How Long Do You Have? — Doctors May
Not Know
Some researchers are trying to reverse the
de-emphasis on making accurate prognoses.
Summary: A century ago the art and science of “prognosticating” or
predicting a patient’s life expectancy was an essential part of doctoring.
It occupied an important position in textbooks, journals and
conversations with patients. But as technology advanced, doctors
began focusing more of their time on treatment and diagnosis and less
on prognosis.
Being able to predict the timing of a patient’s death may be useful, but
the tools to treat and diagnose are more profitable. Perhaps more
important, while there may be an array of successful treatments at hand
to help doctors forestall death, the subject raises the issue of fallibility
and also possibly culpability. “Even in the privacy of their own minds,
doctors don’t like to think about prognosis,” said Dr. Nicholas A.
Christakis of the Harvard Medical School.
There are few tools to help doctors with prognosis. It is rarely alluded to
in most popular medical textbooks or on clinical websites such as
PubMed, maintained by the National Library of Medicine. In order to
help rectify this situation, a group of physicians in California has
collected and studied all the research that has been done on so-called
prognostic indexes. The researchers have been able to find 16 indexes
that could help doctors predict how long a patient might live, but there
is insufficient reason to recommend any of them for widespread clinical
use.
With so little research to help them, physicians often end up making
“guesstimates” which can be wildly inaccurate and adversely affect an
older patient’s quality of life and care. Too much doctor optimism may
mean unnecessary and painful procedures and treatments. Too much
pessimism may lead to a neglect in offering adequate care.
The authors of the study have created a website, ePrognosis, to help
physicians and patients access available prognostic tools. Yet, the
researchers admit this tool is only a small part of what is required. More
work is needed in creating and validating assessment tools and also in
teaching doctors again about the art and science of prognoses. “We
actually have a moral responsibility to our patients to help provide them
with the best prognostic information,” said Dr. Alexander K. Smith, one
of the study authors.
To read the entire article, click on THE NEW YORK TIMES.
Comment: One can appreciate how difficult it may be for doctors to
make reasonably accurate predictions of how long a patient has to live,
but it is a bit discouraging to hear that the subject of prognosis has
apparently been given so little emphasis in medical schools and journals
in recent years. Bravo to the doctors who are trying to change that
situation.
Right now there are simple age-based cutoffs for recommending some
medical testing such as for colon or prostate cancer, but, as the story
pointed out, some patients may be much healthier and could expect to
live much longer than other patients. For example, is 75 a good age for
stopping routine colon cancer screening for everyone?
I believe each of us has the moral responsibility to take care of ourself
and our body (“a temple of the Holy Spirit” 1 Corinthians 6:19) as best
we can. But despite the best care we might get, it is ultimately up to God
to decide how long He wants us living on this planet.
As Christians, we need not fear death. God has given us victory over
death itself. “Where, O death, is your victory? Where, O death, is your
sting? The sting of death is sin, and the power of sin is the law. But
thanks be to God! He gives us the victory through our Lord Jesus
Christ” (1 Corinthians 15:55-57). Repent of your sins and believe in
Jesus Christ for full forgiveness and the promise of a life in heaven that
will never end.
Not Know
Some researchers are trying to reverse the
de-emphasis on making accurate prognoses.
Summary: A century ago the art and science of “prognosticating” or
predicting a patient’s life expectancy was an essential part of doctoring.
It occupied an important position in textbooks, journals and
conversations with patients. But as technology advanced, doctors
began focusing more of their time on treatment and diagnosis and less
on prognosis.
Being able to predict the timing of a patient’s death may be useful, but
the tools to treat and diagnose are more profitable. Perhaps more
important, while there may be an array of successful treatments at hand
to help doctors forestall death, the subject raises the issue of fallibility
and also possibly culpability. “Even in the privacy of their own minds,
doctors don’t like to think about prognosis,” said Dr. Nicholas A.
Christakis of the Harvard Medical School.
There are few tools to help doctors with prognosis. It is rarely alluded to
in most popular medical textbooks or on clinical websites such as
PubMed, maintained by the National Library of Medicine. In order to
help rectify this situation, a group of physicians in California has
collected and studied all the research that has been done on so-called
prognostic indexes. The researchers have been able to find 16 indexes
that could help doctors predict how long a patient might live, but there
is insufficient reason to recommend any of them for widespread clinical
use.
With so little research to help them, physicians often end up making
“guesstimates” which can be wildly inaccurate and adversely affect an
older patient’s quality of life and care. Too much doctor optimism may
mean unnecessary and painful procedures and treatments. Too much
pessimism may lead to a neglect in offering adequate care.
The authors of the study have created a website, ePrognosis, to help
physicians and patients access available prognostic tools. Yet, the
researchers admit this tool is only a small part of what is required. More
work is needed in creating and validating assessment tools and also in
teaching doctors again about the art and science of prognoses. “We
actually have a moral responsibility to our patients to help provide them
with the best prognostic information,” said Dr. Alexander K. Smith, one
of the study authors.
To read the entire article, click on THE NEW YORK TIMES.
Comment: One can appreciate how difficult it may be for doctors to
make reasonably accurate predictions of how long a patient has to live,
but it is a bit discouraging to hear that the subject of prognosis has
apparently been given so little emphasis in medical schools and journals
in recent years. Bravo to the doctors who are trying to change that
situation.
Right now there are simple age-based cutoffs for recommending some
medical testing such as for colon or prostate cancer, but, as the story
pointed out, some patients may be much healthier and could expect to
live much longer than other patients. For example, is 75 a good age for
stopping routine colon cancer screening for everyone?
I believe each of us has the moral responsibility to take care of ourself
and our body (“a temple of the Holy Spirit” 1 Corinthians 6:19) as best
we can. But despite the best care we might get, it is ultimately up to God
to decide how long He wants us living on this planet.
As Christians, we need not fear death. God has given us victory over
death itself. “Where, O death, is your victory? Where, O death, is your
sting? The sting of death is sin, and the power of sin is the law. But
thanks be to God! He gives us the victory through our Lord Jesus
Christ” (1 Corinthians 15:55-57). Repent of your sins and believe in
Jesus Christ for full forgiveness and the promise of a life in heaven that
will never end.
LSI Blog - Friday, Jan. 27, 2012
