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An effective strategy incorporates the patient's expectations. Despite the fact that physicians deal with death nearly every day, many are uncomfortable discussing it with patients. That's especially the case when it comes to prognosis, noted David Ross Russell, MD, a family physician in Wallingford, Conn.

Research shows physicians not only overestimate prognosis, many consciously present a more optimistic prognosis to patients than they privately believe, Dr. For example, in a 2001 Annals of Internal Medicine study of 300 cancer patients referred for hospice, 22. Russell said about physicians' private estimates. But what palliative care physicians, who are more prone to underestimate prognosis, know is that overestimating prognosis often ends up deflating patients.

The last of these can be a challenge to balance, he acknowledged. It's also important to give patients time and privacy to process their diagnoses, encourage them to express their feelings, and avoid euphemisms, he said. Integrate palliative care from early illness onward. Talking points on palliative care address public, patients.

Also from ACP, read new content every week from the most highly cited internal medicine journal. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.

Overestimating a prognosis often ends up deflating patients emotionally. Russell pointed to a 2006 article in the Journal of Clinical Oncology which found the most effective strategies to discuss prognosis were: Establish the patient's desire to discuss the prognosis. If the patient is unwilling to discuss prognosis, acknowledge his or her emotional and informational concerns.

Consider whether the patient's misperceptions of the prognosis are causing inappropriate decision making. If so, propose a discussion with a surrogate. If the patient is ambivalent about discussing the prognosis, talk about the ambivalence. ACP Internist is an award-winning publication: googletag.

Enter a promotion code or Gift Card OK. By the end of the week, a neurologist delivers a devastating prognosis: Sarah suffered a traumatic brain injury that has caused her IQ to plummet, with no hope of recovery. Her brain has irrevocably changed. Afraid of judgment and deemed no longer fit for work, Sarah isolates herself from the outside world.

Her life is consumed by fear and shame until a chance encounter gives Sarah hope that her brain can heal. That conversation lights a small flame of determination, and Sarah begins to push back, painstakingly reteaching herself to read and write, and eventually reentering the workforce and a new, if unpredictable, life.

In this highly intimate account of devastation and renewal, Sarah pulls back the curtain on life with traumatic brain injury, an affliction where the wounds are invisible and the lasting effects are often misunderstood. Over years of frustrating setbacks and uncertain triumphs, Sarah comes to terms with her disability and finds love with a woman who helps her embrace a new, accepting sense of self.

She graduated from City University of Hong Kong in 2013 with an MFA in creative writing. Her essays have earned her a Pushcart Prize. She has been published in the Gettysburg Review, the Sun, the Pinch, Asia Literary Review, and Post Road, among other places. Sarah was a Harkness Fellow at Harvard and holds a doctorate in government and public administration.

She lives in Sydney with her wife and their three dogs and three cats. Prognosis is her first book. Every book is performed by professional narrators, including many celebrities. Listening can also bring the story to life, illuminate characters, and take you deeper into the books you love.

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So we just pass in the beginning of the tag with the variable info. Get the free Kindle app: Enjoy a great reading experience when you borrow the Kindle edition of this book with your Kindle Unlimited membership.

Read more Read less Previous page Print length Contains real page numbers based on the print edition (ISBN 1542004209). It begins with a simple accident, no blood, no dramatic visit to the hospital, just a bump on the head and a dazed drive home. One single, violent blow and then things begin to be taken from Sarah.

There are immediate measurable losses: her IQ is slashed by roughly 40 percent, her job disappears, her strained family breaks apart, and she isolates herself, trusting only her dogs to love and understand her. But there are insidious immeasurable shifts too: her personality changes, language and logic evade her, and her shattered confidence melts into a period of depression and confusion. In short, the things that Sarah believed defined her-intelligence and ambition-begin to disappear completely.

While many of us readers may have been lucky enough to avoid staring into a similar abyss, I must admit that, in a similar position, I may have given up and resigned myself to a life of hiding at home. But Sarah is made of more resilient stuff. Prepare to feel heartbreak, frustration, and anger as you watch Sarah fall headfirst into the void, but know those feelings will be followed by pride, hope, even some laughs, and a deepened understanding of the personal experience of brain injury as you watch Sarah decide-over and over again-to pull herself out, to grieve each new thing she has lost, and to look forward to an altered but untrammeled future.

First the good stuff: In this memoir, the author, a lesbian who had recently come out, details her traumatic brain injury and its aftereffects. Thrown helmetless from a horse she should never have been on at the age of 31, she suffered a TBI without initially realizing what had happened. At first, she finds things in her home in odd places.

Realizing her toaster is missing, she determines that someone has broken in and stolen it. It takes other people to point out to her that she requires medical attention.