An important question that seems to be coming up ever more frequently is:
Should we be concentrating on prognosis rather than diagnosis?
Let’s start by defining each of those terms…
- the likely course of a medical condition.
- an opinion, based on medical experience, of the likely course of a medical condition.
- a forecast of the likely outcome of a situation.
the identification of the nature of an illness or other problem by examination of the symptoms.
Thus, it is evident that one clearly focuses on the current situation and issue at hand, whereas the other (prognosis) looks at what that diagnosis means, how it may progress and the likely outcome.
However, before taking such an approach, we need to consider whether we know enough, and can do enough, to give people a prognosis.
If we were able to give individuals a prognosis we have a few things to consider, for example:
Do individuals really want to know their risk factor, or score, when there is currently no known preventable measure, or measures, that can be taken?
Would this cause more harm, especially mentally and emotionally, than good?
Step 1: Identifying Risk
An important consideration here is whether giving someone a risk factor or risk score could make their prognosis worse. If an individual is delivered ‘bad’ news they may then submit to this and be less reluctant to live life to the full or take preventative measures.
In addition, a lot of training would be needed in order that such prognosis and risk scores are delivered and presented in an effective manner – this is unlikely to be something that is practicable within an already under resourced, and stretched, NHS.
Step 2: Tailoring Treatment
Much the same point as before, at the risk of sounding pessimistic, is it a step too far to expect our already overstretched and under resourced NHS to be able to offer customised treatment to each individual?
We are all too well versed with the phrase, “if you have met one person with Dementia, you have met one person with Dementia”, and we know all too well that no two individuals are affected by Dementia in the same way. Dementia is a condition that has over 200 different types (that we know about!) any many different forms, symptoms as well as conditions that accompany it for many individuals.
A one size fits all approach will not work, but are we really able to offer tailor-made treatment to each individual?
Although this would be amazing, it just seems a bit too far out of reach at the moment.
Whilst, we are also pushing for new treatments and (dare we say) a cure…
Are we really ready for a prognosis?