A recent column by Dr. Pauline Chen at the New York Times explores a surprising oversight in modern healthcare: Doctors don't really have a clue how to predict how long a patient will live. In the absence of a widely accepted, systematic method of prognosis, they're kind of making it up---an informed guess, with the benefit of education and experience, but a guess nonetheless. Prognosis was once a diligently studied, widely practiced part of a physician's job, Chen writes. But as treatments improved, and keeping patients alive longer became ever more possible, the unpleasant but necessary skill of predicting when patients might die fell by the wayside. A recent study, she reports, revealed just how much:
Prognosis was rarely, if ever, alluded to in the most popular medical textbooks and on clinical Web sites used by practicing physicians. Even the widely used medical database PubMed, maintained by the National Library of Medicine, had no specific indexing category for prognosis, making finding any published study on the subject like searching for a book in a library before the Dewey Decimal System.
Any individual prognosis, of course, may prove to be wrong, however reliable the system for generating it. But it's important for both patients and doctors---and the healthcare system as a whole---that such predictions in general tend to be correct:
With so little research on how to predict how long a patient might live and few resources to turn to, physicians often end up relying on intuition. But studies have shown that these “guesstimates” can be wildly inaccurate, and that inaccuracy can adversely affect an older patient’s quality of life and care. Doctors who are too optimistic may prescribe unnecessary and painful procedures and treatments; those who are too pessimistic may neglect to offer adequate care.
Read more at the New York Times.
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