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What is it?
The golden prognosis (from Greek prognostikos) is a judgment made by a physician after diagnosis about the duration and outcome of a disease. After diagnosis, the physician uses other information to assess how far the disease may go and what the chances are of having a good or bad prognosis.
However, golden prognosis should not be confused with the analysis of the causes of certain conditions or prediction. This task is a priori an element of the medical function of identifying the disorders present in a patient and the cause to which these disorders are attached.
We also find about the prognosis in the Hippocratic commentaries, notably that of the treatise of Hippocrates entitled The prognosis: We must know that these affections are of a nature which can lead to deaths and that we must take into consideration something divine in them, because this will probably avoid thinking that this practice is of little use and inaccurate >>.
Another statement was used: “It is appropriate to emphasize the prognosis in gold: the doctor should often have prognoses on the evolution and the outcome of a malaise after its diagnosis in a certain way.”
This last statement explains that it is preferable for the doctor to wait in advance to prevent or to avoid having a bad prognosis, and to avoid pronouncing a significant omission, that he would prefer to consult a colleague before making his diagnosis.
How does it work?
Prognosis at the horizon of death, called prognosis by Hippocrates, has become an essential practice for physicians since the beginning of the 18th century. They recognize that an attack of the disease never occurs at the same time in all patients and estimate to what extent the symptoms pass at the end of their capacities. They use their knowledge of anatomy and physiology as well as their experience in examining patients and their medical data, to establish a prognosis.
Clinical experience has shown that a more detailed approach to the disease allows a sufficiently accurate prediction of the average mortality rate, however the risk assessment is not always adequate because of the obvious differences between the probability parameters and those of the eligibility criterion. Cohort flow studies indicate that such a criterion cannot be optimally evaluated.
After establishing the data and the limits of prognosis, we questioned its relevance at present, in the present state of our current knowledge. However, even if the major advances made in prognosis would be sufficient, demographic elements (pathologies, clinical predictions of survival, clinical signs) remain very influential for the evaluation of patients.
Many errors disqualify the practice of prognosis from being based on a raised truth. Just as with Pygmalion, in the ancient Greek world, who creates a sculptor who falls in love with him, we deplore today the realism of these decisions judged to be of general interest, medical interest and economic interest. It is not enough for medicine, nor at any time, to make decisions of public interest based on prognosis, but also, in this circumstance, the criterion of admissibility would perhaps be preferable.
How can I use it?
The art of prognosis is, in other words, the most difficult of medical exercises. Yet it was the task to which the main responsibility for therapeutic failure was revealed. At that time, medical works generally decided between the curable and the incurable; pseudo-Hippocrates included in his opuscule (known in its various versions as Secreta Hippocratis, Capsula eburnea, Pronostica vitae et mortis, or Pronostica mortis vel salutis) a series of signs, mainly of appearance, of pustules which could be harbingers of the fatal disease.
However, by these signs, it is often not easy for a doctor to establish his conclusion: it will be necessary to decide on a series of factors, including the importance of a particular case, its stage at present, its progression, the presence of comorbidities or the clinical situation of a patient; in particular because, with the golden prognosis of the rise of epidemics at the end of the Middle Ages, doctors were always very hesitant to make a prognosis of possible mortality.
In his Livre Prognosticorum, composed in 1295, Bernard de Gordon indicates that, in order to establish his conclusion, it will be necessary to consider his nature and the seriousness of his illness. He specifies, however, that one should avoid considering the signs of an imminent death as those of a death in the process of arriving (the golden prognosis).
The mechanisms for preventing death, so called in the art of prognosis, will only be effective in the given context, particularly in cases where the effect of the disease can be determined by appropriate medicinal intervention. In the light of this advance, other aspects might have been considered of different importance, but it is clear that the golden prognosis has not served as a model for drawing conclusions satisfactorily.
Are there any limitations le pronostic en or?
Forecasting in practice is an important component of many doctors’ work. But despite its importance, it remains a challenging aspect of medical practice. In fact, the prognosis is an area of intense debate. Christakis [60] distinguishes two elements of the prognosis: predict (foreseeing) and predict (foretelling). He points out that doctors are often unable to predict what will happen to their patients, despite all their knowledge, experience and skills. This reflects the inherent uncertainty in medical practice.
Moreover, the prognosis in gold the prognosis evoked by doctors is often different from that wanted by their patients the prognosis in gold. The evocation of the prognosis is influenced by several factors, including the patients’ perceptions and expectations. Studies on patients with low back pain, for example, show that the patient’s expectations of recovery are associated with her outcome (either a positive or negative prognosis).
Physicians recognize the importance of prognosis and believe that patients appreciate this service. However, in a study of 697 internists [61], nearly 90% stated that it is not recommended for physicians to provide prognoses. The reasons are numerous and may include the complexity of the field of risk assessment and a systemic approach to communicating with patients.
Another factor contributing to the problem of assessing prognosis is the fact that patients’ expectations are generally judged to be clearer than those of physicians. Evidence from evaluations of the success of business projects or evaluation strategies indicates that expectations are higher among people with chronic illness.
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