Giving a patient "6 months to live"

[McDoctor]

I've been meaning to post about this for a while, I see it come up on the news every few months or so. It's a huge pet peeve of mine. That is, Feel-good news stories of someone "beating the odds" after his/her doctor "gave him/her 6 months to live".

(I did a quick Google search and pulled up one of the MANY news stories which represent this phenomena:http://www.rep-am.com/articles/2007/08/03/lifestyle/271256.txt).

Never have I myself gave a patient, or witnessed a doctor giving a patient, a hard number like that with such certainty. Never. I couldn't even imagine it.

If you've ever told a patient they had "6 months to live, period", or witnessed an oncologist make such a prediction post it here. I'm skeptical that this ever happens.

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[secretwave101]

In defense, I will say that patients really push for the prognosis sometimes. "How long do I have, doc?" is something I hear ALL the time. You can blow out some politician's answer like, "In no way should it be misconstrued that I, do not, disapprove." Or, you can say something to the effect that in your experience, most people don't live past X, although there are exceptions to every rule.

Recent Example: Ted Kennedy. Malignant glioma, probably astrocytoma. Depending on treatment, I think approx 60% live past 1 year, and less than 40% live past 5. That's prognostication. Some patient who lives for 366 days will then run around saying, "My stupid (specialist) doc told me I wouldn't live past a year!"

Frankly, the end of life prediction often devolves into a no-win situation without a good relationship with the patient.

 

[MOHS_01]

It happens routinely, and while one should not speak in absolutes, it is done for the very reason stated above. Also, patients do not always come away with an good understanding of what their doc is trying to say -- i.e. what they hear is not always what is said, or they choose to focus on one particular phrase out of a 30 minute conversation.

Patients need to know what to expect -- many times plans need to be made, bridges mended, etc. For example -- metastatic melanoma carries a median survival time of 6-9 months. While I have never said (as this is often led to the oncologist) "you have six months", too many times a patient has asked me "doc, what are my chances". You have to be honest with them (and pray that you are wrong). I tell them that it is absolutely impossible to accurately predict for them, the average (most patients do not understand median) for diagnosis x is y. It is never a fun or enjoyable, and luckily it is a rare even for me to encounter.

 

[McDoctor]

It happens routinely, and while one should not speak in absolutes, it is done for the very reason stated above. Also, patients do not always come away with an good understanding of what their doc is trying to say -- i.e. what they hear is not always what is said, or they choose to focus on one particular phrase out of a 30 minute conversation.

Patients need to know what to expect -- many times plans need to be made, bridges mended, etc. For example -- metastatic melanoma carries a median survival time of 6-9 months. While I have never said (as this is often led to the oncologist) "you have six months", too many times a patient has asked me "doc, what are my chances". You have to be honest with them (and pray that you are wrong). I tell them that it is absolutely impossible to accurately predict for them, the average (most patients do not understand median) for diagnosis x is y. It is never a fun or enjoyable, and luckily it is a rare even for me to encounter.

It sounds like you, and most oncologists, give a patient an honest portrayal of the data, but they tend to be conditioned to HEAR firm deadlines. Do oncologists really "routinely" give patient hard absolute predictions like "You have 6 months to live"? I mean, do they literally say this in those exact words to a patient, as is often reported in these news stories.

As opposed to saying something like "on average, most people die within 6 to 9 months". I suspect most oncologists present things this way.

 

[MOHS_01]

I would be hard pressed to believe that oncologists (or anyone for that matter) would come right out and tell someone that they "have x months to live". Most of the oncologists who I personally know are overly optimistic regarding the success rates of their chemo regimens -- in more cynical terms, cannot convince someone who "only has six months" to undergo a toxic, dreadful three rounds of multi-agent chemo.....

I really try to impress upon patients that we cannot play God and predict responses / results. I do not get "preachy" with them, but I let them know my (and medicine's) limitations and that I share their frustration with said limitations. It is rough, and I thank God regularly that I have not had to have this conversation more than three times in two years..... one of those times a patient's wife looked at me and said "but you were supposed to be the specialist"".... feeling helpless sucks ***...