Published on 19 November 2025

I was recently involved in the care of a patient with end-stage brain cancer.

During a home visit, as I sat with him and his wife, he looked at me and asked the question that so many patients in his situation eventually ask:

“How long do I still have?”

I hesitated. I’ve been wrong before—more often than I’d like to admit. One encounter still stands out vividly in my mind: a family once asked whether it was time to call the distant relatives to say their goodbyes. Wanting to spare them regret, I gently suggested that they come soon. Yet the patient lived for several more months. Since then, I’ve been wary of giving predictions.

This time, I acknowledged my patient’s need to know but admitted that it was difficult to provide an exact timeline. He died a week later.

And I’ve found myself wondering: Did I let him down by not being more specific? Would a clearer answer have helped him and his family prepare for what was to come?

This experience led me to revisit a chapter titled “Who Knows?” in Palliative Care: Core Clinical Skills and Competencies by Emanuel and Librach. It explores the challenge of prognostication—the delicate balance between what we can foresee and what we can foretell.

Foreseeing draws on science, clinical experience, and judgment. It’s about gathering evidence, using tools and making the best possible estimation.

Foretelling, on the other hand, is an art—it’s how we communicate uncertainty with compassion, honesty, and sensitivity to the patient’s emotional needs.

The authors describe the idea of probabilistic planning—helping patients and families think in terms of possibilities: the best-case, worst-case, and most likely scenarios. I found this deeply helpful. It allows for honesty while leaving room for hope, preparation, and acceptance.

This encounter reminded me once again of the importance of being a lifelong learner in medicine. Each patient teaches us something new—about illness, about uncertainty, and about ourselves.

Uncertainty is not something to be conquered, but rather something to be lived with—curiously and humbly. Both the science and the art of medicine invite us to sit with the unknown, offering presence and care even when we cannot offer certainty.