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Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together Hardcover – September 4, 2012


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Product Details

  • Hardcover: 368 pages
  • Publisher: HarperOne; 1 edition (September 4, 2012)
  • Language: English
  • ISBN-10: 0062103822
  • ISBN-13: 978-0062103826
  • Product Dimensions: 9.3 x 6.4 x 1.3 inches
  • Shipping Weight: 1.2 pounds (View shipping rates and policies)
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (23 customer reviews)
  • Amazon Best Sellers Rank: #344,908 in Books (See Top 100 in Books)

Editorial Reviews

From Booklist

In this passionate plea for patient empowerment, Ubel, a physician with a background in bioethics and behavioral science, promotes ways to assist people in making medical decisions. The best choices must always take into account a patient’s particular values. Major obstacles to shared decision-making by patients and their doctors can include medical terminology (a language barrier), empathy deficit (physicians failing to grasp the emotional needs of patients), and the inability of patients to adequately understand medical evidence (e.g., to comprehend statistics). Ubel uses the stories of patients and his own clinical experiences to illustrate his points. An excellent chapter describes the treatment of his wife’s invasive breast cancer along with the many medical questions and decisions that faced the couple. Ubel’s advice to doctors is solid: “Physicians need to offer recommendations with humility and in a manner that invites divergence of opinion.” His suggestions for patients are equally sage: Be informed. Listen carefully. Ask questions. Get guidance from family, friends, and doctors. Don’t rush big decisions. Always remember, you’re not alone. --Tony Miksanek

Review

“Decisions affecting our health and our loved ones’ are some of the most important that we make. As a physician and social scientist, Peter Ubel is unparalleled in his understanding of the influences that guide our medical decisions, and here he shows us how we can make better decisions.” (Dan Ariely, bestselling author of The Honest Truth About Disohnesty and Predictably Irrational)

“Written with clarity and a touch of humor, this is a quick and thoughtful read, a good choice for patients, and a must for medical professionals.” (Library Journal)

“Ubel’s advice for doctors is solid, and his suggestions for patients are equally sage.” (Booklist)

More About the Author

Dr. Peter Ubel is a physician and a behavioral scientist at Duke University. He is the author of three previous books: Pricing Life (MIT Press, 2000); You're Stronger Than You Think(McGraw-Hill, 2006); and Free Market Madness: Why Human Nature is at Odds with Economics--and Why It Matters (Harvard Business Press, 2009). He has contributed to The New York Times , The Los Angeles Times, Psychology Today, and The New England Journal of Medicine , among other publications.

Customer Reviews

4.8 out of 5 stars
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Although it is easy to read, this is an important book.
M. Ross
With Critical Decisions, Dr. Ubel is attempting to change the landscape of how patients communicate with their doctors and engage in decision making.
Kath Pollak
I think every member of the health professions, or at least every student training to join them, should read this book.
Karan

Most Helpful Customer Reviews

5 of 5 people found the following review helpful By Karan on January 6, 2013
Format: Hardcover Verified Purchase
By outlining the evolution of the doctor-patient relationship over across the past few decades, Ubel shows how and why we've arrived at such a thorny time in medical decision-making. Patients come to their doctor more informed and opinionated than ever, and physicians are encouraged to do as the patient wishes--even when it comes at odds with their own professional opinions. But doctors of the old model, keeping decision-making authority to themselves, still abound.

Ubel's historical outline helps frame the provocative chapters that follow, on the irrationality inherent in so much of our most pivotal decisions. Based on years of cutting-edge behavioral research, much of it Ubel's own, I found these to be the most interesting part of the book. I'd encountered many of the studies in my own research on medical decision-making, but never before collected in such a coherent and powerful way.

Finally, Ubel closes with chapters geared toward preparing both physicians and patients for a new era of shared decision-making. This is perhaps the most "practical" part of the book for someone currently grappling with a medical decision, but it might lose its resonance if not for all the anecdotes and analysis leading up to it.

There lies the conflict I see with this otherwise excellent book. At its best, it would serve as a manual for people in the grips of a difficult medical decision. But the historical and theoretical background, though interesting, may discourage someone actively making medical decisions from using this book in the moment. On the other hand, though healthy laypeople should be interested in these issues, I wonder why they'd read an entire book about them (especially with 50 Shades of Grey within reach).
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2 of 2 people found the following review helpful By Peter H. Elias on February 3, 2013
Format: Hardcover Verified Purchase
This book 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, and those who write or think about health care or behavioral economics. 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 both a patient and the family support for patients, so his qualifications are superb. The book is well organized and written clearly. He includes references and additional resources. The topic is incredibly topical. I’ve read it once, taking notes, and will be reading it again, after which it will remain on my shelf for 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 (a time when comfort and hope were all that doctors had to offer), he leads the reader through various stages such as the advent of science, the rise of knowledge as power to be 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, and finally to 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 to trace a path from what was through what is to what we should be striving to create.

A thoroughly enjoyable and educational book. Buy it and read it.
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2 of 2 people found the following review helpful By Alexandra O'Connor on December 28, 2012
Format: Hardcover Verified Purchase
Dr Ubel shows how Doctors think and helps the patients ask the right questions. I would recommend this book to everyone going through a chronic illness.
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2 of 2 people found the following review helpful By Catlady on September 23, 2012
Format: Hardcover
Have you ever left the doctor's office and wondered why you didn't ask the questions you meant to? Or thought to yourself - my doctor is saying something to me, and I have no idea what he is talking about!!? This book richly describes what goes on between doctors and patients and why it's so problematic. In touching, sometimes sad, and often hilarious stories, Peter Ubel recounts his and his colleagues' experiences as doctors, and even his own personal experience as a family member of a patient. Perhaps most importantly, he weaves these stories together with the fascinating history of patient autonomy along with important research findings about how people make medical decisions. And just when you find yourself wondering how we will ever get out of this mess, he offers recommendations for the future, for individuals and their doctors, for medical educators, and for policymakers.
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1 of 1 people found the following review helpful By Spring Texan on July 6, 2013
Format: Hardcover
This entertaining book is that precisely because it is so realistic and has so much heart. Dr. Ubel realizes that people (including him) don't necessarily evaluate similar situations in a logical way and that emotions permeate everything. Despite this, he is resolved to find the best ways to help people make medical decisions consistent with their values, including the use of decision aids and improving the decision aids so that they are better for people to use.

He also realizes how many times we are NOT presented with decisions but simply presented them as fait accomplis by doctors who often do not realize patients may have values different from their own and might choose differently. He gives explicit examples of this from his own wife's medical experiences and many others. He also puts into great historical perspective how and why disclosure/decision expectations have changed between physician and patient.

This book is a beautiful, helpful, thoughtful, and wise contribution and an exceptional book on the topic.
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