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Are you a Blunter or Monitor? The hazards of too much or too little information

Geoff is a 62-year-old university professor and I have just told him that his PSA test, a check for prostate cancer, is elevated, indicating increased risk.

I tell him that the test is not very accurate and chances are he doesn't have cancer, but that we need to do further testing. Then I ask him how he will handle the questions that will inevitably arise before our next appointment.

"I trust you to tell me what I need to know," he says, slightly perplexed. "I have asked the questions I need to right now."

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In the same week, I see Kristina, whose mammogram has a spot that the radiologist thinks is probably nothing, but wants to test further by ultrasound.

Unlike Geoff, Kristina has a lot of questions. "I have many friends who have had this same result, so I'll probably start with them," she says. "Then I will go on the Internet and search as many sites as I can. My feeling is that the more information I have, the better prepared I am."

I was struck by how two patients facing similar situations took two very different approaches to gathering and processing information.

Suzanne Miller, director of behavioural research at the Fox Chase Cancer Centre in Philadelphia, has categorized these two approaches as "Blunters" and "Monitors." The Blunter - Geoff - wants just the basics, while the Monitor - Kristina - craves more information.

Each style has its strengths and weaknesses. But, according to Ms. Miller's research, when people become very stressed, both styles risk becoming more flawed and less effective.

The Blunter can become more rigid and risks sliding into denial. The Monitor can spin out on the glut of information and obsess about missing the single detail that will decide between life and death. The Web has made the Monitor scenario the growth sector. Dr. Google is to stressed Monitors what Halloween is to kids: Both eat until they are sick.

My own clinical experience is that people can often be Blunters about their own health problems, but become spectacular Monitors about their children or parents.

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I am often heartbroken by strife within families or couples that combine a Blunter and a Monitor and also face a serious illness. The two often become frustrated with each other, especially if the disease worsens. I have watched families torn asunder as the healthy information forager can't believe the sick partner doesn't want to seek out the best treatments.

I have seen adult children work the system to create multiple therapeutic options, when dad or mom just wants to keep it simple.

Health information is not neutral, especially when you're sick. Patients often point out how different it is when you are reading about a disease passively, as opposed to when you or a loved one has been diagnosed with the disease.

As Anaïs Nin said, "We don't see things as they are, we see them as we are."

Most people fall somewhere in between the two extremes of Blunter and Monitor. Most days you want to appraise and understand all your options, but some days you just want to say to the doctor, "Just tell me what to do." That's fine.

What impressed me about both Geoff and Kristina is that they both know what works for them. When the stress hit, they were able to keep perspective - for the most part.

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Geoff was diagnosed with prostate cancer - but a type that is often not dangerous enough to warrant immediate intervention. It's being monitored closely instead. In true Blunter style, Geoff sought a referral with a top specialist - and then went with the recommended course of action.

Kristina's ultrasound was fine, but her experience more angst-ridden. "It was quite a journey. I went from being reassured to having tears streaming down my face as I read personal stories [online] You can't help personalizing the information you read."

Dr. Michael Evans is director of knowledge support and patient self-care and an associate professor within the department of family & community medicine at the University of Toronto. He is also director of the health media lab at the Li Kai Shing Knowledge Institute and staff physician at Toronto Western Hospital

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