Stories of MDM: from a conversation to a career of making less data more useful.

Medical decision-making (MDM) research can improve the practice of medicine, health policies, and outcomes for individual or groups of patients. Yet, the models, analyses, and experiments of medical decision-making research are often opaque to people outside the MDM community. To bridge this communication gap, we are soliciting short, narrative-form essays that describe how and why this type of research matters. These ‘‘Stories of MDM’’ are written for a broad audience by MDM researchers (sometimes coauthored with junior colleagues or trainees). Ideally, Stories of MDM are simple, concrete, and (when appropriate) surprising or unexpected descriptions of research journeys, stories that illuminate both the importance of medical decision problems and how medical decision-making research led to potential solutions. We introduce this ongoing, web-only feature with my own Story of MDM below. Prospective authors should submit manuscripts as editorials and preface their title with ‘‘Stories of MDM: . . . .’’ Submissions are reviewed by MDM Editors and Editorial Board members for style as well as content. I was a solution in search of a problem. That was how I felt when I arrived at the University of Michigan in 2002 as a newly minted PhD. I had earned my degree from Carnegie Mellon University in Pittsburgh in ‘‘Behavioral Decision Theory,’’ an interdisciplinary mix of psychology and economics. I knew a lot about decision biases, the way people react (or don’t react) to probabilities, rational models for decision making, and less rational models of the way people make actual decisions. I also knew I wanted a career in medical decision making. I had just survived both years of infertility treatments (which fortunately culminated in my daughter’s birth) and the truly terrifying experience of undergoing an unrelated donor bone marrow transplant (in which my status as a ‘‘good candidate’’ with a ‘‘good match’’ had only bought me a 70% chance of surviving the first year posttransplant). I knew patients needed help making sense of complex treatment decisions, and I knew I could help. But I was lost. Lost because it’s one thing to say you want to improve patients’ medical decisions, but it’s a very different thing to know exactly what needs to be improved. I knew I could put my experimental social science skills to good use in studying medical decision making. But I didn’t know which specific decisions needed improving. So, I asked to meet with several leading clinicians, one on one. I asked each of them, ‘‘What patient decision-making problems do you see in your practice?’’ One of those conversations was with Dan Hayes. Dr. Hayes is currently the Clinical Director of the Breast Oncology Program at the University of Michigan. Back then, he was working with my mentor Peter Ubel and my colleague Angie Fagerlin on a large National Cancer Institute–funded project to do research on patient decision aids in the context of breast cancer chemoprevention. It was one of those rare sunny days in winter or early spring 2003 or 2004 when I met Dan in his modestly sized office high up in the University of Received 8 October 2014 from the Department of Health Behavior and Health Education, University of Michigan, Ann Arbor; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor; and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor. Revision accepted for publication 19 November 2014.