Why your doctor cannot tell you what to do
A friend rang me last year, upset. Her surgeon had laid out two options and then said the choice was hers. She wanted to know why he would not just tell her.
Here is the thing. He could not, and he was right not to.
Both options had roughly the same survival odds. One carried a higher chance of long-term incontinence. The other carried a higher chance of fatigue that might never fully lift. Medicine can tell you the probabilities. It cannot tell you which of those two futures you would rather live in. That is not a gap in the evidence. It is a question about your life, and the surgeon has no access to it.
What frustrated her was the handover. She heard “it’s your choice” as I am not going to help you. What he meant was closer to I have run out of things that medicine knows.
My whole field exists in that gap. When we run a choice experiment, we are asking hundreds of people to make exactly the trade her surgeon could not make for her, over and over, in slightly different combinations. From the pattern we can work out how much fatigue people will accept to avoid incontinence, on average, and how much that varies between them.
That average never tells any individual what to do. What it does is stop the system from quietly assuming. Because if nobody measures it, someone still decides. A guideline gets written, a default gets set, a funding rule gets drafted, and it embeds a trade-off that nobody ever asked a patient about.
My friend picked the fatigue. Two years on she says she would pick it again. I have no idea whether she chose correctly, and neither does she, and that is fine. What matters is that it was hers to get wrong.