PT  - JOURNAL ARTICLE
AU  - Godshalk, A N
AU  - Brown, G C
AU  - Brown, H C
AU  - Brown, M M
TI  - The power of hope: being a doctor is more than relying solely on the numbers
AID  - 10.1136/bjo.2008.141663
DP  - 2008 Jun 01
TA  - British Journal of Ophthalmology
PG  - 783--787
VI  - 92
IP  - 6
4099  - http://bjo.bmj.com/content/92/6/783.short
4100  - http://bjo.bmj.com/content/92/6/783.full
SO  - Br J Ophthalmol2008 Jun 01; 92
AB  - 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.