Video Transcript: Giving Subtle Direction

Dr. Eric Hardt, Geriatrician at Boston Medical Center

Well, I start with the fact that there�s good evidence that doctors are bad at predicting how much time you have left. There are multiple studies on people who have a terminal disease, who are dying � on some level, those are the easy ones to figure out � and the doctors almost always overestimate, sometimes by two or three times, sometimes by eight or ten times, how much time you have left. And I show them the data that basically says, �When the average doc thinks you have three months left, you probably have a little less than three weeks left.�

So I ask them to pay attention to cases that they�ve seen during their training. �If they see somebody who is ill, make a mental prediction in your mind of how long you think that patient will survive.� Within our electronic medical record, they can send a message to themselves in the future to revisit a patient�s chart to see how they are doing, and to see how close their estimate was to the survival time. I do this as skills training.

And then we talk about definitions. I�ll ask people, �What does it mean if somebody comes back and says, �The doctor told me I have six months to live� � what does that mean?� They correctly realize that we�re talking about averages. The doctor told [the patient], �You have six months.� The patient goes home, and, if the sun has gone down, they think they have 179 days left. They think, literally, that [they] have 180 days and no more. Usually, if we make that numerical prognosis, we�re talking about averages, meaning that �Half of the patients in your situation will be alive in six months, and half won�t be.� That�s kind of factual.

And then I share with them my own technique, which I�ve learned over the years. Instead of giving a number, I�ll give some more subtle direction. So my way of dealing with this depends on the season of the year. If it�s the fall, I may say, �Does your family celebrate Christmas or Hannukah or whatnot? This year, I think you should make it a special occasion. This is a good time to hold nothing back. If there�s something special you always wanted to do on that holiday, or some special person that you always wanted to see, this would be the year to do it.�