DEAR DR. ROACH: I am on Medicare, and my primary care physician just retired. Not many places are taking new patients these days, especially on Medicare. Given the choice, should I look for an M.D. (medical doctor) or a D.O. (doctor of osteopathy)? — T.C.

ANSWER: In my opinion, the training of D.O.s and M.D.s is so nearly equivalent that there is not a reason to choose between them. D.O.s are trained in osteopathic manipulation, which some continue to perform and others do not. Otherwise, the training of a D.O. and an M.D. are very nearly equivalent. Studies comparing outcomes have not shown any significant differences.

Personally, I would choose either a D.O. or an M.D. as a personal physician. Experience and philosophy are more important than the degree.

DEAR DR. ROACH: My brother has been diagnosed with prostate cancer. The cancer is also in his hip bones, lungs, lymph nodes, cervical spine and brain. He had brain surgery to remove two critical tumors. There are six more tumors in his brain. He is getting radiation to his brain and spine as well as shots for his prostate. He’ll get chemotherapy for the cancer in his lung.

I know his prognosis cannot be good, but I can’t get anyone to say what his chances are at survival and how long he may have left with us. — Anon.

ANSWER: I am very sorry about your brother and sorrier still that nobody has given you an honest assessment. Unfortunately there is no chance for a cure beyond a miracle, and miracles are very rare. Physicians are generally not good about predicting the future, and any estimate can be way off. However, based on what you have told me, I would say that his life expectancy is weeks to months, not years.

I had a case similar to your brother’s, maybe even more advanced, when I was a resident on the oncology service. He came in late in the evening and was transferred from another hospital with extensive medical records. I spent about an hour reading the records and understanding the stage of the disease and what had been done for him.

When I went in to see him, he was obviously very ill and surrounded by at least 10 concerned family members. I did my examination, and he asked me point-blank if his disease was going to end his life.

I started to explain the uncertainty, but he stopped me and asked me again for my honest opinion, based on my knowledge, of whether this cancer would kill him. Every family member was watching me, and I told him that this cancer was going to kill him. I couldn’t say if it would be days or weeks, but it wouldn’t likely be months.

He had a profound look of relief when he thanked me and told me that nobody had ever told him what was really happening. He passed away three days later.

I was very unsure if my blunt response was the best answer, but for him and his family, it was what they wanted to know. Since then, I have always tried to be honest yet compassionate when discussing a prognosis in a person with advanced cancer (and other diseases that may be just as serious).

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved