Office of the Medical Director
From the Physician’s Point of View
Wouldn’t It be Nice to Have a Crystal Ball?
The most frequently asked question I receive is,
“Doctor, how long….?”
I know it’s a question many of us receive in numerous forms: “How long before the symptoms become noticeable?; How long until there will be pain?; How long can I stay at home?” But all of these questions lead to the most difficult of all, “How long do I have?”
And it’s a fair question. The news of a life-limiting illness strikes hard at our patients and their families. With their minds racing to know “Why and How?”, they of course wish to know “When?” A correct answer could afford them the luxury of being able to plan and prepare at the perfect pace for this change.
The question may be fair, but its answer is so very unobtainable and with so many ramifications, that it is the question we are least able to answer. Even if we were able to use a crystal ball to give an answer, we would also need to use that crystal ball to learn how the information would affect our patient. Would the information help with acceptance and symptomatic relief, or would it lead to a sense of hopelessness?
A major goal of the Hospice movement is to create an environment where patients and their families have satisfactory mental and spiritual preparation for death. Care is palliative rather than curative, however it is not unusual for patients receiving hospice care to outlive their “life expectancies.”
Years ago, in order to receive Medicare coverage for Hospice service, physicians were required to sign a statement saying that the patient would not live over one year. So, in addition to the difficulty of answering “How long?”, we were asked to sign a legal document verifying what we simply could not know.
Fortunately there have been substantial changes in the Medicare regulations and the guidelines are not as strict. If you are not familiar with those changes, a check of our link, Medicare & Hospice would be beneficial. You may also want to visit our page of Questions Doctors Have About Hospice.
“Doctor, How long...?” It’s never an easy question, even with a crystal ball. Happily, predicting the future is no longer necessary in order to provide for our Medicare patients facing life-limiting illness.
