Friday, June 12, 2009

Why life expectancy / medical prognosis is negative

Been thinking about negative medical prognosis lately. Yesterday NZ Herald ran a story about a brain injury patient, quoting the relevant paragraph:

Driving to work from Dunedin on a Monday morning in 1987, he received a major brain injury in a serious car crash just south of Timaru. The injury left him unconscious in Dunedin Hospital for more than four months. "They said to me, 'Ali, you are never going to be able to walk, talk, see. And if by chance you can walk and talk, it will be a miracle."This miracle happened." Dr Danesh, 69, can walk with the help of a frame, talk, see, read and write

That got me thinking about friends of Tiffany. One of their premature twins got infected with meningitis while in an incubator in hospital. They were told that Danella was effectively "brain dead" and was going to be a vegetable all her life and there would be no development.

Three years into this experience Daniella has made significant progress, sure she is still very "behind" in her development, but she is developing none the less. She is able to continue to sit up when placed sitting. She is able to turn her head towards people who talking to her - she is blind and only one ear hears with the help of a hearing aid. She is able to push buttons on musical toys to make them play and repeat (she loves music) and she also responds to touch......

Got me thinking about medical prognosis..... what would you prefer:

1) Be told that your mum (or who ever) had terminal cancer and had 6 months to live, yet she lives 9 months
2) Be told that your mum (or who ever) had terminal cancer and had 12 months to live, yet she lives 9 months

One diagnose you would feel blessed because of the extra time, other option you would feel robbed and upset as had less time than expected.

Thus if I was a doctor or medical person giving negative news, I would always give a worst case outlook so that if the outcome wasn't as bad as expected people would feel positve. Thus we have the situation where the worst case is expected. Thus any negative diagnosis from a medical person should be seen as a worst case scenario.

Was is especially tragic there is another child who lives in the same geographical area as Daniella, who is the same "age" who caught meningitis at the same time. However the parents of that child are still bitter and angry about the infection, and their child is a vegetable just like the doctors predicted.

Take home message: When you are given a pessimistic medical outcome, this is the worst case, and your mental attitude will play a big part in whether this is true or not.

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