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'View from the Other Side of the Stethoscope: How Long Do I Have?' 11/25/12 issue

Regarding Wendy Harpham's "How Long Do I Have?" column in the November 25th issue, I'd like to share another way to deliver the news. In all my years in oncology, I have never issued a direct estimate of the longevity a patient could expect. I watched them relax and settle back in their chair when I responded to their question in that way on many occasions. That their future was not something measurable in absolute numbers seemed somehow reassuring to them.

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In situations where we both, the patient and I, knew that the future was going to be shorter than we would like (and they all seem to know that intuitively when they come in the door), I would approach the situation in this way: "Suppose we could clone you, and make 100 people just like you are right now. Then, suppose we had a convention a year from now and less than half of you may be able to be there. I have no idea if you will be there or not." That seemed to be an effective way to tell them the gravity of their problem, without reducing it to absolute terms that people tend to pay more attention to than they should, as such estimates tend to be wide of the mark in either direction.


Sometimes, I would bring up the concept of the "prudent man rule," which measures what a prudent person would do in the same or similar circumstances. I could then suggest that it might be a good idea to be sure their affairs were in order. And if their treatment should happen to be successful, they would just be better organized than most people are.


That approach seemed to be one that patients and families could accept and deal with reasonably well. Their feedback indicated to me that they realized that there were a lot of uncertainties at work in any patient's prognosis, and they were appreciative of not having a number placed on their days remaining.




Dallas, Texas


Response from Wendy Harpham:

Thank you for taking the time to share your experience and excellent suggestions for providing compact and compassionate ways to answer patients who ask "How long?" The time frame for "the convention" serves as a vehicle for offering a ballpark figure while sparing patients a prognosis in absolute terms. And the "prudent man rule" couches in practical terms the need to proceed with emotionally charged preparations, with the emphasis on the benefit for patients who do well.


Clearly your patients appreciate how you highlight the uncertainty in everyday terms that are not burdensome. As doctors, techniques such as these can help us in our mission to be honest, hopeful, and helpful.