Decision of the Month Archive

The novelty of risk and vaccination intentions

It's 2009.  Early in the year, a 9-year-old girl from California became the first person with a confirmed case of H1N1 ("swine") influenza in the United States.  Shortly thereafter, the U.S. declared a public health emergency and the World Health Organization declared a phase 6 pandemic (the highest level possible).  By September 2009 a vaccination was developed and was available within a month.

You've been following the news about the H1N1 influenza as developments have unfolded throughout the year, and you feel some concern.  You have been wondering about the risk of coming down with the H1N1 flu yourself and have been thinking about whether you should be vaccinated.  Answer the following questions by moving the slider bar.

Informed Consent Document Utilization

What do subjects need to know in order to agree to participate in research?  An informed consent document is assumed to communicate the essential information, but it is not clear how carefully research participants read these documents.

How Risky are “High Risk” Kidneys?

The government requires that potential kidney transplant recipients be informed if an organ donor engaged in CDC categorized “high-risk” behaviors. Are these “high risk” donor kidneys associated with worse survival rates following transplantation? Does this label “high risk” result in usable kidneys being discarded?

The ethics of resuscitation

Traditional ethical teaching suggests that a physician's assessment of a patient's best interest should guide the decision of whether to administer emergency life-sustaining therapy, absent guidance by the patient or family members.  In pediatric medicine, physicians may insist on life-saving therapy if they believe it is in a child's best interest to receive it, even if the parents seek to refuse it.  It is unclear exactly how physicians make such assessments, however, and whether/how these assessments influence decision-making in critical situations.  Consider the following scenario:

How old is too old for cancer screening?

Cancer screening is generally recommended for people over the age of 50. Screening tests, such as colonoscopies, mammograms and PSAs (prostate specific antigen), can help detect cancer at an early stage and prevent deaths. These screening tests, however, do have risks so, along with their doctor, people need to make a decision about how often to get screened and when or if one should stop getting screened.

Do You Know Enough to Take That Medication?

People in the U.S. make decisions about their health on a regular basis. For example, they are often asked to consider taking medication to treat common health problems, such as hypertension. But do patients have sufficient information to make these decisions? And what factors might influence the knowledge patients have, and their treatment decisions?

MD vs. WebMD: The Internet in Medical Decisions

With just a simple search term and a click of the mouse, a person can find a large amount of health information on the Internet. What role does the Internet play in how patients make medical decisions? Does using the Internet as a source for information to help patients make informed decisions vary by health condition? Does the Internet substitute for detailed discussions with a health care provider?

I Saw It on a Billboard

What is the impact of medical advertising that is directly targeted at patients? What information do consumers of medical products and therapies need in order to make informed decisions about their health?

The Diabetes Lobby

Tell us what you think about certain public policies designed to reduce the incidence of diabetes in the US.

Leaving the Emergency Room in a Fog

Alfred made a visit to his local Emergency Room. What was his diagnosis? What did the medical team do for his problem? What was he supposed to do to continue care at home? And what symptoms was he supposed to watch for to alert him to return to the ER?

Ladies and Gentlemen of the Jury

How should the US judicial system determine compensation for  “pain and suffering”?  Take a look at a complicated case. 

How much will chemotherapy really help you?

After breast cancer surgery, additional treatments such as chemotherapy can reduce the risk of cancer coming back. But do women understand how much (or little) benefit chemotherapy provides?

Should this patient get a liver transplant?

There aren't enough donor organs to go around for patients who need a liver transplant. This sometimes forces doctors to make tough choices. If you were the doctor, how would you decide in the following scenario? 

Drilling for Answers

Find out about some experimental treatments for Parkinson's Disease. And then decide how you'd respond if you had a chance to participate in this research.

Is it disgusting?

People vary in their attitudes toward physical disabilities. Give us your reactions, and we'll tell you the results of surveys of the general public--and of actual patients.

The Privileged Choices

What's the difference between opting in and opting out of an activity? Who decides if people will be put automatically into one category or another? Click this interactive decision to learn how default options work.

What's in a Name? A Pregnancy Scenario

Tell us how you'd respond to the results of a blood test for fetal chromosomal problems. And find out how your response compares with that of participants in a national survey.

Are you a numbers person?

Many types of medical decisions involve making sense of numbers such as test results, risk statistics, or prognosis estimates. But people vary in their ability and confidence with numbers. How would you rate your own "numeracy"?

A Matter of Perspective

Are opinions on whether health care funding should be rationed dependent on an individual's perspective?

Give me colostomy or give me death!

Click to decide between death and living with a colostomy. Which would you choose? Are you sure?

Get it out of me!

A 5% chance of death or a 10% chance of death:  which would you choose?

How would you adapt?

Could you cope and find happiness if you were living with paraplegia?

The Importance of First Impressions

How do your risk estimate and your actual level of risk impact your anxiety?

How bad would it be?

For certain diseases, receiving treatment can disrupt daily life considerably. How would this disruption affect your happiness?

Should we keep going or give up?

What prompts people to keep trying after failure, when there is the risk of failing again? What prompts the decision to quit?

Give or take a few years

A longer life may result from the amount of social support present in your life, but is the longevity due to giving or receiving that support?

It's your call: your intuition against the experts' advice

A respected national organization has released new guidelines. As a physician, would you change your patient's treatment based on these recommendations?

Hey, how much for that organ of yours?

What changes in organ donation policy could get more people to choose to be donors?

When Money is Tight

Because of the high cost of many prescription drugs, some people take fewer pills than prescribed. What are the health implications?

Doctor, are you game?

Are you willing to "cheat" a little bit for the sake of your patients? What motivates you to cheat or not cheat?

Will Dr. Bettereyes help you see better?

What influences your choice of a doctor?

Would you participate if you knew this?

When you decide to participate in a research study, what do you think the reserachers should inform you about?

Sorry, Doc, that doesn't fit my schedule

Patients sometimes skip treatments because they just feel too busy. What should physicians do when their patients ignore their recommendations?

A New Drug for the New Year

Out with the old drugs and in with the new! How is your doctor prescribing for you?

Is your well-being influenced by the guy sitting next to you?

Rating your satisfaction with your life may not be a completely personal decision. See how your satisfaction rating may be influenced by others.

Is doing harm okay if you can say you didn't mean it?

Direct action vs. indirect action--does it matter how you act if the outcome will be the same?

What is the price of life?

Do you think that your life is worth more than the amount that the government usually uses as the maximum to spend to provide one year of life?

Is Bill Gates' time worth more than yours?

Informal caregiving for relatives (parents, grandparents, spouses) can be time consuming. Can we attach dollar value to that time? Is everyone's time worth the same amount?

Does order matter when distributing resources?

Should people with more severe health problems receive state funding for treatment before people with less severe health problems? See how your opinion compares with the opinions of others.