Cover image for Port in the storm : how to make a medical decision and live to tell about it
Port in the storm : how to make a medical decision and live to tell about it
Giller, Cole A., 1954-
Personal Author:
Publication Information:
Washington, D.C. : LifeLine Press, [2004]

Physical Description:
xx, 266 pages ; 23 cm
Format :


Call Number
Material Type
Home Location
Item Holds
RA776.95 .G54 2004 Adult Non-Fiction Non-Fiction Area

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"Dr. Giller has tamed the toughest problem facing anyone with important medical problems: deciding what to do. His plan is authoritative and yet warm, incorporating specific hard-to-find advice into an uplifting and insightful look at how good decisions can be made in times of crisis. This wonderful, compassionate guide will be essential reading for anyone facing a medical decision for years to come."

- Nancy Brinker, Founder of the Susan G. Komen Breast Cancer Foundation, Dallas

Author Notes

Cole Giller, M.D., Ph.D., is a board-certified neurosurgeon and associate professor of neurosurgery at Southwestern Medical School in Dallas, Texas

Table of Contents

Prefacep. xiii
Acknowledgmentsp. xvii
Why Read This Book?p. xix
Part I Basics
Chapter 1 The Decision Crisisp. 3
Changes, Changesp. 4
Medical Decisions: Not What They Used to Bep. 4
Information Is Not Enoughp. 6
Chapter 2 The Basic Nature of Medical Decisionsp. 9
You Are Not Alonep. 9
You Are Not Yourselfp. 10
What Is a Decision?p. 11
Why Decisions Hurtp. 12
Decisions Are Relativep. 13
Chapter 3 Some Philosophical Principlesp. 17
Realize That You Have Decisionsp. 17
Realize That You Must Decidep. 18
Realize That Life Is Hardp. 19
Realize That Everything Has Risksp. 20
Who Is as Important as Whatp. 21
You Need a Captain of Your Shipp. 22
Don't Fight Yourselfp. 24
Take Some Breaksp. 25
Part II The Six Steps of Medical Decision Making
Chapter 4 An Introduction to the Six Steps of Medical Decision Makingp. 29
How We Decide: The Theoryp. 30
How We Decide: A Practical Six-Step Planp. 31
Step 1 Identification of Your Optionsp. 31
Step 2 Identification of Tradeoffsp. 32
Step 3 Discovery of Datap. 33
Step 4 Interpretation of Numbersp. 34
Step 5 Gathering Your Beliefsp. 35
Step 6 Contemplation of Meaningp. 38
Chapter 5 Step 1: Identification of Your Optionsp. 41
Use Your Sourcesp. 42
Can I Really Talk to My Doctors?p. 42
Keep an Open Mindp. 42
Where to Go for Your Medical Carep. 43
How to Find and Be Seen at Outside Medical Centersp. 45
The Small-Town Syndromep. 46
Whom to Choose for Your Medical Carep. 47
Be on the Lookoutp. 48
Chapter 6 Step 2: Identification of Tradeoffsp. 49
You've Been Framed!p. 49
How to Shift Framesp. 51
Search for Difficult Tradeoffsp. 53
Chapter 7 Step 3: Discovery of Datap. 55
Preparing to Searchp. 55
It's Harder Than You Thinkp. 55
Reasonable Expectationsp. 56
Do Your Homeworkp. 57
Make Sure It's About Youp. 58
Seek Painful Informationp. 59
All Sources Have an Agendap. 60
Nobody Tells It Straightp. 61
The Sourcesp. 63
Booksp. 63
Medical Booksp. 63
How to Use a Medical Textbookp. 65
Reference Booksp. 67
A Warningp. 67
Suggested Medical Textbooks and Reference Booksp. 68
Articlesp. 72
Medical Articlesp. 72
How to Read a Medical Articlep. 74
Practice Guidelinesp. 77
Newsletters, Newspapers, Television, and Advertisementsp. 78
The Internetp. 81
Beware the Internetp. 83
Tips for Internet Usep. 84
Before We Begin: One More Wordp. 86
Suggested Medical Web Sitesp. 87
How to Search the Web for Medical Web Sitesp. 96
How to Look at a Medical Web Sitep. 98
How to Use PubMedp. 99
Final Wordsp. 101
Friends and Familyp. 101
Individualsp. 101
Groupsp. 103
How to Benefit from Friends and Familyp. 106
Your Doctorsp. 107
A Suggested Strategy for Finding Medical Informationp. 107
Chapter 8 Step 4: Interpretation of Numbersp. 109
Building Skepticismp. 109
Trust No One, Believe Nothingp. 110
... But You Must Trust Your Sourcesp. 111
Go Beyond Wordsp. 112
It's All in How You Say Itp. 112
It's All in How You Frame Itp. 113
How Much Information Is Enough?p. 116
What if There Aren't Any Numbers?p. 117
Timing Isn't Everythingp. 118
The Mathematics and Statistics of Decision Makingp. 119
How to Interpret Percentagesp. 120
Pitfalls and Special Circumstances of Percentagesp. 123
The Myth of Zero Riskp. 126
Statistics Made Easyp. 127
How to Evaluate a Medical Testp. 128
More Tests: Backward and Forwardp. 131
What Happens for Two Events?p. 132
When There Are Multiple Optionsp. 133
Chapter 9 Step 5: Gathering Your Beliefsp. 137
Personal Beliefsp. 138
What Do You Believe? And Why?p. 138
We See What We Want to Seep. 139
Judging Books by Their Coversp. 140
Beliefs in Wishes and Controlp. 141
Beliefs in Happy Endingsp. 143
Beliefs in Medicinep. 144
Beliefs About Moral Questionsp. 145
Challenge Your Beliefsp. 146
Hope versus Realityp. 148
Beliefs about Datap. 148
Beliefs Based on Coincidence: Why We Know What Isn't Sop. 149
Coincidence versus the Scientific Methodp. 151
Beliefs Based on Small Numbersp. 153
Beliefs Based on Bad Choices: Selection Biasp. 155
Beliefs Based on Single Reportsp. 156
The Need for a Guidep. 157
Beliefs About Testimonialsp. 158
Chapter 10 Step 6: Contemplation of Meaningp. 163
Sleep On It!p. 164
The Road to Meaningp. 165
Use Your Imaginationp. 166
Repeat It Over and Overp. 168
Keep Notesp. 168
The Meaning of Riskp. 169
The Meaning of Detailsp. 170
The Meaning of Inconveniencep. 172
The Meaning of the Pastp. 174
The Meaning of Stylep. 175
Thinking the Unthinkablep. 176
The Meaning of Faithp. 177
Part III How to Use Your Doctors
Chapter 11 Ambivalence, Anger, and Acceptancep. 181
Ambivalencep. 181
Angerp. 182
Do We Really Want a Vote?p. 183
Acceptancep. 184
Chapter 12 Managing Your Doctorsp. 187
Finding Doctorsp. 187
Do I Need a Doctor?p. 187
Second Opinionsp. 188
Small Town versus Big Centerp. 188
Practical Tips for the Appointmentp. 189
The Use of Doctorsp. 192
Use Your Doctor as a Providerp. 193
Don't Use Your Doctor as a Friendp. 194
Don't Use Yourself as a Doctorp. 195
Use Your Doctor as a Doctorp. 196
The Use of Doctors-Recapp. 197
How to Interpret Your Doctorp. 197
Beware Pollyannap. 197
Facts, Opinions, and Value Judgmentsp. 199
Expect a Spectrump. 200
Doctors with Hammersp. 200
Multiple Doctors and Captainsp. 201
The Myth of Informed Consentp. 201
Chapter 13 When Doctors Disagreep. 205
Know the Issuesp. 206
Know Your Doctorsp. 206
Seek Other Opinionsp. 207
Lump Them Togetherp. 208
Rejecting the Doctor's Advicep. 208
Part IV Deciding for Others
Chapter 14 Deciding for Friends and Familyp. 213
The Thoughts of Othersp. 214
Relationship Dynamicsp. 215
Chapter 15 Deciding for Childrenp. 217
General Thoughts: Anxiety and Trustp. 218
When Parents Disagreep. 219
Does the Child Get a Vote?p. 220
Part V Special Problems
Chapter 16 Pitfallsp. 223
Some Decision Don'tsp. 223
Remembering It Allp. 225
Insurance and Financial Mattersp. 228
What If Your Can't Decide?p. 230
Chapter 17 Special Decisionsp. 233
Choosing to Do Nothingp. 233
When There Isn't Timep. 234
Deciding About Medical Testingp. 236
Deciding to Participate in Experimental Trialsp. 237
Deciding About Alternative Treatmentsp. 239
When There's No Hopep. 240
Part VI You've Made Your Decision; Now What?
Chapter 18 How to Know When Your Medical Decision Is Goodp. 243
Two Criteriap. 244
Changing Your Mindp. 245
Chapter 19 The Good and Bad of Afterwardp. 247
Afterward: When Things Go Wrongp. 247
Afterward: When Things Go Rightp. 249
Part VII How to Begin
Chapter 20 An Example: Cancerp. 253
Step 1 Identification of Your Optionsp. 254
Step 2 Identification of Tradeoffsp. 254
Step 3 Discovery of Datap. 255
Step 4 Interpretation of Numbersp. 255
Step 5 Gathering Your Beliefsp. 255
Step 6 Contemplation of Meaningp. 256
Recommended Readingp. 259
Indexp. 261