We’re Bad at Evaluating Risk. How Doctors Can Help.

My patient and I were locked in a game of decision-making hot potato.

“What would you do, Doc?” he said. We’d been discussing whether he should get screened for prostate cancer.

Such questions trouble most doctors. We often lob the choice back to patients, or “on the one hand, on the other hand” so much they start sympathizing with Harry Truman, who jokingly wished for one-handed advisers.

But the evidence wasn’t clear. I passed the potato back.

Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions — to weigh trade-offs, to grapple with how their values suggest one path over another. This is particularly true when medical science doesn’t offer a clear answer: Doctors encourage patients to decide where evidence is weak, while making strong recommendations when evidence is robust. But should we be doing the opposite?

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