Doc, how much time do I have?

On my last post I promised to discuss why physicians would ever offer predictions on how much time a patient has left. Why do you think?

Often physician are responding to their patients' question: Doctor, how much time do I have? This question is a common reaction when patients learn that their treatments have stopped working and they've run out of options. Patients want to know their life expectancy (or think they want to know), so they can make some choices and plans.

There is no one, simple answer as to why some physicians answer with a specific time frame. Maybe physicians feel

• an obligation to respond to their patient's request with a specific time frame.
• they are being asked as an expert and are supposed to know.
• they are doing the patient a favor by offering an estimate as a prediction.
• they are providing a prognosis, even though presenting the time frame as a prediction
• difficulty dealing with -- or talking about -- uncertainty
• a personal need for a sense of authority, control, power (I hope not, but suspect this might be the case sometimes).

So how should a physician answer a patient who asks, "Doctor, how much time do I have?"

Comments

[Finn]

I think they should preface their reply with "Of course no one can say for sure. All I can tell you is that among people your age and condition, at this stage of the disease when treatment stops working, the average is ____________ [a range]. However, it can be shorter or longer. These are statistics about large groups of people, and not specific to you or any one individual. They can't predict what you will experience."

It might be even better to start with explaining what the patient should expect in terms of energy, symptoms, debility, etc., as the disease progresses, before talking about numbers. I haven't been in this situation but I'm thinking people ask the question because they want to know what to expect, to help them make decisions and plans, and not just a date. I think doctors should neither dodge the question nor be overly specific or confident in the times they give, but they do owe it to the patient to do what they can to explain why such predictions may be educated guesses but are nevertheless guesses.

[Wendy S. Harpham, M.D.]

Dear "Dr." Finn,
Your answer is spot on. So good, in fact, that I'll post it as my next post for people who don't read the comments.

With hope, Wendy

[kate]

People who opt to stop dialysis often ask me how much time they have. I've usually answered with a range of days and then what they might expect over the course of those days. I think this is a slightly different question; withdrawal of life sustaining treatments generates more predictable outcomes with time frames.

[Wendy S. Harpham, M.D.]

Dear Kate,
Thanks for your comment. I agree that it is a slightly different question when withdrawing life-prolonging treatment as opposed to leaving progressive disease to take its course.

But you also showed how even under those more predictable circumstances, you offered a range AND you told them what to expect. I'm sure you've helped many families through difficult times.

With hope, Wendy

[Pat Foote]

I was given an 18% chance to live 1 yr in 1980. The odds are still about the same for ovarian cancer today, but new protocol and prolonging treatment has changed. My oncologist answered my question by saying, "You are the statistic", and sure enough, here I am 29 years later after several recurrences, surgery, chemo, radiation, etc. So, who knows!
Pat Foote

[Wendy S. Harpham, M.D.]

Exactly, Pat. Who knows? Thanks for sharing with my readers. With hope, Wendy