Death Foretold: Prophecy and Prognosis in Medical Care / Edition 2

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"How long do I have, Doctor?" asks the anxious patient in novels, movies, television shows, and real life. Those six words, a ready cliche for the onset of bad news, mask a complicated web of information, anguish, vulnerability, and uncertainty. Patients and families have many concerns when asking this question, and now Nicholas Christakis takes us inside the world of the doctors who must answer it.

Death Foretold explains the act of prognosis in its varying forms--doctors telling patients if their cancer is curable, when their pain will stop, if they will live to see their child graduate from college--from the perspective of doctors. Christakis examines why physicians are reluctant to predict the future, what uses doctors make of prognosis, the symbolism it contains, and the practical and emotional difficulties it involves. Drawing on his experiences both as a doctor and as a sociologist, he conducted interviews with scores of physicians; he searched medical textbooks and medical school curricula for discussions of prognosis; and he developed quantitative data showing that physicians are systematically optimistic in their predictions. With its combination of approaches and methods, Death Foretold is the most rigorous study of a murky area of medical practice that, despite its importance, is only partially understood and rarely discussed.

Christakis argues that physicians and the medical profession as a whole have the duty to prognosticate, and shirking the difficult questions--as most doctors tend to do--advances neither medical knowledge nor the care seriously ill patients receive. Death Foretold is a clarion call for a renewed effort to understand and improve the art and science of prognostication.

"....reveals that physicians frequently make errors in their prognosis & can convey an optimistic bias...also discusses how physicians can improve prognostication skills through careful clinical practice and education."

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Editorial Reviews

Journal of the American Medical Association
Death Foretold makes an important start in addressing the dearth of scholarship on the art, science, and mystery of prognosis. Although the author's purpose is to elucidate how physicians view and approach prognosis, the book should also appeal to patients interested in understanding how and why doctors too often fail to address the fundamental query, "Doctor, what will happen to me?"
Library Journal
In this important book on the issue of medical prognostication, Christakis explains that even though doctors commonly encounter situations that require a prognostic diagnosis, they feel poorly prepared, find it stressful, and believe that patients might judge them adversely in the face of prognostic errors. Drawing on his own knowledge of bioethics, his experience as a sociologist, and his work as a physician, Christakis has taken on the task of interviewing his colleagues, searching medical school curricula, gathering medical texts, and creating his own quantitative research to provide readers with a comprehensive consideration of this murky area of medical practice. This treatment takes us from a history of the social construction of prognosis, to an examination of the need for it, through the perils of accountability, and concludes with a "clarion call" for the duty of the healthcare industry (especially physicians) to find better ways to prognosticate. Highly recommended for everyone from patients wrestling with their personal prognosis to any medical practitioner touched by this bioethical dilemma. Especially suited for medical school libraries.--Rebecca Cress-Ingebo, Wright State Univ. Libs., Dayton Copyright 1999 Cahners Business Information.
Drawing on interviews, surveys, and his own experience as a physician, Christakis (medicine and sociology, U. of Chicago) examines how prognoses from the simplest to the direst are made, how often doctors err in making them, and the uncertainty with which they are pronounced and interpreted. He intends his account to be accessible both to doctors and to patients. Annotation c. Book News, Inc., Portland, OR (
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Product Details

  • ISBN-13: 9780226104706
  • Publisher: University of Chicago Press
  • Publication date: 2/28/2000
  • Edition description: 1
  • Edition number: 2
  • Pages: 328
  • Product dimensions: 6.00 (w) x 9.00 (h) x 1.00 (d)

Meet the Author

Nicholas A. Christakis, M.D., Ph.D., is an associate professor of medicine and sociology at the University of Chicago.

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Table of Contents

1. Prognosis in Medicine
2. Making Use of Prognosis
3. Error and Accountability in Prognostication
4. Professional Norms Regarding Prognostication
5. Telling Patients Their Prognosis
6. The Self-Fulfilling Prophecy
7. The Ritualization of Optimism and Pessimism
8. A Duty to Prognosticate
Appendix 1: Original Sources of Data
Appendix 2: Detailed Survey Experiment Results
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