When I was first diagnosed with multiple myeloma five and a half years ago, I was told by my local oncologist that the place to go for treatment was the University of Arkansas.  So that was the first stop on my multiple myeloma journey.

I was introduced to the aggressive Arkansas Total Therapy protocol: high dose chemotherapy with multiple active agents, followed by tandem (two back-to-back) stem cell transplants, and then two to three years of maintenance therapy.

The team of physicians and staff there were well trained and highly qualified.  They were adamant that this was the best treatment.  I was scared and more then a little daunted.

Before making a decision, I returned to Tampa, where I live, and got another opinion at Moffitt Cancer Center.  Their recommendations for initial treatment were very different than the Arkansas program: a different induction treatment and one stem cell transplant.

Moffitt is also a very well-regarded cancer center, and the physicians and staff were well trained and highly qualified.  They were equally assured that this was the way to go.

I relate this story not to debate the relative merits of the two different treatment centers or their preferred treatment regimens but to reflect on the fact that two highly qualified experts in the field had widely differing opinions about the best treatment.

Jerome Groopman, M.D., in his book How Doctors Think notes, “Most people assume that medical decision-making is an objective and rational process, free from the intrusion of emotion.  Yet the opposite is true.”

As patients, we want to look to our physician as the one with all the answers, the final word.  However, this is not always the case.  Physicians are people too, and they are subject to the same emotions, motivations, and decision biases as anyone else.  They can have good days and bad days.  They can be tired.  Decisions can be strongly influenced by something they saw recently.  Decisions can be influenced by career and professional considerations.

The other problem is that there is a tremendous amount of uncertainty in medical decision-making, especially in an area such as the treatment of multiple myeloma where the landscape changes so rapidly.

Which treatment option really is better?  It should be easy enough to figure this out.  Do clinical trials to figure out which is better.

As Dr. Groopman notes in his book, “This seems simple but in fact ignores the complexity of human biology and patients’ needs.”

Everyone is different; no clinical trial is going to tell how an individual is going to react to a given treatment.  So dealing with uncertainty is an essential part of the process.

When I was young and new in my medical practice, I was afraid to say, “We don’t know,” for fear that patients would think that I was too young, inexperienced, or poorly trained.  As I grew older and more secure in my own abilities, I became more comfortable with the idea of uncertainty as part of practicing medicine.

This has been especially true when dealing with multiple myeloma.  The doctor does not always know the best course of action.  Sometimes it’s just based on a feeling, colored by an experience they just had, affected by the patient they saw in the next room, or a shot in the dark.

At this point, I’m OK with the fact that my doctor might say, “We really don’t know the answer to that.”  In fact, I respect them more for having the ability to say that.  I realize that with the treatment of multiple myeloma, as with almost everything in medicine, there are more questions than answers.

Hippocrates said almost 2,500 years ago about the practice of medicine, “Life is short, the art [of medicine] long, opportunity fleeting, experience delusive, judgment difficult.”  The fact that we have so much more knowledge, medications, and technology now has not altered that one bit.

The bottom line is: understand that doctors are people too.  While they are highly trained, skilled, and well meaning, they are not infallible and they are not all knowing.  Accept the fact that uncertainty is often a critical part of dealing with treatment.  Most importantly, what this means is that we, as the patients, must always, first and foremost, be watching out for ourselves.