Decisions, Decisions – and a Leap of Faith

Many recent articles in AIDS magazines that I’ve read recently have focused on HIV treatment decisions. They have addressed issues such as when to start therapy, when to change therapy, and even when to fire your doctor. These articles give a great deal of information and advice, but to me something seems missing. When people with HIV are faced with making decisions that affect their health and their lives over and over, no one seems to be talking about just how one goes about making a tough decision, whatever it is. Perhaps looking at a few specific techniques for decision-making might help.

One of the best tools I’ve used is also one of the simplest – making a list of pros and cons. On a piece of paper, draw two vertical columns. At the top of one column, write “Pros” – the arguments for a particular course of action. At the top of the second column, write “Cons” – the arguments against that action. Then list the pros or cons that come to mind. For example, if someone has “iffy” viral load and CD4 numbers and she is trying to decide with her doctor whether to start medications, perhaps a “pro” of starting meds is feeling empowered to take action against the virus. Perhaps a “con” of that is a fear of side effects. After you’ve made a list in each column, look at which column is longer – are there more pros or cons to this decision? And here’s one of my favorite hints to this exercise: In which direction do you find yourself “cheating” about? Wanting to write more in the pros column or the cons column? That little part of you that’s trying to cheat toward one direction is the part of you that unconsciously has already made this decision!

Another technique is to act like a detective who is trying to decide who, among a group of suspects, has committed a murder. Think of how TV’s “Columbo” did it – What information do you have? Is your information from reliable sources? Are there inconsistent parts of your information that conflict? How can you fill in the gaps? What are the unknowns? Do you have enough information to make a decision? If not, whom do you need to contact to get the information you lack? How do you go about contacting them? If your decision were evidence in a murder case, would you have enough information to make an arrest “beyond a reasonable doubt”?

Another technique is about options. Ask yourself, “What is the challenge?”, then ask yourself, “What is my goal for the outcome of this challenge?”. Then, brainstorm all the different ways you can think of to bring about this outcome. Start with “I could…” and then fill in the blanks. For our example of the person considering meds, she could…discuss things with a treatment advocate…call another friend with HIV….read a treatment magazine…visit a website…visit a support group…talk about it in therapy…get a second opinion from another doctor. Then, evaluate the pros and cons of each option. At the end, which option seems the best one for you? OK, now act on it.

Another technique is about Now, the Future, and Others. What is best for you right now, given the information you have? What is best for your long-term future? And what is best for the other people in your life whom you care about who would be affected by this decision? Perhaps the best option for now is to avoid meds, but the best option for the future and for your children is to start treatment.

Another way is to use logic borrowed from the computer programming world, such as “If” and “Then”. IF I take my meds and I have side effects, THEN I will call my pharmacist and ask for help. IF I delay for now, THEN I will get my viral load and CD4’s measured again in two months (or whenever the doctor recommends) and take meds if my viral load increases by one log or more. Having specific criteria you’ve set for yourself, and knowing that you have future options even if your initial decision doesn’t work out, are empowering thoughts.

Finally, think about how your chosen decision will affect different areas of your life. Physically? Mentally? Emotionally? Financially? Temporally (the amount of time it will take)? Spiritually? Morally (again, the effect on others)?

After doing these exercises, more of your true feelings about the situation should emerge. Try doing these exercises now, and then again in a week or so, if you have the time. How do your responses change? The answers that stay consistent are probably the most reliable. If you still need more help with decisions, an HIV-knowledgeable therapist can help guide you through the process – not to make the decision for you, but to help you clarify your own feelings. In the end, have confidence and faith in yourself to make the best decisions you can, and trust that whatever the outcome, you’ll handle it.

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