Is it wise or accepted to forecast the life span of incurable moribund patients by the treating physicians and express it to her/him or to their relatives? What is your opinion on this practice?
That is a very important question and simultaneously one of the most difficult in medicine to answer. Actually, it depends on the nature of the patient. Some are naturally born fighters, others prefer a white lie.
According to my personal experience, it depends on the true nature of the person whether it is good, to tell the truth, or not. Age plays its role too. Younger people get more disappointed and frightened by the possibility of nearing death than older ones.
A very important factor is that so-called truth can easily become a nocebo as we tell it to a patient. How does it work with placebo/nocebo? Our body is, more that we are willing to accept, governed by our mind and spirit. When we do discourage the person from activating his/her healing powers, he can disconnect the body from the immense influence of the mind and spirit. This can activate a strong and fast demise.
On the other hand, some patients when they get a 'fatal' prediction, they have enough power in their mind and spirit to activate all healing powers in their body.
It is very, really very difficult to estimate who is who. On top of it, even a single patient can change the above categories once or even more times during his life.
According to my personal experience, it is the most important to 'probe' patient and 'guess' what is the best. There are certain messages from the previous life that can tell us how tough the given person is.
To rely only on statistics based on the lives of other patients is not sufficient. Patients are not numbers. The role of motivation is tremendous.
CANCER patients are said to be in a 5-years horizon until terminal period. This is a known to both patients and doctors. The sooner the patient knows and accepts the reality the better to cope and fight for a better chance; thus, making each day counts. It is more unacceptable to lie to patients about the facts of their illness.
Dear Dr. Paul, you are correct, but perceiving the prognostic life span sometimes expedites to be nearer to death in some patients. Life becomes miserable, indeed!
That is a very important question and simultaneously one of the most difficult in medicine to answer. Actually, it depends on the nature of the patient. Some are naturally born fighters, others prefer a white lie.
According to my personal experience, it depends on the true nature of the person whether it is good, to tell the truth, or not. Age plays its role too. Younger people get more disappointed and frightened by the possibility of nearing death than older ones.
A very important factor is that so-called truth can easily become a nocebo as we tell it to a patient. How does it work with placebo/nocebo? Our body is, more that we are willing to accept, governed by our mind and spirit. When we do discourage the person from activating his/her healing powers, he can disconnect the body from the immense influence of the mind and spirit. This can activate a strong and fast demise.
On the other hand, some patients when they get a 'fatal' prediction, they have enough power in their mind and spirit to activate all healing powers in their body.
It is very, really very difficult to estimate who is who. On top of it, even a single patient can change the above categories once or even more times during his life.
According to my personal experience, it is the most important to 'probe' patient and 'guess' what is the best. There are certain messages from the previous life that can tell us how tough the given person is.
To rely only on statistics based on the lives of other patients is not sufficient. Patients are not numbers. The role of motivation is tremendous.
No one knows exactly how long someone will live with an incurable, eventually terminal illness. As a hospice supervisor I've seen patients taken off the hospice program because they were still alive at the 6 months standard for expected death.
However, I believe patients have a right to know the truth about their situation and family members, too, who have medical power of attorney. It is desirable to present the information as a general statement, such as, "Most people who have your condition live about ????? However, everyone is unique."
That gives patients and loved ones a guideline, preparation time without dashing hope.
Thanks Madelaine Lawrence for your valuable comment as an expert on this affairs which is also quite a balanced one, indeed. Thanks once again. Regards- Rabiul
Dear Prof Jiří Kroc , Im really amazed to hear from you in detail about your tough and real-time experiences of patient management. Quite often, we also face these type of scenario. Thanks for sharing. Best of luck. Rabiul
Dear Prof Rabiul Alam,
In some moment of my life, a decision was made to distill my personal experiences into the information shared with all: patients, MDs, and researchers.
It is the result of long thinking about why so many medical errors and mistakes occurred in my life and lives of others, which must be consequently resolved by other medial interventions or by my own and their own efforts (diet, lifestyle, Qi Going & Taiji Quan, various compensating techniques, meditations, and spiritual practice).
This struggle for understanding led me to biomedical research where I work in the field of complex systems and their applications in biomedical research, you can check details in my research outputs.
Surprisingly, according to many researchers, there is a high area of yet unknown mathematical models and solutions in medicine, which includes a better understanding of disease dynamics including their progression or remission with time.
Personally, I do see better ways of assessing the actual condition of any patient during his/her own life. It seems to be reasonable to start research in this area according to complex system approaches (for the mathematical background you can check my review paper of complex systems in medicine with apps, it is designed as an intro).
To me, it seems to be the next natural step is to employ mathematics that I currently use in the prediction of arrhythmias to predict the lifespan of patients and especially assessing the dynamics of diseases.
There are a great future and space for the development of such mathematical approaches.
All that I do is done for better lives and longer lives of other patients :-)
Dear Prof Rabiul Alam,
I just checked your profession. Anesthesiology is already using fruits of the type of research I am speaking about. The depth of anesthesia can be assessed using complex system measures -- usually by measuring the entropy of the EEG signal.
My research on prediction Torsades de Pointes arrhythmias, ventricular arrhythmias, and ventricular fibrillation is creating a small subset of your question. It is working with arrhythmias surprisingly well!
Details and citations about the application of prediction in your field can be found in the review paper: "https://www.researchgate.net/publication/330546521_Complex_Systems_and_Their_Use_in_Medicine_Concepts_Methods_and_Bio-Medical_Applications"
The poster about complex systems in medicine, see my title page, is serving as an introduction to the review paper.
I think that information presented in both paper and poster enables anyone without prior mathematical understanding to grasp the core -- mathematics -- of your question. We all know that to be capable of doing some prediction of the system, we must be able to quantify it.
This is shown in both, paper and poster. We are very probably observing the very beginning of massive quantification of medicine and the state of the human bodies. It is exciting to be able to observe this transition.
Have good luck with helping others,
Jiri
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