Accepting Reality

Dealing with Doctors - April 30, 2014

Recently I attended a support group meeting for cancer patients. During the course of this meeting I met several people who were told at their initial diagnosis that they should expect to survive less than a year and yet every one of them has survived for several years. Two of them have survived more than 10 years. I thought of them later when I had a conversation with another healthcare professional I know. She shared with me her concerns about a patient of hers. This individual has a rare genetic disorder that unfortunately means the prognosis is quite grim. She was worried that this patient doesn't appear to be accepting the facts of the condition and is making life plans far into the future that likely won't be possible to achieve. She was concerned about this patient's failure to "accept reality" and that this failure might be harmful. My first thought was of all those cancer patients I know who have beaten the odds they were given and wondered if this patient would do well to continue not to accept reality. But I also know that it is very important to listen to and follow the advice and recommendations of medical professionals. It's not a good idea to bury your head in the sand and ignore your doctors.

So what is the best approach to "accepting the reality" of the experts' dire predictions? There are a lot of people living happy lives right now who wouldn't "accept the reality" their doctors gave them. And there are many more patients, like my husband who's disease did progress in the way the professionals predicted. There are no easy answers to these difficult questions because the most important reality for all of us to accept is that no one really knows the future. Medical science can at best give patients a good guess based on statistical probabilities gathered from information on what happened to others in the past. This is useful and helpful and the best indicator available but it is by no means a "crystal ball glimpse" into the future.

When digesting the predictions of medical professionals, I recommend you ask for details from the person on how they have determined their expectation. It is important to fully understand how they have arrived at their opinion. Then if you choose to get a second opinion or if you're doing independent research and find contradictory information you can better understand the difference. It's also important to ask how confident they are in their prediction, if they have had similar cases and how those cases resolved. If their expectation is different for your case ask them why it differs. Basically the key is not to simply accept the prediction you are given but find out more about it so you can fully process that information.

It's also important to remind yourself that whatever prognosis you are given, it is an opinion not a fact. So ask yourself if focusing on that prediction is helpful and useful to you. Does focusing on the prognosis (positive or negative) make the patient feel empowered? Many times having this information even if it's not positive can give the patient and their caregivers a structure for planning and managing the illness. Sometimes a patient can be inspired by a dire prognosis; it encourages them to fight harder. If the prognosis does not seem to be helpful, then I recommend you do what you can not to focus on it. That does not mean you should ignore it or discount it, but you can choose to focus the majority of your attention on effectively managing your treatment and living your life as fully as you can.

Patients are given so much information to absorb, and predictions and assessments are never certain. There is no simple way to process it all and determine what to accept or politely decline. So all you can do is find a solution for using the information in a way that works for your situation. That may sometimes involve accepting reality as presented by the professionals or it may not. These are not "one size fits all" scenarios. All that matters is the choices made work for the patient.