I feel like we spend a lot of energy thinking about prognosis in terms of time, but it’s not always a matter of time. In fact, for many of my patients, “how much time do I have left” is often less important than “can I feel, in some way, like myself again?”

This is a pretty well-understood concept in palliative medicine, the concept of quality of time vs quantity of time. And yet, when we discuss prognosis with our patients, we tend to speak in hours to days to months or years – we tend to assume that the most important, or relevant, aspect of prognosis is time.

Reframing prognosis in terms of what matters most is often helpful. Temporal Prognosis may take a back seat to Functional Prognosis, or Identity Prognosis, or Legacy Prognosis. This is something we consider quite a bit in our inpatient rehab and stroke units where physical function and independence are typically affected. A REMAP headline may become less about “time is short” and more about what it is, or is not, possible looking ahead.

And if you’re unsure about which type of prognosis matters most to your patient? Then the best thing to do is explore with empathy and curiosity (an “I wonder” statement may work well here!).