If a doctor tells you a spot he found has metastasized?

The psychological aspects of getting medical treatment, especially for something that involves strong emotions, like cancer, can be surprisingly difficult. I know that it affected me even though I was trained as an engineer; I worked in software development; I think of myself as hyper rational; and in college I even studied both statistics and logic. Nevertheless, it was sometimes difficult to make the right decision because of emotional factors.

In my case someone close to me was actively discouraging me from getting treatment. I told her that I would ask my doctor about what she said. My oncologist told me "You have cancer. If you do not get treatment you will die." That was helpful.

Even without that obstacle, sometimes it was difficult to make a decision to undergo a treatment that was risky, or otherwise unpleasant. I kept focusing on the mortality rate from the treatment. My elderly uncle helped me by reframing the question about what to do so that the question was about which decision would give me the best chance of surviving. To be specific, I was focused on the approximately 15% chance of dying as a result of getting a bone marrow transplant. However the chance of dying from getting only chemo, in my case, was about 96%; or looked at the other way, I had a 4% chance of survival without a transplant. My uncle reframed the question by pointing out that if I had the transplant I had an 85% chance of being alive in the near term, but only a 4% chance if I did not get the transplant. Even in my distraught state I could see that 85% was greater than 4%, and that very simple comparison (even though it was somewhat simplified) was enough to help me move forward with the transplant.

I think maybe your brother could benefit from avoiding people who would reinforce his beliefs if they are getting in the way of medical treatment. Instead, seek out someone who is calm, dispassionate, objective, and rational. Your brother's beliefs may be a rationalization for what he wants to do, which is to avoid the whole issue of cancer and its treatment. In that sense, it might be a psychological way for him to feel better, or feel less stress, but of course it does not serve him well if he has cancer. One way to approach this is to ask him what he would recommend to another person who is in the same situation. It is often easier to arrive at a rational conclusion if we are thinking about another person rather than ourselves.

Something I have found helpful to avoid being overwhelmed is to do one thing at a time, like making a follow-up appointment and focusing on just that instead of trying to think about the whole course of my life.

The key question is: What he can do to increase his chances of survival? In my own personal experience I found that doing what my doctor wanted me to do was a simple and effective survival strategy.

I was able to trust my doctor's judgment because I respect people who are highly educated and to have deep expertise in their field. Moreover, I knew that my doctor was talking to other specialists in his field about my case in order to gain the benefit of their knowledge and experience.

Finally, if there is someone in your circle of family and friends who is a nurse, it might help to talk with the nurse. A nurse may be able to reassure your brother that the healthcare team is there to help him, and that there are all kinds of good drugs these days to help with things like pain and nausea. Lots of people go through cancer treatment, and he can too.

Thank you for your response. Unfortunately his wife who reinforces his beliefs. Even before they left the emergency room she talked him out of getting the tetnus shot which he needed due to the gash on back of head, I mean love his wife dearly, i just know I'm gonna have a lot of resentment towards her if (GOD FORBID) something were to happen to my brother.

I have two further ideas.

First, find someone from his doctor's office or the hospital to talk to your brother. I had a tricky family situation involving my stem cell donor, who was a family member. The interpersonal relationships were so bad that I did not think I could do any good by talking to him myself. Instead, I asked the transplant coordinator, who was a nurse by training, to see if she could handle the situation. She did. People you might turn to include: your brother's doctor, a nurse from the doctor's office, a social worker from the hospital, or a hospital chaplain.

Second, I don't know if reason would be effective here if his wife is interfering, but in some healthcare systems doctors are paid through a system of capitation. What that means is that they get a fixed amount of money for all of their patients. This does not create an incentive to do more procedures. In fact, it creates the opposite incentive.

In my case, I broke off the relationship with the woman who told me not to get treated. It was easier than in your brother's case because I was not married to her. In any case, you can try going to your brother's healthcare team and explaining the situation. I would expect that they would then reach out to your brother with the goal of getting him into treatment. They probably have experience with exactly this type of thing.

You've been very helpful.