Patient Information

Author: Theodore J. Iwashyna

When you find yourself at the point you had hoped never to reach, asking the question, “How long do I have, Doc?” you are asking for a prognosis.

What is Prognosis?

A prognosis is a prediction about the future of a patient’s illness, including information about how the disease will affect the quality of life and when it might end a life.

A prognosis is based on:

  • what the diagnosis is (the prognosis of appendicitis is different from that of lung cancer)
  • what treatments are available (the prognosis of pneumonia changed with the introduction of antibiotics)

Why is Prognosis Difficult for Doctors?

The science of prognosis, like most science, is developed for large numbers of people.  It shows what will happen to most people most of the time.  What it does not show is what will happen to a particular person (you) with a particular disease (your illness) at a particular time (now).  The problem is that it is difficult to take data from a large population and apply it to a single individual. You are unique. You may have more than one disease.  You may be frail or hearty.  You may have excellent social support or you may be alone in the world.  All of these things can affect how long you have to live.

Doctors want to be honest and helpful as well as optimistic, but they can not accurately answer the question, “How long do I have to live?”

So What Can You Do?

You can recognize that medical knowledge is limited, and that while your doctor can not predict your future, he or she can enter into an on-going conversation with about what is happening now and what might happen next.  Such conversations are difficult, however, for both you and your doctor.

To get the most out of them, consider these suggestions:

Be clear about your goals and discuss each one separately:

Do you want an approximate timetable?

Do you want information about what therapies are available?

Do you want to know if you will be in pain?

Do you want to die at home?

Do you want invasive procedures to live longer even if they cause pain?

Ask for information in different ways

“How long does the average patient live?”

“How likely am I to make it to Christmas?”

“Do you think I’ll see my grandson graduate next June?”

“Is it time to draw up my will?”

“Should I bring my son home from overseas?”

Asking concrete questions is clarifying—it keeps everyone from falling back on phrases like, “weeks to months.”

Expect the conversation to continue and, possibly, change over time as new information arises.

You may respond to some therapies and not to others.

Your disease may prove to be more aggressive or less aggressive.

While predicting an individual’s prognosis is difficult, doctors and patients can work together to reach relevant goals and answer the most important questions.

 

Based on a paper by Theodore J. Iwashyna and Nicholas A. Christakis, Nov. 2005.
Click Here to view paper.

 

Translate »