Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Is there a difference between a good and bad prognosis? It depends.

James C. Salwitz, MD
Physician
December 14, 2016
97 Shares
Share
Tweet
Share

It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:

“Our therapy goal is palliative. Prognosis is good.”

Now, this was clearly not what the author had intended. In common practice when someone is so sick that we are focusing on purely palliative ends, comfort care, it means that the patient’s prognosis is limited, bad, even grim. If the prognosis is “good,” we have more lofty goals than just quality of life.

Nonetheless, it occurs to me that it is a matter of definition; what do we mean by “prognosis?” For most of us, it means the likelihood of healing, rebuilding or cure. A bad prognosis means there is little chance for recovery. Someone with a good or excellent prognosis is probably going to get better. Does this really make sense? What if “good” meant something else?

Prog – no – sis: the likely course of a disease or ailment. A forecast of the course of a disease, ailment or situation. Origin: pro = before + gignoskein = know. To this, we add the judgment: good, bad or even terminal.

However, what if we start with the basic idea that all life ends, that even the most excellent prognosis is terminal? What if we also accept that disease is a natural life event? Then something absolute, such as death, is not good or bad, it simply is. Can one have a “good prognosis” even while actively dying?

Joe and Jim both have prostate cancer. Their cancers are growing despite treatment, and both have three months to live. Most of us would say, “They have a bad prognosis.”

Joe receives the benefits of a sophisticated pain regimen, nursing support, a robust family system and first-rate hospice care. Jim is poorly connected to caregivers, uninsured, has limited access to food, let alone pain medications, and he lives alone in a substandard, poorly heated, apartment. Do these men have the same “prognosis?”

Their prognosis, “likely course of their ailment,” is quite different. Joe may be able to stay at home with his family, his pain in control and perhaps enjoy social events and support. Jim will be alone, probably ending up on a hard gurney in a crowded, noisy late-night emergency room with limited palliative care, and he’ll likely be in continuous pain, poorly ambulatory with bedsores down to bone and will not able to enjoy a single meal, let alone a holiday repast.

Joe has a “good prognosis.” Jim … not so much.

We cannot change the final infinite prognosis. Death is not the enemy. Sometimes not even disease. Suffering is the ultimate evil. Therefore, prognosis is not just about length of life or therapeutic result, but about quality of life. If we always define life as a fight against illness and time, we will not be able to optimize final planning or care. If we set our goals to achieve the best in life, realizing that “good” means more than “heal” or “recover,” we make possible precious quality time, even at life’s end.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Image credit: Shutterstock.com

Prev

Why can’t we control outrageous health care costs?

December 14, 2016 Kevin 18
…
Next

Telemedicine: What could go wrong? A lot.

December 14, 2016 Kevin 10
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Why can’t we control outrageous health care costs?
Next Post >
Telemedicine: What could go wrong? A lot.

More by James C. Salwitz, MD

  • Each line on the radiology list is a patient’s line in the sand

    James C. Salwitz, MD
  • The broader mission for hospice care

    James C. Salwitz, MD
  • Is the medical profession at its end?

    James C. Salwitz, MD

Related Posts

  • The non-difference between MDs and DOs

    Brandon Jacobi
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Primary care makes a difference for patients and the nation

    Glen R. Stream, MD
  • Would a Hippocratic Oath for health care executives make a difference?

    Paul B. Hofmann, DrPH, MPH
  • Shortening time in medical school is a bad idea. Or is it?

    Charles Dinerstein, MD, MBA

More in Physician

  • A tense family drama unfolds as a young daughter pursues unconventional career path

    Osmund Agbo, MD
  • Decoding the brain’s decision-making: insights for medical professions and strategies for success

    Harvey Castro, MD, MBA
  • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

    Jay K. Joshi, MD
  • Discover your true north: Navigating life’s confusions and embracing your path to success

    Tyler Jorgensen, MD
  • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

    Anonymous
  • From journalism to medicine: Unveiling the untold stories of patients’ medical conditions

    Veronica Bonales, MD
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Insomnia Symptoms Tied to Stroke a Decade Later
  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • Full-On Reversal of Cardiac Amyloidosis Possible With Antibodies
  • Spell Check-Up: Do You Have the Skills to Pass This Spelling Test?
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds

Meeting Coverage

  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds
  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • Promising Gene Therapy for Overactive Bladder
  • Shotgun Sequencing of Small Intestine Reveals Species Tied to GI Symptom Severity
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician
    • Decoding the brain’s decision-making: insights for medical professions and strategies for success

      Harvey Castro, MD, MBA | Physician
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
    • Discover your true north: Navigating life’s confusions and embracing your path to success

      Tyler Jorgensen, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Is there a difference between a good and bad prognosis? It depends.
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...