Montaigne wrote –
Except for old age, which is an indubitable sign of the approach of death, in all other ailments I see few signs of the future on which to base our divination.
When I read this I immediately remembered a conversation I had with a patient one day. She’d just told me that her husband had been diagnosed with cancer and had been told he had six months to live. I asked her how she felt about that.
That’s not such an uncommon response when people hear such bad news, but I don’t take anything for granted so I asked her to say why she felt angry.
“How come he gets to know how long he’s got, and I don’t get to know how long I’ve got?!”
Well, that surprised me! I hadn’t heard a response like that before.
So I took some time to explain that having a particular disease did not bestow any certainty about the future. Prognosis is a tricky a practice. When speaking statistically about groups or “cohorts” in studies we can say one thing, but when speaking about an individual, it’s actually much, much harder.
The diversity of human experience undermines predictions every day. I think that was one of the best lessons I learned as a doctor. Beware of false certainties!