Regardless of your disease, you will want to understand your prognosis - that is, the probable course of the disease. This conversation first occurs after the initial diagnostic testing or surgery has taken place. However, discussion of prognosis should remain an ongoing consideration during any treatment planning, including when there is evidence of advanced disease. You and your doctor will often find it hard to confront these issues. It is always easier to "put it off until the next visit."
This conversation might be easier if you include it in nearly every encounter. Try out something like this: "I understand that we are always pretty uncertain when looking at the future, but what I understand now about how this disease is likely to go is that I am likely to live with it for some months before it starts taking its toll, and that then I will probably have just a few months left. Is there anything else you can tell me now? Is it reasonable to think that I will still be able to travel to be with my children this Christmas?"
Some days, you really just wonít want to deal with the future. Even then, you can help the conversation next time by saying something like this: "With all the worries of the last few weeks, I canít really bear to think of things getting worse. Still, next time I see you, I would appreciate an update on how Iím doing and what problems are likely to arise, given how my disease is progressing and how I feel." By doing this, you create an opening that will make it easier for either of you to bring up the subject next time.
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|Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.|