Transcript Slide 4 Connections: Communication Case Studies: Mr. Williams

Mr. Williams Case Study
Stuart J. Farber, MD
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Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Mr. Williams is a 53-year-old heavy smoker. Seven months ago
he had surgery to remove a segment of his lung for treatment of
adenocarcinoma. He left the hospital with the surgeon’s
assurances that he would make a "complete recovery.“ Recently,
he has been readmitted because of progressive disease, and his
distressing symptoms include shortness of breath, severe pain,
weakness, and anorexia.
Mr. Williams
Age 53
Heavy Smoker
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Slide 2
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Less Effective Responses
(Click the response text to play an audio clip)
Blaming:
I can't believe those doctors have done this again.
It's just terrible.
Rescuing/Solving the Problem:
What you need to do is sit down with those doctors
and tell them what it is you want for your father.
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Slide 3
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Less Effective Responses
(Click the response text to play an audio clip)
Jumping to Conclusions:
You need a pain consult.
His pain management isn't working.
I'll call your doctor and sit with you
while you talk with him.
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Slide 4
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Less Effective Responses
(Click the response text to play an audio clip)
Feeling Helpless or Overwhelmed:
I don't know what we can do about this.
When I get a chance, I'll read his chart to see
if there's anything else we can do.
I'll do what I can, but I have other patients.
No response - Leaving the room.
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Slide 5
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Effective Responses
(Click the response text to play an audio clip)
Help me understand what you mean by "It's really bad.”
Share with me what the doctor has told you so far.
It sounds as if you both have been having a rough time.
Mr. Williams, what are your concerns?
I'm glad I'm here too. I'm going to work with you
to help your dad. Let's start with your helping me
to understand exactly what your concerns are.
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Slide 6
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
A hallway consult takes place regarding care plan.
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Slide 7
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Breaking bad news: Disease-based approach.
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Slide 8
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
Breaking bad news: Patient and family centered approach.
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Slide 9
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
DNR discussion: Patient-family centered
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Slide 10
Connections: Communication
Case Studies: Mr. Williams
Case Study: Mr. Williams
DNR Discussion: Task centered
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Slide 11