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In order to make decisions in one’s own best interests, one has to be able to assess the likelihood of the various possible outcomes on the horizon. What are my chances if I have surgery? What are they if I opt for radiation? Assessing probabilities is critical if one is to take appropriate action. Consider the following questions taken from a longer survey by Weinstein (1980): Weinstein (1980) found that people thought that they were significantly more likely to experience the positive events than their cohorts and significantly less likely to experience the negative ones. This is reminiscent of what psychologists have called the Lake Wobegon Effect. Like the residents of that mythical town in central Minnesota, we are all above average when we evaluate ourselves. Buunk, Collins, Taylor, VanYperen, and Dakof (1990) and Helgeson and Taylor (1993) have found that patients facing health problems also show significant biases in evaluating their own health state compared to others with the same disease. I am aware of an instance in which a physician told a patient that she had only a 10% chance of surviving the next two months. A nurse was surprised when she found the patient to be in a rather buoyant mood a short time later. The nurse asked, “Didn’t the doctor talk with you about your prognosis?” “Yes, he did,” the patient answered. “He told me that I had only a 10% chance of living two months, but I’m 90% sure I’m in that 10%.” The anecdote above is congruent with the results of an analysis by Arkes et al., (1995), who showed that patients were far more optimistic than their physicians and substantially more optimistic than their decision-making surrogates when assigning probability estimates to their own 6-month survival. One obvious negative consequence of these divergent viewpoints is that decision making by the patient-physician-surrogate group will not proceed smoothly if the patient’s prognostic estimate far exceeds that of the other two group members. Another consequence is highlighted by Weeks et al., (1998). These investigators found that among those patients whose physicians were relatively pessimistic about their prognosis, patients who assigned relatively high probability levels to their own survival were significantly more likely to advocate aggressive care compared to patients who assigned more realistic probability levels. The latter group were relatively more likely to prefer comfort care. Because patients’ prognostic estimates were far less accurate than were their physicians’ probability estimates, the patients’ misestimation might interfere with the care which would be in his or her own best interests. It should be added that there may also be positive benefits to patient optimism (Taylor and Brown, 1988, 1994). Illusions of optimism may result in a self-fulfilling prophesy if persistence is fostered by the illusion and if the persistence is not futile. For example, a patient who entertains unrealistic optimism that he or she will be able to walk normally again may be more motivated to undertake a rigorous regimen of physical therapy than a person who has a more negative albeit realistic view of the prognosis. If the physical therapy will greatly improve mobility even if it will not restore normal gait, then the optimism may be highly adaptive.
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