Cole A. Giller, MD PhD

We live in an age of patient empowerment. We have the freedom to make our own  medical decisions, and we have superb sources of medical information to help us.  But as anyone who has had a medical problem can tell you, it’s not that easy.  Medical science has given us so many options that it’s difficult to pick the  best one. How can we decide between chemotherapy, surgery, radiosurgery and  immune therapy when each choice has its own pros and cons, and when even our  doctors don’t agree? And how can our doctors possibly know which choice will fit  our personality, hopes and expectations? We all want a say in what happens to  us, but deciding between complex medical options can be overwhelming.

As a cancer survivor and doctor, here are six steps I think may help.

 The first step is to discover  your options. Don’t try to decide which choice is best at this point—just find  out as many options as you can, even if some seem far-fetched. Talk with your  doctors, but don’t hesitate to use friends, family, newspaper, television and,  of course, the Internet.

Now that you have a list of  options, find out the good and bad about each one. The goal is to find the  compromise that hides in each decision. For example, a particular surgery might  be great for tumor control, but might also have a risk of paralysis. Or the use  of blood thinners might offer protection from blood clots, but would increase  the risk of bleeding if you fall. You must know the bad along with the good in  order to make a good decision.

 Find as much as you can about  each option. Talk with your doctors, and don’t be afraid to do research. A  librarian can guide you to medical textbooks and articles. Use the table of  contents and index to find information about your medical problem. You may not  understand every word but the books contain valuable information. Finally, check  out MEDLINEplus (

. These are helpful user-friendly medical  websites.

 Make sure your sources are credible.  For example, find out which companies sponsor the websites you are using. If you  are reading about a particular treatment, make sure that the patients treated  have the same medical problem that you do. Is the recommendation of a certain  medication based on its success in just one patient or a randomized trial of  1,000 patients? A useful technique is to say things backward. A surgery that  cures 75 percent of the time is the same surgery with a failure rate of 25  percent.

 Because medical decisions are  made in the face of uncertainty, our beliefs must guide us. Do you believe that  medical care is best in large general hospitals or in small specialty centers?  Do you believe that medication is bad in the long term? It’s not that you should  let old beliefs keep you from making rational decisions, but you will be happier  following your beliefs if no other information is available.

 Each medical decision means  different things to different people. The decision to undergo surgery to relieve  back pain might be obvious to a 56-year-old man with a large family. But an  82-year-old man who is the sole caretaker of his ill wife might choose to endure  the pain rather than take the risk that the surgery would prevent him from  caring for his loved one. Find the meaning that your medical decision has for  you and your life—it will be worth it.

—Cole A. Giller, MD, PhD, is medical director of the Baylor  Radiosurgery Center at Baylor University Medical Center in Dallas and author  of

 Port in the Storm: How to Make a Medical Decision and Live to Tell About  It

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