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

4.8 out of 5 stars 25 customer reviews

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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


“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)

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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: 6 x 1.2 x 9 inches
  • Shipping Weight: 1.9 pounds
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (25 customer reviews)
  • Amazon Best Sellers Rank: #803,249 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

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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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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Format: Hardcover Verified Purchase
Interesting and fast read. Amusing and revealing anecdotes. Perhaps there isn't much of a solution. The end of the book leaves a feeling of wishy-washiness without any concrete solutions to take away. Thus one star taken away because in the end, this feels more like a collection of anecdotes rather than a "study" of the problem.
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Format: Hardcover Verified Purchase
Peter Ubel's book on medical decisions is a wonderful exploration of the issues (and problems) that arise in making decisions about medical treatment. The book is easy to read and engaging, and it addresses topics that we will all need to face sooner or later. We will all have to interact with doctors as we gather information and make important decisions about what sort of medical treatment we want for ourselves and those we love. I think I will approach those decisions better now that I've read Ubel's book.

As other reviewers have noted, the point of departure for the book is our current state-of-the-world, where the patient empowerment movement has given us control over medical choices but where we patients still don't have the education and information needed to make those choices intelligently. Ubel explores the history of how we got here, with lots of interesting stories, and he works through how we can get the help we need--from physicians and from technical decision aids--to exercise intelligent control over our treatment options.

The book is a fun read, too! Ubel's use of stories and his occasional jokes about even the most serious topics keep you going strong through chapters on things we need to think about, but don't always want to think about. (In a chapter about end-of-life care and decisions to let people cease treatment, he mentions that primary care physicians sometimes tell the joke: "Why do coffins have nails? To keep out the oncologists!")

I read the book straight through and then gave it to a friend who is facing some difficult treatment choices for his child. If that's not a recommendation, I don't know what is.
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