Let us prognose
November 2nd 2007, 11:50
It's been said that medicine is the new religion. Drugs and surgery have replaced God in our drive for certainty and control in a world that appears random. For his part, the doctor often dons a white coat as a player in the brave new priesthood, while dispensing prescription sheets to the laity, or patient.
As a priest-like figure, the doctor has enormous power. I'm sure there is a placebo effect even in prescription drugs, especially if the patient is convinced they will work.
But perhaps his greatest power is the prognosis, his considered view of the patient's chances of survival and recovery. The prognosis is so influential in the outcome that it becomes self-fulfilling, especially for the patient who is open to suggestion.
I have direct experience of the prognosis. My own mother was given three months to live after she had hidden her breast cancer from everyone for several years. We didn't tell mum what the doctor had said, but instead took charge of her therapy ourselves. She made a full recovery within a year, and went on to live for quite a few years afterwards.
I'm reminded of the power of the prognosis, and how uncannily inaccurate it is, by a report in today's British Medical Journal. A study found that doctors at 92 intensive care units consistently got their prognosis wrong, even though they were so sure of its accuracy that they saw little point in treating the patients they had already consigned to the mortuary.
More than 60 per cent of patients were alive 180 days after treatment, when doctors had said less than half would survive that long. Even the patients who were at death's door survived far longer than the doctors predicted. Doctors reckoned just 10 per cent would survive the next 180 days, but 40 per cent did so.
Perhaps they survived so long because they were too ill to hear the prognosis.