Tuesday, May 10, 2005

New Poor Prognosis - Part II

First of all, I apologize for the delay. My aunt's memorial was this past Sunday, causing the delay in my response.

I am not sure this post requires a second part to it. Everyone provided very valuable and key feedback as to what was wrong with this scenario. Together, you all offered the answers that I would have said. I am learning, too. I don't want to give the impression that I know the answers any more than you do either. These scenarios are truly about having a discussion.

That said...

The only thing I would add... If you suspect the patient may not want to know the prognosis... because their culture opposes using the word "death" or because the family insists the patient is not mentally stable enough to handle the news, you can start the conversation with a simple statement, such as:

"We have some very difficult decisions to make regarding your illness. Would you like me to be frank with you as to what we are seeing and what your options are or would you prefer another family member or designated person make those decisions for you?"

Like several of you suggested, this gives the patient the option of whether or not they want to know information such as prognosis.

And prognosis doesn't necessarily need to be stated that clearly. Because, to be honest, we can almost never give that precise of a timeline. At best, we can predict months to weeks, weeks to days, days to hours - in that terminology.

Thank you all for your participation in this discussion. I enjoy hearing your thoughts and hope you find the scenarios thought-provoking. And I always welcome questions - such as the clarification between diagnosis and prognosis. Excellent question, Jeremy.

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