Keeping hope alive

Dr. Ron Davis, president of the American Medical Association, has advanced pancreatic cancer, which is a terrible thing. But it does give him the chance to reflect on the diagnosis and provide his fellow physicians with some important advice:

“As a physician, I know the survival statistics for someone with stage 4 pancreatic cancer,” he said. But if the five-year survival is 5 percent, that’s not zero… So, never take away someone’s hope.”

There’s plenty of attention given to the high amounts of medical resources used at the end of life and the underuse of hospice care. But I’m equally struck by the tendency of the medical profession to write people off prematurely. A relative was told he wasn’t a candidate for chemo due to his age, then got it anyway because he and the family pushed for it; he ended up doing fine for more than a year. The laments about end-of-life spend are made retrospectively, since it’s hard to define the day of death in advance. And sometimes patients with living wills change their mind about how much treatment they want when they actually get sick and decide that illness actually isn’t worse than death.

Personally I lean toward Dr. Davis’s view. Very sick patients tend to hang on their doctors’ every word. When they hear (or sense) they are being written off the consequences are real. Telling someone they have a 5 percent chance isn’t providing false hope.

June 16, 2008

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