Clinical Nihilism and Self-Fulfilling Prophecy: A 9-Year Analysis of Neurosurgical Outcomes in Rural India

Abstract

Objective: To analyze the impact of clinical nihilism and self-fulfilling prophecy in rural neurosurgical decision-making at Jorhat Medical College and Hospital (JMCH) in a low- and middle-income country (LMIC) setting. The study explores treatment refusal, referral patterns, and patient outcomes over a 9-year period (June 2015– May 2024). Methods: A retrospective cohort study was conducted on all emergency neurosurgical cases managed at JMCH from June 2015 to May 2024. Data included clinical decision-making patterns, referral rates, left against medical advice (LAMA) cases, and patient outcomes. Statistical analysis was performed to identify trends in nihilistic decision-making and its impact on patient mortality.