Medscape Med Students Letter Regarding Prognosis: Poor Kurt P. Merkelz, MD, Ivan Oransky, MD [Medscape Med Students, 2001. © 2001 Medscape, Inc.] Several of the statements in Ivan Oransky's article Prognosis: Poor, are quite concerning, especially regarding communicating prognosis when patients are faced with terminal stages of their illnesses. Recommending that doctors refrain from offering opinions regarding prognosis is ridiculous; we should be obligated to communicate all care plans available based upon the stage of illness at which a patient presents. Being aware of the natural course of diseases, both cancer and noncancerous, is vital to ensure that appropriate and timely recommendations are offered. Being unaware of the outcomes and prognoses of patients diagnosed with stage 4 cancers is inexcusable. Appropriate discussion entails offering our patients the option to exclude aggressive care in end of life and receive palliative care treatment. Hospice is the choice when we have exhausted all treatment options; it is a reasonable -- and more often the most appropriate -- decision. Physicians need to be realistic and appropriate when discussing treatment options with patients. Additionally, I agree completely with the comment made by Andrew Dwyer, who objected to your reference to the patient dying while on hospice care, "doped high on morphine." It is, again, of utmost importance that we communicate care plans appropriately. Using pain medications for comfort care is not doping and should not be discussed as such. Further, using pain medications in end of life does not kill patients -- their terminal illness does. Your article illustrates how far we have to go in educating physicians in end-of-life care. Kurt P. Merkelz, MD Palliative Medicine, 7/02 J Clin Onc, 2/05 Archives of Surgery, August 2008 JAMA, October 2008 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.