I was rewatching an old video on YouTube and the guy was able to walk again after 10 months of practicing yoga and losing 140 lbs. If no one on earth can exactly predict when someone will die or if they’ll be able to walk again, how and why do doctors come up with these predictions?
https://youtu.be/qX9FSZJu448
In: Mathematics
I’m an MD. The question is so broad because it’s a very different question/anwser in different clinical settings (geriatric patient dying in the ICU from sepsis vs pediatric cancer diagnosis) , and crosses different diagnoses and pathology. Usually these types of assessments are multi-factorial but a few points:
1. “Doctors told me I only had 2 days/weeks/months to live” or any permutation like that is almost never said in that format. That is usually a marketing or self-promotion trope that is used to sell you on a story or product. Doctors talk more broadly. “For stage 4 cancers the 6 month survival is usually low, honestly we could be looking that time frame or less because of x,y, or z factors”.
2. I always look for reversibility. End-organ damage is a big one for critically ill patients in particular. If tissue is dead there is no way to make it un-dead. If your kidneys fail and don’t respond to treatment and you are suddenly dialysis dependent we crossed a certain threshold. If your ejection fraction of your heart is low because that heart muscle is dead (it can be low for other reasons..excluding those) then we can’t expect that function to recover only managed.
3. Always consider the broader context of the patient’s health. If someone’s grandparent has dementia and has lost function every year for the last 5 years and now they have a diagnosis with limited reversibility… It’s silly to expect them to every have a quality of life better than what their established baseline has been if there is a major insult requiring ICU care as an example.
4. For patient in the hospital that are really entering the phase of actively dying (signs of death, nothing medicine can reverse) we look at trend in vital signs, end-organ damage, failure to respond to treatment. Later signs include agonal breathing, skin mottling. By then we’ve usually already spoken to the family about changing or goals from treating the pathology to treating any pain and air-hunger and making the patient comfortable (i.e. we are shifting our goal in particular because there is no demonstrable reversibility). Prior to that we always give a warning shot before giving bad news and then say something like “[the patient] will not survive this hospitalization, it’s hard for doctors to predict but there isn’t much time”. For certain situation it needs to be direct. It’s always nested in a long sweeping summary of what has happened, why there was no improvement, and how we can move forward.
5. So a summary to that is: it’s a combination of blood work, imaging, vital signs , physical exam, reversibility of problem + the context about the patient’s health + what the published data shows about that particular disease stage. (Sorry not a great ELI5)
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