Author Insights: Remembering the Lost Art of Prognosis

Physicians should provide realism and not allow unchallenged optimistic perceptions to unrealistically cloud patients’ views of their prognoses. (Image: JAMA, ©AMA)

A new study appearing today in the Archives of Internal Medicine adds to the body of evidence that a patient’s hopeful expectations following diagnosis of a disease or condition is associated with clinically important benefits. But Robert Gramling, MD, DSc, and Ronald Epstein, MD, urge physicians to be cautious about excessive optimism.

In an invited commentary in the same issue of the journal, Gramling, an associate professor of family medicine, and Epstein, a professor of family medicine, both at the University of Rochester Medical Center in New York, say that medical training and practice focuses on the arts of diagnosis and treatment while underplaying the art of prognosis.

In a conversation, Gramling explains how promoting an overly optimistic prognosis can sometimes be detrimental and why it is important to be both realistic and hopeful when discussing the future with a patient.

“Physicians are good at doing the next treatment in modern medicine; even when those treatments have diminishing returns. So an optimistic but unrealistic prognosis can lead to aggressive treatment with adverse effects that may take away from a patient’s remaining quality time.

“Sometimes avoiding presenting a dire prognosis to a patient or family members prevents a discussion of treatments and possible outcomes that they want to have but do not know how to ask for. Communication is the key. A physician needs to sense what the patient or family members want to know at a particular visit.

“I find it useful to assess what they believe the situation is; it helps you to see if you are in the same ballpark as to expectations. Once you know that, you can tailor your conversation to ultimately convey realistic expectations.”

Categories: End-of-Life Care/Palliative Medicine, Medical Ethics, Medical Practice, Patient-Physician Relationship, Quality of Life