Wouter Leclercq

General Introduction and outline of thesis 11 1 GENERAL INTRODUCTION Oh, do not fear the darkness, it is the home of light. Had we no dark skies over us, ne’er we’d see stars so bright. 1 Nobody chooses to be born; nobody chooses to become ill. Illness happens unexpectedly and violates your normal daily routine. Being diagnosed with a disease may feel that you’re losing your grip on life. The realisation of how vulnerable you are as a human being may suggest that you are falling into a black hole as in dreams may occur. Insecurities, anxiety and health symptoms can hinder rational thinking and influence emotions, at a time when extraordinary circumstances potentially diminish a patient’s ability to listen, judge and make choices. For centuries, options for treatment were limited. 2 One chose either prayer or resignation, and often not much else. Like small stars shining a tiny light in a dark universe, there were ointments, leeches, or herbal potions, but often a more powerful treatment, acting as a beacon in the darkness, was lacking. In the past, surgical procedures were performed, but only in precarious situations with obvious consequences such as an amputation, ranging from a finger to a limb, or the removal of abscesses or tumours. 3 As a result of advances in science and safer operating conditions, surgical alternatives have also greatly increased. While there was often no surgical option 150 years ago, nowadays there are many possibilities. People are faced with a wide range of treatments that they can hardly grasp, or have even heard of. In their fall into the black hole of their diagnosis, these options now appear as stars that bring light into the darkness. 4 However, there are so many that it is not easy to decide which option suits the patient best: ‘confusion by superabundance’. For decades, physicians have guided their patients through this forest with the paternalistic idea that they always know best what is good for their patients. Gradually, the position of a physician has changed to an advisor of options. 5 The physician sums up possibilities and impossibilities and advises his patient, but the patient ultimately chooses what is or feels best in their situation. What is good for one patient may not be optimal for the other. What one patient likes, another considers a burden. 6 The patient’s personal preference has become the focal point of the medical treatment. 7-9 For a previous healthy person, any disease comes unexpectedly, and the speed makes a well-considered choice rather difficult. Unfortunately, there is often little time to make a choice when a disease is diagnosed and your physician suggests surgery as an option.