There is an old joke that illustrates many people's perceptions of the difficulty physicians have discussing prognosis with their patients. According to this story, a nervous patient comes to his doctor's office for follow-up results following a biopsy of a suspicious shadow in his lung. The doctor enters the room with a furrowed brow. The anxious patient blurts out: "Is it bad news doctor? Am I dying?"
The doctor nods: "I'm sorry, I wish it had been better news. But it looks like the shadow is a tumor."
"A tumor? Oh no?"
"It's always hard to put a number on these things," said the doctor. "But I'd have to say, ten..."
"Ten?," the patient interrupts. "Ten what? Years? Months? Weeks?..."
Ok, so doctors aren't normally that bad at delivering bad news. But in a recent post, I laid out a question to readers — about whether and how physicians should discuss the prognosis among patients whose shortened life expectancy is the result of their already long lives. I asked whether doctors need to talk to 85 and 90-year-olds about the fact that they probably aren't going to live a whole lot longer. Dr. Alexander Smith and colleagues wrote a nice essay on this topic in the New England Journal of Medicine in December of 2011. (Google "Discussing overall prognosis for the very elderly" and you will find it.) They report some important facts about life expectancy in elderly patients. For instance, the average life expectancy of an 85-year-old is 6 years. In fact, 25% of 85-year-olds will live at least another ten years. And the majority of such patients (65% according to their own research) want to discuss life expectancy with their doctors.