Monday, May 6, 2013

The Cancer of Optimism

In yesterday’s New York Times, there was an Op-Ed about doctors being overly optimistic with their patients about their prognosis.  It was written by a resident physician just starting his medical career.  He discusses a patient who unexpectedly died.  The writer called himself a “victim of irrational optimism, a condition running rampant in both doctors and patients, particularly in end of life care”

He goes on to quote some statistics from a cancer study from The Annals of Internal Medicine in 2001 that stated “doctors were up front about their patients’ estimated survival 37% of the time; refused to give any estimate 23% of the time and told patients something else 40 % of the time. Around 70% of the discrepant estimates were overly optimistic”.

“This optimism is far from harmless.  It drives doctors to endorse treatment that most likely won’t save patients’ lives, but may cause them unnecessary suffering and inch their families toward medical bankruptcy.”

“Studies have shown that patients almost universally prefer to be told the truth.  If physicians cannot deliver the hard facts, not only do they deprive their patients of crucial information, but they also delay the conversation about introducing palliative care.”

He does on to cite a study that showed that cancer patients who had palliative care combined with standard care lived a few months longer than those with standard care alone.  The writer went on to state that nonetheless, doctors usually insist on more invasive treatments even when there is little chance that they will work. 

It appears that patients are not being given truthful information about their prognosis and how effective the next invasive treatment will be. Doctors are telling patients to undergo more invasive treatments because they are hoping they might work.  The problem is that these procedures lower quality of life without much extra longevity. 

If I get to the point where a new treatment is not likely to work, I would hope that my doctor would tell me to enjoy the rest of the time I had without furthering invasive procedures if they are futile.

The Op-Ed can be seen in the link below: