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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."
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