Demystifying Medicine One Month at a Time

Doc, How Long Have I Got? [UPDATED]

"Rage, rage against the dying of the light..."

[Editor’s note: I’ve truncated this post because it was picked up by Slate for their Medical Examiner column. Check it out over there & feel free to comment there and here! -GH]

A year ago, U.K. officials released convicted Lockerbie bomber Abdelbaset Ali Mohmet al-Megrahi to Libya on humanitarian grounds, based on a prediction that he had only three months to live. Karol Sikora, the British cancer expert on whose opinion the decision was based, recently owned up to his miscalculation to a London paper: “There was always a chance he could live for ten years, twenty years…But it’s very unusual.” The decision to release al-Megrahi was vilified by victims’ families, and the issue was placed on a short list of U.S. concerns in a recent meeting between President Obama and new British Prime Minister David Cameron.

Which raises the obvious question: How did Dr. Sikora get it so wrong?

To find out, head on over to Slate and read the whole article called “The Worst Fortune Tellers: Why doctors are so bad at predicting how long their patients will live.”

GlassHospital

4 Comments

  1. denise cost

    As a hospice nurse, I, too, am often called upon to prognosticate. If there is a doctor “handy”, I defer to him or her. Most of the time these requests come from family members of dying patients who want to know how long the dying process will take. I can’t remember ever being direct with a patient about a time line, and I have great empathy for physicians who must do this. I agree with Nicholas Christakis that there is a duty to prognosticate, and was surprised to learn about the trend in medical education away from including prognosis in the study of disease states.

    Of course, in hospice care, we doctors and nurses have an advantage because it has all ready been acknowledged that the patient IS in fact going to die soon or is dying right now. Even then, we are asked ” when?”, and it is still a hard question to answer. Hope does spring eternal and in seemingly the most unlikely places. There is, for example the family of a 102 year old frail, somewhat demented and obviously suffering elder, who are anxious that every small crisis spells the end. And I have seen very sick and very very old people [90-105] live week after week and month after month and even year after year, on hospice care, subsisting on next to nothing except ensure and the ministrations of nursing aides. It is truly amazing. We find ourselves wrong often enough that we tend to hedge our answers at the next inquiry.

    I have come to the conclusion that we just don’t die like we used to. It’s really hard to die in our present culture and medical environment. My experience particularly with the elderly, is that they get treated with procedures,IV’s, antibiotics and other medications, and they are pulled through the kinds of illnesses like pneumonia, strokes, MI’s and metabolic crises that used to kill people. It’s a new world of medical care and it’s here to stay. Prognosticating needs to evolve along with the medical advances and discoveries of the time.

    Thank you, John Schumann, for developing this very fine website. I am enjoying the thoughts and ideas found here and will share this with my nursing and medical colleagues.

    • glasshospital

      Denise, I truly appreciate your comments. Thanks for sharing your stories and observations.
      -John S.

  2. Alex @ Happiness in this World

    John,
    This was simply an outstanding post, well-written and well-reasoned. I couldn’t agree more with your conclusion and would add only that I think the most important reason we physicians must learn to prognosticate better is to empower us to have the difficult conversations we must with people facing terminal illnesses to help them know what to expect. That, more than anything, it seems to me, is what people want and deserve.

    Alex

  3. Michael Follon

    The following is the text of a letter which was published in today’s issue of ‘The Scotsman’ (www.scotsman.com) newspaper –

    ‘A year ago when the Lockerbie bomber was given three months to live, the media weren’t exactly inundated by oncologists and other cancer experts publicly challenging the prognosis.

    Yet 12 months later we have numerous “cancer experts” saying “I told you so” or “I was always unwilling to give a three month prognosis”. Truly, hindsight is a wonderful thing.

    So how accurate have these “experts” been uptil now? Since 1993 24 prisoners in Scotland have been granted compassionate release on the basis that they only had three months to live. However, not a single one has died on the day when the three month deadline was reached.

    Seven prisoners (27 per cent) survived for more than three months. Seven died within days of release and one died in custody. If the three months were meant to be spent preparing for death, these latter prisoners were woefully short-changed by the experts who gave them a terminal prognosis. It also suggests that estimating time of death is at best a guess.

    This reality is recognised within the US judicial system. There Megrahi would have been held in a federal penitentiary. Under the federal compassionate release scheme he would be entitled to release if he had a year left to live. However, the federal system also allows for release for terminal illnesses that do not “lend themselves to a precise prediction of life expectency”.

    Strangely, this detail seems to have escaped the attention of those US senators who believe a prisoner failing to die as predicted represents a failure of the Scottish medical establishment.’

    The opinion of Karol Sikora, the cancer specialist employed by the Libyan government, was not received until 4 days after the release and therefore did not influence the decision. For more about Karol Sikora go to:

    ‘THE LOCKERBIE DIVIDE’, ‘Some background on Karol Sikora’ –
    http://lockerbiedivide.blogspot.com/2010/07/some-background-of-carol-sikora.html.

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