Monday, August 2, 2010

Optimistic Expectations

Atul Gawande writes about end-of-life medical decision-making, and the view is disturbing at times. And not because the end of life is such a fraught component of the life course.

One of the most shocking issues the article reveals is how doctors tend to overestimate survival probabilities of their terminally ill patients, a result reported by Christakis and Lamont in BMJ. For medicine to be efficiently employed, decision-makers should be well informed. It would be regrettable but perhaps not unsurprising that patients might have little knowledge of the underlying probabilities of outcomes. But if doctors do not have rational expectations either, it seems unlikely that choices can be optimal.

A colleague remarked that maybe patients demand optimism. Another one thought it might be hard for doctors to face their jobs without optimism. But another finding by Christakis and Lamont, that the overoptimism rises with increased knowledge of the patient, does not fit particularly well with either story and suggests instead that doctors may find it (increasingly) costly to be objective with terminally ill patients. Gawande's piece seems consistent with that.