For a patient to expect an accurate statement of survival is not reasonable and produces confusion, anxiety. Therefore, when a patient or family asks “the question,” for what answer should they be looking? Alternatively, put another way, what is the “right question?” The question that may result in the best answer is, “Is this a curable disease?
- If not what is likely to happen with this illness?
- What events may occur?
- What complications are probable?
- Doctor, in your personal experience, with all you have seen, what might future hold?”
The doctor in answering either “the question” or perhaps the “right question” must be aware of both his limitations, as well as the needs of the patient. The physician’s limits include the reality that he is not a deity and therefore cannot see the future. However, he has most likely seen this illness many times and can offer a great deal to help each family plan and cope. In order to deal with the future, it requires a basic understanding of the course of the illness.
- Will the patient get stronger?
- Will hospitalizations be likely?
- If there will be pain, how will it be treated?
- Can the patient travel?
- What may be the costs, physical limitations, choices of treatment, or psychological impact?
- If this will be a chronic condition what will that mean for the patient’s lifestyle?
- If this will be a fatal condition what may happen near the end of life.