A recent column by Dr. Pauline Chen at the New York Times explores a surprising oversight in modern healthcare: Doctors don’t really have a clue how to predict how long a patient will live. In the absence of a widely accepted, systematic method of prognosis, they’re kind of making it up—an informed guess, with the benefit of education and experience, but a guess nonetheless.
Prognosis was once a diligently studied, widely practiced part of a physician’s job, Chen writes. But as treatments improved, and keeping patients alive longer became ever more possible, the unpleasant but necessary skill of predicting when patients might die fell by the wayside. A recent study, she reports, revealed just how much:
Prognosis was rarely, if ever, alluded to in the most popular medical textbooks and on clinical Web sites used by practicing physicians. Even the widely used medical database PubMed, maintained by the National Library of Medicine, had no specific indexing category for prognosis, making finding any published study on the subject like searching for a book in a library before the Dewey Decimal System.
Any individual prognosis, of course, may prove to be wrong, however reliable the system for generating it. But it’s important for both patients and doctors—and the healthcare system as a whole—that such predictions in general tend to be correct:
With so little research on how to predict how long a patient might live and few resources to turn to, physicians often end up relying on intuition. But studies have shown that these “guesstimates” can be wildly inaccurate, and that inaccuracy can adversely affect an older patient’s quality of life and care. Doctors who are too optimistic may prescribe unnecessary and painful procedures and treatments; those who are too pessimistic may neglect to offer adequate care.
Read more at the New York Times.
Image: Shutterstock
January 20th, 2012 at 12:14 am
We should build databases to look for individual doctors who consistently over or under estimate. Then we could pair together optimists and pessimists and have them refer one another for second opinions!
January 20th, 2012 at 12:05 pm
Prognosis is based what you learn in medical text book or recent statistics. Yes, it is statistics, not precise prediction for individuals.
January 20th, 2012 at 4:59 pm
Cody,
Why not just look for the ones who are most often right, and have them teach the rest?
January 20th, 2012 at 6:33 pm
Strange fluff article.
Doctors as a whole UNDERESTIMATE and the numbers strongly support this.
There are many upsides to underestimating:
1. Patient’s personal fulfilment “You’re a fighter. You’re beating the odds.”.
2. Motivational to continue healthy practices and treatment.
3. Family takes immediate planning steps to prepares for eventuality
4. Family feels uplifted because patient defied the odds
There are only downsides to overestimating.
1. Perceived doctor incompetence if patient falls below average
2. Family is angry
3. Patient doesn’t experience immediacy/desperation of short time line so doesn’t follow all medical recomendations
4. Legal exposure
January 22nd, 2012 at 11:36 am
My grandfather suffered a stroke, after which the doctors gave him only a couple months to live. He continued living for 2 more years in a nursing home and even then hospice called the family in at least 5 times to say that he only had a few hours left to live. Surprise, he didn’t die any of those times but emotionally it felt like it. I don’t believe doctors or anyone in the health care field should ever try and predict how long someone has.
January 24th, 2012 at 11:56 pm
I agree with Eric. When a professional gives you a few days, weeks, months the patient expects to pass around then so his/ her hopes and moral go down to dangerous levels. Just let them go off happy and peacefully not depressed and nervous…
January 25th, 2012 at 10:29 pm
I wholly agree with Eric, from personal experience as well. My Dad was diagnosed with a cancerous tumor attached to the outside of his lung. The Dr. immediately told him he had only 3 mos to live. His moral went right into the toilet. I told Dad, according to the bible, every spoken word becomes a living thing. The spoken word, is also how we put curses on others, and to my way of thinking, this Dr’s words were in essence, a curse upon my Dad, whether intentional or not. My mom and all 5 of us (children) finally convinced him to find another doctor. This Dr was shocked to learn that the previous physician would put a date on my Dad’s life expectency. He told my Dad, you could live for months, or you could live for years, there is just no way of telling. Dad lived another 18 months, and those months were the best. We took family vacations together, and we all had time to try to come to terms with his passing, ahead of time. Regardless of how this first Dr described Dad’s future as a horrible, lingering death, dad died smiling, breathing perfectly, without oxygen, at hospice, with a nurse singing a christian song. It was so peaceful, we thought he had simply fallen asleep.
January 26th, 2012 at 1:41 pm
This article illustrates a common problem with doctors: assuming they have complete information. This doesn’t only apply to predicting death, but also to selecting treatments. Doctors commonly think that because they or the people around them have not heard of it, it does not exist. But their knowledge cannot be complete, as they cannot possibly read all reserach journals or talk to all doctors. What is needed is a database of information – an expert system – to help the decision process. This system will track all results, and can even be used in ways that Cody and Geack suggest.
February 2nd, 2012 at 2:00 pm
To some of those above, I would find comfort in having an educated guess at a time to live. Additionally, I could see much anxiety and nervousness arising from a situation in which the doctor said “there is just no way of telling.” A prognosis of months, or years, or longer, is essentially the same for everyone, there is no new knowledge gained here. So what is the point of asking a doctor? The point is that they are the most trained in making these estimates, and even though there are a great number of variables to juggle, they are much better at juggling them than we are.
February 14th, 2012 at 11:20 pm
Patient: I always see spots before my eyes. Doctor: Didn’t the new glasses help? Patient: Sure, now I see the spots much clearer.