Map of life expectancy at birth from Global Education Project.

Thursday, February 27, 2014

Treatment decision making

I study how people make decisions about medical treatments, and how they talk with their doctors about those decisions. That's what I do for a living.

So now I'm trying to observe myself, and see what I can learn from it. That's surprisingly difficult.

The story is that I have arthritis in my left hand. Specifically, I have a total loss of cartilage at the base of the thumb -- the joint between what's called the carpal bone, and the metacarpal. The carpal at the base of the thumb is called the trapezium. This was very painful; for much of a year, it ached constantly. I finally got a cortisone injection, which stopped the aching, but didn't stop it from hurting when I use it. The issue has really been forced since my friend talked me into buying a guitar, and getting back into playing it. I also can't really play the sax comfortably, because the left thumb operates the register key, and I realize that's why I pretty much put the sax down as well.

So, the choice is surgery. What they do is to completely remove the trapezium and fill the gap with a tendon harvested from the wrist. Supposedly I won't miss  the tendon. However, the procedure means I'll be in a cast for a month, then have to go in for physical therapy twice a week for several weeks, and it may take a full year to completely get back to full functioning. After that, supposedly, more than 90% of the time, you have great results and never have pain again.

So, that's a bit of a daunting prospect. The difficulty is that I don't really have much insight into how my own brain is processing this decision. I would hope to get at least 20 and preferably 30 years of having my left hand working perfectly, playing music, woodworking, farming, and all the things I want to do which will help make life worth living; to get there, I have to go through a few months of pain and inconvenience.

It seems like a no-brainer when you put it that way but it's actually hard. I have to screw up my courage to make the call to schedule the surgery. Of course there's an instinctive aversion to having my body cut open and pieces chopped out and rearranged. There's a fear of the small chance of something going wrong. And there's time discounting -- the pain is in the near future, the gain in the farther future. All this may be classified as "irrational" but I'm not sure that makes sense -- it's how our minds work.

Well, here goes . . .

4 comments:

roger said...

sociologist study thyself.

hoping that it works out well.

robin andrea said...

That does sound like a very challenging medical decision. I'm guessing that you've read all the pertinent studies and details, know the risks (how many people have this surgery without noticeable improvement, or worse?). Pain is an amazing motivator. Good luck.

Cervantes said...

Seems to be a very high probability of success, just an ordeal in getting there.

kathy a. said...

Sending good wishes! Obviously, you are thinking this through with the best tools at your (considerable) disposal. This stuff's scary! And also a real pita even for a good outcome.