Doctors love to use long, mysterious or complex words; maybe they think it makes the money spent on their education seem worthwhile. Take “prognosis.” Doesn’t it sound great? Wouldn’t you have to be well educated to use and understand such a word?
Of course, the answer to both these questions is “No,” because prognosis simply means a prediction of an end result given a certain set of circumstances and, in medicine, it is an attempt to predict the outcome (or end result) of an illness. Will the patient survive? How long will it take for him or her to recover?
For many diseases, especially those that have been known and treated for decades or centuries, doctors can often predict the course of events. Researchers have gathered data and statistics, and “survival rates” or “probability of survival” can be discussed with some degree of accuracy.
But individual patients are not statistics or data, and they don’t always follow a convenient set of rules. Patients have been known to “beat the odds” seemingly terminal conditions have mysteriously gone into remission and some might say simply that “miracles can happen.”
Most doctors are well aware of the pitfalls involved in predictions, and experienced physicians avoid making them, especially distant ones. My system is to offer an accurate appraisal of the patient’s current status, a description of the general course of the disease, and a disclaimer that it’s impossible to be completely certain regarding the outcome, for any specific patient.
Unfortunately, though, some patients and their family members feel uncomfortable with uncertainty and actually prefer a prediction — even if the doctor suspects the patient will not recover or that death is imminent. Sometimes, patients truly want to know what the future holds for them and whether they need to “put their house in order.”
Thus a compromise might be in order. If the disease is life-threatening, with a predictably poor outcome, I share this information with the patient. And I offer some suggestions: Live one day at a time, as if each is your last, and enjoy each waking hour; seek peace of mind by “mending fences” with former friends or alienated family members; travel, take art classes, learn to be a gourmet cook — or whatever it is you’ve always wanted to do but never had the chance.
Most people faced with terminal situations choose to continue their familiar lifestyle, seeking comfort from relatives, friends and clergymen. Often, they see the world around them through “different eyes,” appreciating each flower, bird, tree and sunset. And they try to pass along to others this new-found appreciation, knowing it will be their legacy to humanity.
Dr. Michael M. Warren is Ashbel Smith professor of surgery at University of Texas Medical Branch Division of Urology.
