Why doctors are so bad at predicting how long their patients will live.

Health and medicine explained.
Aug. 18 2010 11:37 AM

The Worst Fortune Tellers

Why doctors are so bad at predicting how long their patients will live.

(Continued from Page 1)

Such technology can complicate predictions further: Take former Vice President  Dick Cheney, who last month had a left ventricular assist device implanted in his chest to augment the pumping of his weakened heart. By conventional measures, given the severity of his reported  congestive heart failure, the likelihood of his surviving past one year would be only 50 percent. But don't yet file his obituary: Doctors not involved with his treatment have given optimistic projections that carefully selected patients with LVADs can live more than an additional year with the device; one patient survived more than five.

So how do we become better at prognostication?

Advertisement

Christakis argues that studying and delivering prognoses to patients is part of the ethical obligation of doctors to their patients. "Furthermore," he writes, "physicians should legitimate discussions regarding prognosis not only with their patients but with each other." As such, doctors would recast the professional norm to include open and frank discussion of prognosis in medical care.

In so doing, we need to strive for honesty and avoid "hanging crepe," the idea of delivering a poor prognosis simply to combat our tendency to be overly optimistic and to keep our hands clean: If the patient dies, I predicted it and therefore appear accurate; if the patient outlives my prediction, everyone is pleasantly surprised and thus I'm not held accountable. Dahut reminded me of the oncologist's rule of thumb: If a patient was walking around three months ago and still can, he'll probably be around a little while longer; if he can't get out of bed, "the disease is likely to progress at the same rate." Framing it this way helps patients and families manage expectations, by not giving a limited time interval that can feel like either an immutable sentence or an obstacle to overcome.

Beyond that, there needs to be fundamental change in the way that doctors are educated in prognosis calculation and delivery. Prognosis should not be left to the realm of mordant comments in pathology lectures or sotto voce remarks to students and residents outside a patient's room during ward rounds. Instead, medical education at all levels should feature actuarial information on the major causes of death, with modification for the age of the patient and the various treatment options. Patients will have to more overtly demand prognosis to help spur these changes.

Of course, in an age of patient empowerment, you may well be the ones to lead the charge to make doctors more attuned to answering that fundamental question, which lies at the very heart of medical practice. We can only hope that future doctors will be better prognosticators than old Dr. Sikora.

Like Slate on Facebook. Follow us on Twitter.

TODAY IN SLATE

Foreigners

More Than Scottish Pride

Scotland’s referendum isn’t about nationalism. It’s about a system that failed, and a new generation looking to take a chance on itself. 

What Charles Barkley Gets Wrong About Corporal Punishment and Black Culture

Why Greenland’s “Dark Snow” Should Worry You

Three Talented Actresses in Three Terrible New Shows

Why Do Some People See the Virgin Mary in Grilled Cheese?

The science that explains the human need to find meaning in coincidences.

Jurisprudence

Happy Constitution Day!

Too bad it’s almost certainly unconstitutional.

Is It Worth Paying Full Price for the iPhone 6 to Keep Your Unlimited Data Plan? We Crunch the Numbers.

What to Do if You Literally Get a Bug in Your Ear

  News & Politics
Weigel
Sept. 16 2014 7:03 PM Kansas Secretary of State Loses Battle to Protect Senator From Tough Race
  Business
Moneybox
Sept. 16 2014 4:16 PM The iPhone 6 Marks a Fresh Chance for Wireless Carriers to Kill Your Unlimited Data
  Life
The Eye
Sept. 16 2014 12:20 PM These Outdoor Cat Shelters Have More Style Than the Average Home
  Double X
The XX Factor
Sept. 15 2014 3:31 PM My Year As an Abortion Doula
  Slate Plus
Slate Plus Video
Sept. 16 2014 2:06 PM A Farewell From Emily Bazelon The former senior editor talks about her very first Slate pitch and says goodbye to the magazine.
  Arts
Brow Beat
Sept. 16 2014 8:43 PM This 17-Minute Tribute to David Fincher Is the Perfect Preparation for Gone Girl
  Technology
Future Tense
Sept. 16 2014 6:40 PM This iPhone 6 Feature Will Change Weather Forecasting
  Health & Science
Medical Examiner
Sept. 16 2014 11:46 PM The Scariest Campfire Story More horrifying than bears, snakes, or hook-handed killers.
  Sports
Sports Nut
Sept. 15 2014 9:05 PM Giving Up on Goodell How the NFL lost the trust of its most loyal reporters.