Bioethics Discussion Blog: Doctor,Doctor: Just How Long is there To Go?

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Sunday, January 30, 2005

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?”

2 Comments:

At Sunday, January 30, 2005 1:07:00 PM, Blogger Cheenivaz said...

This is the most difficult question as far as i am concerned...it is very diffcult to confront a patient who is asking this question...especially if you are the primary physician treating the patient...
So it takes different forms with different patients - some patinets are extremely emotional whereas some are straightforward and blunt and sound "strong" and in between this black and white there are multiple shades of grey...

For the most emotional patients, i'll get the patient to really into a conversation about what is actually haunting him/her about it...what are his /her fears and apprehensions...what is troubling him...and try to slowly build the answer on that aspect...

For the extremely straightforward patient . which is even mroe diffcult to handle for me - is to get them also to come out with what their fears and apprehensions..and usually thy dont really coem out with it..so i gently tell them the disease process and the literatures estimate of life expectancy at their condition...slowly ...

Usually I have to be calm and untroubled to do this kind of studff...if i am in such hurry or speed..i generally ask the patient for some time when we can talk about it for some time...and try and finish it that day itself...
Even though i have hardly 5 years of clinical experience after med school...this is still the most hdiffcult thing for me to do...
This is so especially since i m the resident doctor..patients connect more with me rather than the rouding consultant....and so the responsibility of their trust and answering their questions lies on me more than my rounding consultant...

By the way like ur posts very much.

 
At Sunday, January 30, 2005 4:47:00 PM, Blogger Maurice Bernstein, M.D. said...

Cheenivaz,I am 46 years out of medical school and this professional duty is still tough! Thanks for your compliment. ..Maurice.

 

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