Gloomy prognoses keep lawyers happy but are bad for patients
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7555.1459 (Published 15 June 2006) Cite this as: BMJ 2006;332:1459All rapid responses
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I disagree with the suggestion that we give out a gloomy prognoses to
keep ourselves out of court. While indeed it seems our system is becoming
more litigious, patients are still priority.
The trouble is, as a doctor we are expected to provide answers to
some of the most difficult questions dealing with life and death. Yet, as
I continue through my surgical training, it amazes me how variable the
body, life and recovery can be. So at times there is no absolute answer
but merely a hypothesis based on both evidence and anecdotal experience.
This is not meant to be gloomy nor keep me out of a court of law, but
realistic.
One area where this is of particular importance is duing the consent
procedure. Discussing the potential risks of surgery can be arduous with
an already anxious patient. However, these risks are real and the patient
should be able to make a fully informed decision. And while the majority
of patients who undergo a procedure do benefit, it is the ones who don't
that give you those sleepless nights.
Ultimately, people would prefer to hear good news while prepared for
the worst than receive bad news when expecting the best.
Competing interests:
None declared
Competing interests: No competing interests
Neither undue optimism nor pessimism should dominate discussions with
seriously ill patients and their family members. Instead physicians should
gravitate towards enlightened realism.
When treatment cannot be expected to work patients and their family
members should be given this news in a kind and compassionate manner, free
from the distraction of being asked to make an informed decision.
When treatment might help, uncertainty, expressed in a positive
manner, should prevail.
"This might help, it might not, The only way to find out is to try.
Since it could help, I think we should proceed. While the prognosis is not
good some patients do much better than expected. Maybe your mother is in
this group."
Competing interests:
None declared
Competing interests: No competing interests
Gloomy Prognosis Can Make Lawyers Unhappy
Contrary to Dr Lawson's view[1]expressing an extremely cautious
prognosis or putting the worse case scenario is unlikely to "keep lawyers
happy".Rather the lawyers would be unhappy with such level of caution by
doctors because that would minimise the chances of bringing a successful
legal action, and thus,lawyers will have fewer clients with accompanying
loss of income (for them fees,disbursements, and VAT).On that basis,nor
would it be sensible to advice "our sons and daughters to go into law"[1].
However, in reality the clinical negligence market is booming, and who's
fault is that?
References
[1]Richard Lawson.
Gloomy prognoses keep lawyers happy but are bad for patients.
BMJ 2006; 332: 1459.
Competing interests:
None declared
Competing interests: No competing interests