It’s also important for physicians to help patients fully explore the risks and benefits of all available options to mitigate future regret. Assuming it’s not a medical emergency, doctors should, for example, encourage patients to consider how their decisions may vary in “hot” versus “cold” emotional states. As Dr. Jerome Groopman and Dr. Pamela Hartzband explore in the New England Journal of Medicine, when we’re in a “hot” state of mind — when we’re scared or hurting — we’ll do anything to fix the problem. We discount risks, overestimate the benefits, and pursue paths we otherwise might not. In “cold” states, by contrast, we misjudge how much our preferences can change over time and, subject to the pull of inertia, forgo treatments we later wish we’d had. By actively envisioning how things could unfold in both scenarios, however, we can minimize the regret we feel after making tough decisions.
Increasingly, technology may also play a role in reducing regret. Indeed, had my patient been treated promptly he might have had a different outcome, and his wife may have experienced less regret. Some hospitals are now using mobile stroke treatment units, or specialized ambulances dispatched when someone calls 911 with symptoms suggestive of a stroke. These modified ambulances are equipped with a CT scanner, a camera, a nurse and medications, including T.P.A. On the way to the emergency room, the patient’s brain scan is uploaded and a neurologist at a nearby hospital can look for signs of stroke on the image, perform a remote neurological examination via telemedicine, and ask the nurse to administer the brain-saving drug if needed.
At my hospital, which started operating its mobile stroke unit in 2016, patients treated in these specialized ambulances receive T.P.A. more than 30 minutes sooner than those transported by traditional ambulances. Research from similar programs has found that patients are six times as likely to receive T.P.A. in the first 60 minutes after symptom onset — the so-called “golden hour” during which the drug is most likely to reverse the ill effects of a stroke.
“It can be the difference between being in a wheelchair and walking independently,” said Dr. Mackenzie Lerario, medical director of the NewYork-Presbyterian Mobile Stroke Unit. “Or between needing constant nursing care and living how you were previously able to.”
Even with advances in medical technology, we will, of course, never eradicate regret. Regret is a fundamental aspect of being human. But there are high- and low-tech steps we can take to ease the sting. Perhaps none more important than embracing regret as part of life, and focusing not on what might have been but on what still is.
Dhruv Khullar, M.D., M.P.P (@DhruvKhullar) is a physician at NewYork-Presbyterian Hospital, an assistant professor of health care policy at Weill Cornell Medicine, and director of policy dissemination at the Physicians Foundation Center for the Study of Physician Practice and Leadership.