I Want to Live!
“Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults”
-headline of article by Lee SJ et. al., Journal of the American Medical Association, February 15, 2006
Hey gang - there’s a new fun test out there for the parents and grandparents to take! As the JAMA article title refers to, it is a predictive model or a “mortality prediction index” that consists of twelve simple questions to determine a person’s risk of dying in the next four years.
Exactly what type of “person” are we referring to? Well, the quiz is only for “community-dwelling inviduals older than 50 years,” which excludes those living in nursing homes (for good reason one assumes), as well as youngsters (who need not bother since they are destined to live forever anyway). The index gives a point total that places one in either a high-, intermediate- or low-risk group for biting the dust sometime during the next four years. For example, a score of 0-5 points means one has only a 4% risk of dying within four years but a score of 14 or more points places that risk at 64% (yikes)!
The test is only accurate 81% of the time, so let’s not all get our hopes up if we have a perfect score, nor should we get fitted for a pine box if our point total would win 99 per cent of all major league baseball games played this summer.
Of course, the mainstream media in their typical News-You-Can-Use fashion is hyping this story with such idiotic headlines as “When Will You Die? Take This Quiz.”
Now there’s a little piece of bedtime reading that will bring sweet dreams, eh? I guess we had better practice pushing chairs across the living room if we want to be around for a few more decades or see the Cubs go to the World Series again, whichever comes first.
Some of the questions in the index are self-explanatory, such as “Have you smoked cigarettes in the past week?”, or “Has a doctor told you that you have cancer or a malignant tumor, excluding minor skin cancers?” I don’t doubt that a “yes” to those two might just put one at a higher risk for dying, but pushing a chair across the room? That’s just not fair to Grandma to expect her to perform what I consider to be a Herculean task at any age (we have really heavy chairs in our parlor - believe me). It’s not fair - but it is accurate, and if she can’t pull nor push the rocker over to the bay window Granny is going to get one point added to her score. Lord, how cruel these geriatricians be!
Don’t get me wrong about this prognostic index - I wholeheartedly applaud its development and wish that all adults over 50 (sorry, I’m too young to take the test) would take its warnings to heart. It’s just that this concept is not new to those of us who spent the first year out of medical school working in what is called “the internship.” Back then we had our own test to determine the risk of not surviving this 12 month sentence at hard labor, and used it to encourage those doctors who were unlikely to live to see the next summer to drop out of the program before it was too late.
As part of our policy here at The Cheerful Oncologist to disclose all secrets of the medical profession it gives me great pleasure to print this formerly suppressed prognostic index for all the world to judge. I encourage all interns to answer these twelve questions honestly. The life you save may be your own.
“Development and Shameless Self-Promotion of a Prognostic Index for 12-Month Mortality in Interns”
[All “yes” answers are worth 2 points unless otherwise stated.]
1. Has a nurse ever looked at you and made the sign of the cross?
2. Do you consume over 40 cups of coffee per day? (add 1 extra point for eating stale danish)
3. Have you ever spent over one hour attempting to perform a lumbar puncture?
4. Would you consider eating food off of a patient’s tray rather than walk to the cafeteria? (add 1 point if patient put up fight)
5. Give yourself one point for every consecutive day you have gone without bathing.
6. Have you ever released a hyena-like laugh when informed of a patient’s demise? (4 points)
7. Have you ever smoked a cigarette while at work? While standing outside the hospital with one of your patients? (add 3 points)
8. Have you ever examined a patient while he or she was sitting on a commode?
9. When presenting a case to the Chief during morning report have you ever used the phrase “well-known dirtbag”? (3 points)
10. Have you ever tried to coach a demented patient to shout out a new repetitive phrase? (add 1 point if a nurse’s name was involved)
11. Give yourself one point for every second you wait between the time your code blue beeper goes off and you start running to the patient’s room. (maximum 60 points)
12. After being informed of a patient’s fever, hypotension, tachycardia or hypoxemia have you ever responded as follows: “Who gives a sh*t?”
BONUS QUESTION: Have you ever wanted to write the following order: “Pith in A.M.”? (10 points)
Unfortunately the scoring system was lost after the great V.A. hospital fire of ‘87, but as I recall the only intern who ever broke the record for points ended up doing a Psychiatry residency in Brownsville, Texas.
One can clearly see how valuable these prognostic indices are when attempting to come to grips with the challenges of our modern world. I only hope that those who choose to take these tests handle them with the same care as if they were a duffel bag full of red kryptonite. Arrivederci!
