Our clinical ethics journal clubs are monthly meetings of clinicians across UCSF hospitals to discuss a chosen article highlighting ethical issues that arise in the healthcare setting. For our first meeting, we read “Assessment of Discordance Between Physicians and Family Members Regarding Prognosis in Patients With Severe Acute Brain Injury” by Kiker et al. The authors found a high rate of discordant prognostic predictions between patients’ families and attending physicians, with family members typically more optimistic than physicians. The authors also distinguished between optimistic beliefs (in which family members acknowledged a gap between their expectations and physicians’) and misunderstanding (in which family members believed that physicians were more hopeful than those physicians actually were).
Much of the discussion focused on the clinical utility of prognostication itself. Given the roles that physicians and family members have, is it physicians’ responsibility to provide realistic if harsh predictions in order to better prepare for care decisions? Alternatively, do family members have a social imperative to be optimistic as a way of expressing support and concern for patients?
Readings for this and future meetings are archived for members of the UCSF community at https://tiny.ucsf.edu/ClinEthicsJC.