andthemoreinformativeone.Yet,lessthantwodecades
later,herewewerewithmyfather,inaneurosurgeon’s
office in Cleveland, Ohio, talking about MRI images
showingagiantanddeadlytumorgrowinginhisspinal
cord, and this other kind of doctor—one willing to
genuinelysharedecisionmaking—waspreciselywhatwe
found.Benzelsawhimselfasneitherthecommandernor
ameretechnicianinthisbattlebutinsteadasakindof
counselorand contractoronmy father’sbehalf. Itwas
exactly what my father needed.
Rereading the paper afterward, I found the authors
warningthatdoctorswouldsometimeshavetogofarther
thanjust interpretingpeople’swishesin orderto serve
theirneedsadequately.Wantsarefickle. Andeveryone
has what philosophers call “second-order
desires”—desires aboutourdesires. We maywish,for
instance, to be less impulsive, more healthy, less
controlledbyprimitivedesireslikefearorhunger,more
faithful tolarger goals.Doctors wholistento onlythe
momentary,first-orderdesires maynot beservingtheir
patients’ real wishes, after all. We often appreciate
clinicians who push us when we make shortsighted
choices,suchasskippingourmedicationsornotgetting
enough exercise. And we often adjust to changes we
initially fear.At some point,therefore, itbecomes not
only rightbut also necessaryforadoctorto deliberate
withpeopleontheirlargergoals,toevenchallengethem
to rethink ill-considered priorities and beliefs.
Inmycareer,Ihavealwaysbeenmostcomfortablebeing
Dr.Informative.(Mygenerationofphysicianshasmostly
steered away from being Dr. Knows-Best.) But Dr.