires. I tell them I have no symptoms at all. Then the physician’s assistant says that she is scheduling a biopsy for me. She’s marking that down on the chart. Then I ask: what’s a biopsy? They go through your lower bowel, puncturing it and taking samples from your prostate. And what are the risks? She tells me, and they are substantial, possibly life-altering. So I say, no biopsy thanks. And she says “Knowledge is power!” And I think “Ignorance is bliss.” I ask her for more information, and it’s clear she is reciting from a memorized script, ready to move on to the next patient. I object and want to talk to the physician. That will take 6 weeks I’m told. I object more and finally I talk to the clinic supervisor, who is a nurse with lots of clinical experience in urology. She goes over options, and I agree to have scans done that will tell us if there is cancer, though not if it’s slow-growing or fast-growing. Only a biopsy will do that. So I get two scans at the hospital the next week. And I also ask my family doctor to do another PSA test.
When the results are in, I see my family doctor. She is wonderful, so clear and helpful, working with me about what to do. The results: no sign of cancer at all. If there is any cancer it must be miniscule, and with no symptoms don’t worry about it for another year. The PSA test came back at 133 again, and that is really strange, but apparently it can happen.
So I call the supervisor of the clinic and tell her that the results show no cancer. And she says we should do a biopsy. I said no, just cancel my follow-up appointment.
Can you say “Overtreatment”? The cure and testing are worse than the (possible) disease.
So why am I telling you folks about this? It’s not (just) because I am a garrulous old man who wants to tell everyone about his health. I really don’t want to share my medical history. But it is such a perfect example of how people get bullied by medical “professionals”. If I’d just gone along, I wouldn’t have made a bad decision. I wouldn’t have made any decision at all. The physician’s assistant and the supervisor would have made the decisions for me. No talk even of risk versus benefit. And that’s why I’ve written the new book *How to Reason*. It’s a small book, based on the old *Pocket Guide to Critical Thinking*, but better (I used my experience teaching in the local jail). It’s meant to lead to the final section “Making Decisions”, which has a chapter on evaluating risk that includes a part on medical decisions.
We, all of us, need to know how to stop and reason, how to think in order to make decisions. And crucial to that is learning how to evaluate risk. Your life is your own. Don’t give it away to a medical “professional”.
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