They really don't know

A few weeks ago I blogged that its really just A Bunch of Numbers on how doctors just give us numbers and that's all they are when we hear statistics about survival, prognosis, age or whatever from our doctors.

Now a doctor says the same thing in this article, A Doctor's Struggle with Numbers.

"Oncologists are notoriously bad at predicting survival, and none of us wants to be known as “the doctor who told me I would be dead by now,” the doctor who made a prediction of imminent demise, sending a family into a terrifying tailspin of goodbyes, only to be proven wrong and subsequently mocked for years to come. One of my patients, upon being told by another doctor that she had two months to live, held Christmas in April so she could spend one last holiday with her grandchildren. She survived to see two more Christmases.

At the same time, we need to be truthful and give guidance to people who want time to prepare, time to write wills and pay off debts, to say goodbyes and to leave instructions, to tie up the loose ends of a life now heavy with meaning.

We try to provide hope, but not false hope.

So we give ranges, starting with the best estimate of survival, because my patients have told me they shut down after they hear the worst estimate. We talk about setting goals, about maximizing quality of life, because we don’t have much leverage with quantity of life. We emphasize spending as much time as possible with family and friends, and as little time as possible with people wearing white coats. We tell them we’re not going to give up if they don’t give up.

But the truth is, we don’t know."

I always appreciate honesty from my doctors. If one of my doctors said to me, instead of giving me a range, something like 'statistics say you have a 10-20% chance of [fill in the blank], but my feeling is that you are on the high end of this due to your medical history'. I would be very appreciative of this little 'translation' or personal input from the doctor.

I can understand the doctor's point. They only have the numbers given to them but quoting statistics learned in medical school does nothing for me. Please add in a little bedside manner for me. Thanks.

Copying Lance

Since Lance can do it, I can too. I will make my full confession.

I take drugs. Yes I do. I take them on a daily basis. I have a large collection of prescription bottles obtained from a variety of sources. I succumb to peer pressure and take them regularly. I have been doing this for years.They might even be consider performance enhancing medications.

There I feel better having confessed.

Now allow me to explain.

I take drugs regularly. I take them on a strict schedule of before breakfast, after breakfast, dinner, time, and as needed for pain and crankiness.

I take drugs that come from several sources - who are all linked by computers and know what I take from each of them.

They also come from several pharmacies who aren't linked but who are all paid by the same evil insurance company which oversees their repayment.

I consider them to be performance enhancing because without them, I would not be able to move around at all, would be in constant pain, and would have no metabolism. With them I am moving faster than if I could without them.

I succumb to peer pressure from doctors, nurses, friends, family members (who are concerned about crankiness) to take my pills regularly.

But there is a difference between Lance and I - mine are all legal and have not been banned through anti doping agencies.

Communication, optimism, and honesty

A recent study at the Dana Farber in Boston (because we needed another study to keep the researchers busy) looked at late stage lung and colon cancer patients and their thoughts on being cured and on their doctor. Two very interesting points were raised:

• "They found that 69 percent of patients with metastatic lung cancer and 81 percent of ¬patients with advanced colo-rectal cancer reported that their chemotherapy might be curative, despite the fact that the drugs were extremely unlikely to cure their cancer."
• Patients who thought their doctors were worse communicators were more likely to have a realistic view of the potential benefit of their treatment.

Do patients rate their doctors as better communicators because they provide a more optimistic message? So if the information is more in line with what the patient wants to hear is the doctor considered to be a better communicator? But if the doctor is more honest, the patient considers them a worse communicator because they are being told things they don't want to acknowledge?

A sugar coated doctor appointment isn't really a good thing. I want the truth. I have even been known to pull together every brave little molecule in my body and ask my oncologist what my prognosis is. Sometimes the truth isn't pretty but I think its needed.

I know not everyone is the same as me in wanting to hear the truth and doctors do not necessarily know the patients will react to news. I think they assume have to gauge what they say based on what the patient says. I make sure I ask the direct questions so I get the direct answers in return.

I do not want to have a rosy picture of life if it isn't going to be that way. I can't digest and cope with bad news if its sugar coated. I have to adapt to reality and then learn how to make lemonade with my latest life lemons.

Flab, honesty, and health care costs

First they tell us we can bet fat and fit at the same time. Then they (this is the evil them who secretly rule the world) tell us that as our bodies widen, our health care costs will spiral out of control. Make up your mind will you! I know its an evil conspiracy if they can't kill us, they can confuse us.

I am fat, I admit that. Well I am fatter than I wish I was but my BMI has not hit that evil O level. But I also go to the gym three times a week for 40 minutes of cardio followed by working with weights and other tortures.

I don't think my flabbiness has contributed to additional health ailments - I mean I have enough already. I know being overweight can contribute to all sorts of problems. And as obesity rises in the US, they project  health care costs will bulge to cover them. I can understand that but I question the math behind it.

How did they get the weights of people? They called them and asked them. If someone called you and asked you on the phone your height and weight. Would you tell them the truth? Oh, please.

"The CDC data indicate that the South is the most obese region of the U.S., but that may not be entirely true either, said George Howard, professor of biostatistics at the University of Alabama at Birmingham. No one was weighed or measured in the collecting of the information; people were merely asked about their heights and weights via telephone -- so they could have lied.

Howard speculates that there may be bias in the data because "there's not a social stigma attached to being fat in the South," he said. "If you ask people how fat they are, they tell you."

Correlations between obesity and the South may be tied to other factors, Allison said. Certain ethnic groups, people from rural areas, and people of low socioeconomic status are more likely to be obese than others."

So maybe our obesity rates are tied to our honesty rates as well as our waistlines. Not that we are a nation of liars but have you ever deducted a few pounds or a few years if asked? Why don't we have a real survey where people are weighed and measured.