How do doctors determine how much time some patients have left (or is it just in movies)?
No, it’s not just in the movies; it’s real. The person facing you has been deemed to have a poor chance of surviving for any meaningful period of time. A typical example would be one where an advanced stage of cancer has been diagnosed. It’s likely that the person has only a few weeks or months left in their lives based on data and statistics of good quality.
Going beyond: I am going to venture beyond the limits of this question. There are many major elements of terminal illness that are important. In my practice, this situation is possibly the hardest encounter I have had with patients and their families.
Be truthful, be gentle: The most important thing to do in this situation is to be truthful without being blunt; a lot of gentleness and empathy are needed.
- Never deny hope, never give hard numbers and data; I prefer to speak in general terms.
- Hiding information from a patient out of a mistaken intention of being kind actually does them a disservice. There are personal agendas and activities that may need to be fulfilled. The person should be given a chance to go after them.
Pain: An important question that always arises is the prospect of pain in the final days. There are strategies available that can keep them comfortable while maintaining clarity of mind. This has to be handled with confidence.
Home, not alone: I also advocate that the last few days be spent at home, in familiar surroundings, rather than in a hospital, cut off from family and close friends.
DNR: A “do not resuscitate” decision, once taken by the patient, has to be announced to the care givers. The issues at hand have to be clearly discussed ahead of time.
“Lies, damn lies, and statistics”: There is one important reason why I stay away from giving hard numbers. There is always a patient or two who goes well beyond the expected time frames and survives for much longer periods than predicted. The human body-mind is a mystery we cannot fathom.
Must read this: In conclusion, I would recommend reading a superb article on terminal illness written by the well-known evolutionary biologist, the late Stephen Jay Gould — objective and hopeful. The median isn’t the message