Patients need more accurate information on their prognosis

Why are doctors so bad at predicting how long a patient has to live?

That’s the interesting question posed by John Schumann, an internal medicine physician who blogs at GlassHospital, recently in Slate.

There are many reasons why doctors evade the question of prognosis:

We don’t like to be wrong; we don’t want to take away hope for survival or good quality of life in the time that remains; and we just aren’t adequately trained to do it. And our reluctance to make such guesses means that when we do try to predict the future, we’re pretty lousy at it.

The last issue — poor training — resonates.  Research shows that, in “teaching, and communication, we focus almost exclusively on the ever-expanding sciences of diagnosis and treatment, leaving prognosis almost entirely to the side.”

Most textbooks focus almost exclusively on diagnosis and treatment, limiting prognosis to “a paragraph or less.”

I like Dr. Schumann’s suggestion that doctors be more analytical when giving prognostic information to patients and families in terminal cases:

Prognosis should not be left to the realm of mordant comments in pathology lectures or sotto voce remarks to students and residents outside a patient’s room during ward rounds. Instead, medical education at all levels should feature actuarial information on the major causes of death, with modification for the age of the patient and the various treatment options.

So when confronted with the question, “How long do I have to live?”, it’s essential that better education encompassing a more actuarial approach will train doctors to give the answers patients need.

But like much of medicine, that push needs to come from patients in order to overcome the inertia that resists any change in the way physicians normally do things.  Don’t be afraid to ask your doctor for specifics when it comes to your prognosis.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://evimedgroup.blogspot.com Marya Zilberberg

    Kevin, all well and good, but we often look like idiots when we make these predictions. The trouble is, as with all of prediction tools, they give you a population distribution, whereas the patient’s outcome is binary. The challenge of this contradiction is obvious, and requires a tremendous amount of work within the patient-clinician relationship to address adequately.

  • http://thehappyhospitalist.blogspot.com The Happy Hospitalist

    Scenario A

    Patient: Doctor Happy, How long do I have to live?
    Happy: You have weeks, maybe a month. It’s time to get your affairs in order

    Three months later
    Patient: Dr Happy, you’re an idiot. You told me I only had a few weeks to live so I got another opinion and now their giving me this experimental medicine that the super duper subspecialist says he has had a great experience with. I’m here because I’m in septic shock and on my death bed but I don’t want want you taking care of me. You made me think I was going to die.

    Scenario B

    Patient: Dr Happy, how long do I have?
    Dr Happy: I have no idea, everyone is different
    Patient: I know, you’re not God. Thanks for being honest.
    Dr Happy: Just enjoy every day you have left to the fullest.

    Three months later:

    Dr Happy? Is that you? I’m the wife of Mr Smith who died from his advanced cancer. He had the most wonderful last two months of his life. What did you say to him?