Breaking good news
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7355 (Published 31 October 2012) Cite this as: BMJ 2012;345:e7355
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Boy this guy can write! Loved it. Hilariously puncturing delusions of medical omniscience. I took reference to LCP as great satire on recent coverage. More from Dr Farrell please.
Competing interests: No competing interests
I initially thought that this would be an excellent piece - outlining the professional dilemma when prognosis turns out not to be as expected or predicted. Unfortunately, the last sentence of the piece ruins what could have been a thought-provoking reflective essay and transforms it into a dreadful piece of writing by an ill-informed individual and written in very bad taste.
Experienced and informed professionals specialising in end of life care, and the many more generalists who provide significant amounts of similar care, are currently struggling to reassure their patients and the public that end of life care can be appropriate and of a high quality, despite the recent scaremongering tactics about the LCP by second-rate journalists. Dr Farrell adds nothing to the debate and, in fact, potentially causes great harm through his writing by, barely obliquely, suggesting that the LCP can be used to end a patient's life.
I view this as contemptible, irresponsible and unprofessional behaviour, and do hope that Dr Farrell takes the time to learn more about the LCP or, if he has done so previously, realises that he needs re-training in its principles and use.
Competing interests: No competing interests
Re: Breaking good news
Prediction of prognosis is a very difficult task even when a patient is riddled with cancer and is not being actively treated. (1)(2). So it is not surprising that prognostication for non-malignant conditions is even more difficult as highlighted by Liam Farrell.(3). Better to be honest with patients and families about the huge uncertainties inherent in prognostication.
References:
1. Gripp S, Moeller S, Bölke E, Schmitt G, Matuschek C, Asgari S, et al. Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J. Clin. Oncol. 2007 Aug 1;25(22):3313–20.
2. Parkes CM. Accuracy of predictions of survival in later stages of cancer. Br Med J. 1972 Apr 1;2(5804):29–31.
3. Farrell L. Breaking good news. BMJ. 2012;345:e7355.
Competing interests: No competing interests