Truth in the most optimistic way.
نویسنده
چکیده
W hile I was in residency at the Mayo Clinic, my oncology attending arrived for rounds one day with a sheepish grin on his face. It was June 3rd, you see, and for the 7th straight year a former patient of his had called him and angrily exclaimed, " I am still alive, you idiot! " before slamming down the telephone. Seven and a half years ago, the oncologist had given the man 6 months to live. Since then, I have stopped giving patients specific predictions about their life expectancies. I recognize that patients need to know their prognoses to make treatment decisions and plan their affairs. However, I have found that relatively nonspecific prognoses are sufficient. I might say, " I cannot predict the future, but in my experience, patients with your illness typically live a matter of months, not years, " or " Many people in your condition will live for only a matter of weeks, but some live significantly longer. I do not know what your fate will be. " In these conversations, I discuss concrete treatment goals with patients. I do not hesitate to say when I think the goal should shift from cure to palliation. When things are grim, I suggest that it is time to visit with friends and family because " it is better to be safe than sorry. " I give enough prognostic information to help patients make decisions, but I avoid using numerical wording that suggests I have a prognostic crystal ball. In this issue, Lamont and Christakis (1) report the results of a survey of physicians who had referred patients with cancer to local hospices. They asked each physician to estimate how long his or her patient would live. In a later question, they asked physicians what prognostic information they would communicate if patients insisted on receiving such information. They found that almost one quarter of physicians would not communicate a temporally specific prognosis, 37% would communicate the same prognosis that they had estimated, 28% would provide an optimistic prognosis (a longer survival than predicted), and a small number would provide a pessimistic prognosis. I do not know where my practice style would fit in this classification scheme. On the basis of conversations I have had with other physicians since reading Lamont and Christakis's article, my communication style is relatively common. The physicians I spoke with, an admittedly unscientific sample, …
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ورودعنوان ژورنال:
- Annals of internal medicine
دوره 134 12 شماره
صفحات -
تاریخ انتشار 2001