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The power of hope: being a doctor is more than relying solely on the numbers
  1. A N Godshalk1,
  2. G C Brown1,2,3,4,
  3. H C Brown1,
  4. M M Brown1,3,4,5
  1. 1
    Center for Value-Based Medicine, Flourtown, PA, USA
  2. 2
    Retina Service, the Wills Eye Institute, Jefferson Medical College, Philadelphia, PA, USA
  3. 3
    Eye Research Institute, Philadelphia, PA, USA
  4. 4
    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
  5. 5
    Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  1. Dr G C Brown, Center for Value-Based Medicine, Box 335, Flourtown, PA 19031, USA; gbrown{at}


Aims: To ascertain whether a physician’s positive or negative attitude significantly impacts the quality of life of ophthalmic patients.

Methods: A standardised, validated, time trade-off, utility instrument was administered to consecutive vitreoretinal patients by interview to assess the quality of life associated with their current ocular health state (baseline scenario). Each was then given a scenario for the exact same health state with the same long-term prognosis in which their doctor emphasised the possible negative consequences (bad-news scenario) and one for the same health state in which their doctor emphasised the positive consequences (good-news scenario).

Results: Among the 247 patients enrolled were 140 women (57%) and 107 men (43%) with a mean age of 66 years and a mean educational level of 13.8 years after kindergarten. The mean baseline utility for 247 patients was 0.87 (SD = 0.19; 95% CI 0.84 to 0.89). The mean bad-news scenario utility was 0.80 (SD = 0.22, 95% CI 0.78 to 0.83), a 70% diminution in quality of life compared with the mean baseline utility (p = 0.0009). The mean good-news scenario utility was 0.89 (SD = 0.18, 95% CI 0.86 to 0.91), an insignificant difference compared with the mean baseline utility (p = 0.26).

Conclusion: Ocular patients had a considerably poorer quality of life when their physician emphasised the possible negative consequences associated with their eye disease(s), as opposed to a more positive approach. While at times necessary, a negative emphasis approach can theoretically result in a considerable loss of life’s value.

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  • Funding: The Center for Value-Based Medicine and the Eye Research Institute (ERI), Philadelphia, PA funded the study. Neither organisation had any role in the design and conduct of the study, collection and interpretation of the data, or preparation and approval of the manuscript.

  • Competing interests: None.

  • Ethics approval: The patients were advised of the intent of the study and treated in accordance with ethics as put forth by the Declaration of Helsinki of the World Medical Association.

  • Patient consent: Written informed consent was obtained from each patient.

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