Medicine Lodge, Kansas's Locally Owned And Operated Newspaper


Opinion / Religion - February 23, 2015


End Notes: By Dr. Amy Clarkson South Wind Hospice

When we turn on the news or listen to the radio to hear what the meteorologist is predicting the weather will be, we donít usually call this Ďthe dayís weather prognosisí. We use the term forecast, and yet a forecast is essentially the same concept of what a prognosis is.
Predicting the weather and predicting the outcome of a life limiting disease may carry the same foundation, but they differ vastly on their accuracy. Weather forecasting has an overall accuracy for temperature determination (give or take a few degrees) of 85%. A medical prognosis, however, regarding how long someone has to live (give or take a few days or weeks) is usually only accurate 20% of the time, and actually 65% of the time doctors overestimate prognosis by a factor of 3-5.
Yet so often patients who have a terminal disease leave the doctor having latched onto a prognosis as if itís as guaranteed as an expiration date on grocery goods.
Many factors go into misinterpretations of prognosis. Iíve mentioned overestimation, but research also shows that the longer a doctor has taken care of a patient or the more they know that patient, the more they overestimate. Besides overestimation, another problem is how doctors even approach prognosis. Often times they will use something called the median survival rate when discussing prognosis. Patients get this confused with average. Median, however, is just the middle number of a range. If a doctor says, the median survival is 6 months, that means half of the people with that disease die before 6 months. What median doesnít tell us is, of those people who died before 6 months, did most of them die in 1 month or 5 months? Thatís a big difference!
One thing doctors donít do well is to discuss the worst-case scenario along with the best-case scenario. They assume itís too depressing to talk about bad outcomes with the patient. Also, sometimes during prognosis talks as issue is that patients are shocked, retreat into their brains, and canít listen to the prognosis. One suggestion that can help with both these problems is to have the doctor actually write out the worst-case prognosis, the best-case prognosis and the most likely prognosis.
What can be very challenging is that many prognoses have a very wide range of possibilities. Some cancers carry the possibility of dying in 6 months or living out the rest of your life essentially cured. Itís the same as if a meteorologist announced that for tomorrowís forecast the possibility was for snow, or maybe rain, but also could be hot and sunny. If you were traveling to a location like that, youíd pack for the extremes, wouldnít you? This is how we need to treat prognosis as well. Prepare for the extremes.
A good prognostic conversation should do this; explore the extremes so that you can plan. The next time you hear a prognosis think of it as a forecast, but one with only 20% accuracy. Also, be sure to ask for the worst-case and best-case extremes, it will help you prepare for the journey.

 

Click Here for complete opinion page

 

 

Premiere Inside

School
Sports
Record
Local
Deaths
Opinion
KWIBS
Classifieds
Business Dir.
Subscribe
Ad Information
Staff
Contact Us

Warp Your Favorite Local Person. A Different Victim Each Week!!

Premiere letter policy

Due to the volume of letters to the editor and limited space available, The Gyp Hill Premiere has revised its letter policy effective immediately.

To be eligible for publication in this paper, a letterís content must meet the following criteria: 1) contain information of interest to the community that directly affects the City of Medicine Lodge, Barber County or its citizens; 2) contain information on local public policy; or 3) contain a response or correction of content published in this paper for purposes of clarification.

Letters in response to items published on the opinion pages may or may not be published, depending on their relevance to the community or content involved. Viewpoints expressed on these pages are the opinions of the authors, and do not reflect the viewpoints of The Gyp Hill Premiere or its staff.

Letters to the editor must be typed or neatly handwritten, contain a signature, return address and telephone number for verification purposes. Letters submitted via e-mail are also welcome, provided that they contain a valid reply-to address.

Letters will be published exactly as written, however The Gyp Hill Premiere reserves the right to edit letters for length, spelling, context or clarity as deemed necessary.

All letters are subject to review and will be published at the discretion of our editorial staff. Letters that contain offensive or defamatory language, libelous statements or content that is generally intended to defame will not be published.

Letters that contain obvious factual errors will not be published, however The Gyp Hill Premiere is not responsible for validating the content of letters.

We also reserve the right not to publish letters that do not meet our publication deadline of noon on Friday.

A copy of this policy is available at The Gyp Hill Premiere office at 110 N. Main Street during normal business hours.