With Doctors, There's No Telling the Future
By Rick Weiss
Washington Post Staff Writer
Saturday, December 2, 2000; Page A10
URL: http://www.washingtonpost.com/wp-dyn/articles/A3523-2000Nov29.html
Date accessed: January 7, 2001
A problem arises as doctors begin to use genetic tests to predict a patient's medical future: Doctors, it turns out, are deeply afraid of predicting the future.
It may seem counterintuitive, given the high status that soothsayers have enjoyed through history. But studies confirm that most physicians actually dread prognostication, especially when the patient's future looks grim.
Given a chance to avoid predicting the outcome of a person's serious illness, doctors will let that obvious question go unanswered. When pushed to say something, research indicates, they consistently exaggerate in favor of optimism, telling patients their odds of doing well are better than they are or that their quality of life will be better than the doctor truly believes.
Some reasons for the fear are obvious, said Nicholas Christakis, a professor of medicine and sociology at the University of Chicago who has intensively studied doctors' attitudes toward prognostication. Predictions carry risks, including the risk of being wrong and the risk of being blamed for problems that come from being wrong.
But there is also a surprisingly unscientific reason that doctors dread prognosticating, said Christakis, author of "Death Foretold: Prophecy and Prognosis in Medical Care" (University of Chicago Press, 1999). "Physicians tend to believe in self-fulfilling prophecy. They believe that a negative prediction will somehow cause an unfavorable outcome."
Christakis's research strongly concludes that most doctors, like other people, subscribe to a superstitious system of "magical thinking," in which they believe that by giving voice to the idea that someone is going to die they make it more likely to happen.
The growing availability of predictive genetic tests could force more doctors to confront this fear, Christakis said. Perhaps genetic tests will even help doctors overcome their aversion to prognostication by allowing them to see on a genetic level that doctors do not create their patients' fates.
That, he said, would be a boon for patients, for whom a compassionately drawn glimpse of the future can provide a therapeutic dose of certainty and peace.