Doctor,Doctor: Just How Long is there To Go?

From the chorus of “Doctor,Doctor” by Who:

Do you think it's time that I made out my will?
I'll leave everything to you to pay my bill
Just how long is there to go
Please tell me I want to know
But on second thoughts don't tell me, I'm too ill.

“Just how long is there to go”(“How much time do I have to live?”) is a question that is often posed by patients when they first learn that they have a potentially terminal illness. And it is often one of the most difficult questions for a physician to answer. We discuss this issue with the medical students in their first year.

What is the answer? Do doctors really know the answer? No. Doctors really don’t know for the specific patients who question them. There may be some statistical information about the disease in the literature and there is the physician’s own clinical experience with the disease but is that sufficient to yield an answer to the distraught patient? Not really. If so, then on what basis should the physician reply with anything beyond “I don’t know”. Students are taught to ask the patient for the reason for the question. The patient’s reply often provides a host of issues for which the physician can get insight into the patient’s psycho-social life and may be able to provide emotional or other support even without giving a definitive answer.

It is the physician who promptly replies to the patient’s question with a short, arbitrary answer and without further questioning or discussion who will be long remembered, but not in a helpful sense, by the patient who has also long survived the “6 months” death sentence.

Students are taught to be certain that the patient wants to talk about the prognosis in quantitative terms since “on second thoughts, don’t tell me”. If it is clear the patient wants to talk about their remaining lifespan, the only thing the physician can do is describe the data in the literature to the patient and explain the uncertainty of the statistics as applied to the individual patient.

It is a difficult experience for a doctor to give the patient “bad news” and it is most difficult to find answers to all the questions that follow. I would be most interested to read from other physicians who visit my blog how they approach the answer to the question “Just how long is there to go?”