It’s not only a hypochondriac who worries when a new headache, abdominal ache, or low back pain appears. Like many of us, you may immediately think it’s cancer until proven otherwise. Your doctor responds by ordering a CT scan or MRI. The report comes back, and there it is: a shadow, an abnormality in your heart, lungs, or brain. He tells you that may be normal but suggests you consider a biopsy for diagnosis. Although the decision to move forward—to know—seems obvious, there are a few things to consider before agreeing to the procedure.
Balancing Risk Versus Uncertainty
- There is no free lunch. Anytime a doctor comes towards you with a sharp object (remember a biopsy requires cutting out a piece of your body) bad things can happen. Excessive bleeding, organ damage, even death are possible.
- Biopsies aren’t 100% accurate. Sometimes normal or too little tissue is sampled or the pathologist can’t make a diagnosis. Re-biopsy is one of my least favorite things to do.
- What will you do with the results? You may want to ask the about next steps before the biopsy. Although biopsy results can be reassuring, if abnormal, are you willing to undergo treatment? If not, reconsider how much you want the results.
- Your doctor doesn’t necessarily know the right answer. Everything is an educated guess. Contrary to popular belief, physicians don’t get much in the way of feedback. Decisions are often made based on their last worst mistake rather than the overall odds.
- Doctors don’t want personal risk. Minimizing risk depends on being right about a prognosis. But being right as a physician often requires risk, cost and worry for our patients in the form of additional tests and procedures such as biopsies. Consider that very few law suits are related to over cautious treatment. Sadly with the increase in shift work, creating a scenario where the doctor and patient are much more likely to be strangers, modern healthcare has broken the doctor-patient relationship. With more trust between doctors and patients, more conservative alternative treatment options are available.
- Finally, realistically assess your ability to deal with uncertainty. If you can’t live/sleep/eat without obsessing over the possibility of cancer, than biopsy may be worth the risk. If you can cope with uncertainty, watchful waiting may be a more reasonable course.
Healthcare is imperfect. Medical decisions aren’t black and white but rather an assessment of risk versus benefit. Providers have a responsibility to manage expectations and hopefully offer counsel on various options. Your job, as a partner in your health, is to help providers factor in your ability to cope with uncertainty.