Dr Phil Hammond, GP and BBC presenter, blogs for us…
‘Don’t ever tell a patient how long he or she has left to live. You will rarely succeed.’ This advice was drummed into me by a wise consultant over thirty years ago and it would appear from this recent analysis of 12,000 prognoses that we still haven’t mastered the art of predicting when death will occur. I was taught to offer a ‘catch all’ range of possibilities – ‘it could be weeks or months – but I did once have a patient with a cancer like yours who lived for over a year.’ That covered cautious realism and hopeful optimism, without falling into the trap of deadly soothsayer.
It’s not surprising that doctors and nurses err on the side of optimism – without hope, life is pretty rotten. And it may also be that the demands of transparency put pressure on staff to ‘name the date’ when old fashioned obfuscation might be wiser. When I trained, patients often weren’t given their diagnosis and rarely did anyone mention the word cancer. People had a warty growth down below, or a spot of inflammation in the liver. Beneficent paternalism ruled, and doctors decided what information was in the patients’ best interests, and what it would be kinder to keep hidden. Only one consultant – from Yorkshire – spoke openly about cancer and in a very explicit way. He told one patient ‘You know what your problem is, don’t you? You’ve got cancer and you’re going to die.’ Another was told ‘you’ve got so much cancer it’s metastasised to the bloke in the next bed.’
Such behaviour would likely lead to a misconduct charge today, and it maybe that the public and press scrutiny of doctors has made us not just kinder and more hopeful, but also wary of upsetting a patient or relative for fear of complaints. Perversely, this may be making us less truthful in this age of candour. Plenty of our patients are fat, but it’s a brave doctor who tells a patient directly.
What we can say for certain is that we are all going to die sometime. If we don’t take our own lives (men under 50 beware), we’re likely to die of heart disease, cancer or a stroke. But the human spirit can be as unpredictable as any illness, and all doctors have stories of patients who didn’t live up to, or outlived, their prognosis. What matters more is that our deaths are gentle, whenever they come, and at a place of our choosing if possible. To do that requires difficult questions and tricky answers, some of which will be proved wrong. But like most things in life, death is often smoother with a bit of thought, talk and planning.
Dr Phil Hammond is an NHS doctor, BBC presenter, Private Eye journalist, campaigner and comic. His Health Revolution is touring the UK soon. Details http://www.drphilhammond.com
Dr Phil Hammond is touring the UK in 2016/2017 with Dr Phil’s Health Revolution