|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:
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:
Ask for information in different ways
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.
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.