Prognosis is not a term familiar to most people unless used by a doctor to explain the expected course of a medical condition. Even then, the word or its implications may not be understood. At times of a medical crisis all we want to hear is that the outcome is going to be good. However, explanations about poor prognosis may often be spoken in code or heard in incomplete sentences.
The issues surrounding prognosis remind me of Pete from our 2003 video “Voices From The Lived World Of Illness” He talks about being diagnosed with advanced lung cancer but remains hopeful while still feeling a bit of skepticism about his future. He goes on to say that his doctor posed a question about life expectancy rather than initiating a direct discussion about prognosis. Pete recounts the interaction.
“After talking with him [oncologist]—not that he has a crystal ball but he has more knowledge about cancer and possible longevity than I do—he asked me what I thought about 10 years. I said I’d be delighted. It really changed my outlook. There have times since then that I thought 10 years may be optimistic but maybe I can do it. ”
No doubt, it’s uncomfortable for doctors to talk candidly about life expectancy. And, of course, these predictions are not an exact science. It’s also hard for patients and loved ones to hear that time may be limited. Under these circumstances there can be an avoidance of honest communication for both doctors and patients, which can lead to a “collusion of silence.”
Talking in code may be a more gentle way of introducing a poor prognosis but should we leave the patient trying to interpret what it means?