Monday, May 12, 2008
What Is That Guy Thinking?
When the Attending Is the Person Who Needs the Intervention.
Pallimed Case Conferences (cases.pallimed.org) is closed to comments and new posts as of April 25, 2013.
This site will stay online as an archived source, but will no longer be updated.
For active posts on these cases and new cases go to www.pallimed.com.
By Elizabeth Chaitin, MSW, MA, DHCE
Originally posted at the Institute to Enhance Palliative Care, University of Pittsburgh Medical Center
Vol 8, No. 1 - February 2008
(Original PDF)
Case:(Original PDF)
Mr. James Martin is 74-year-old man admitted to an outside hospital with a two-month history of shortness of breath, edema, and recent difficulty ambulating. He has a history of an aortic aneurysm, hypertension, cellulitis of his lower extremities, chronic obstructive pulmonary disease from years of heavy smoking, as well as ischemic cardiomyopathy and congestive heart failure. Mr. Martin had worsening renal functioning upon admission and was found to have two masses, one on each adrenal gland. He was scheduled for surgery and an ethics consult was called because the patient “didn’t seem mentally right.” The ethics consultant interviewed the patient and family and discovered that Mr. Martin was “mentally slow” and was illiterate. He never attended school and was raised and cared for by family until his adult years when he rented a small apartment near his sister Debbie with whom he is quite close. The consultant recommended that his sister sign for consent for the surgery for she felt Mr. Martin was neither able to comprehend the severe nature of his current condition nor could he comprehend the risks undertaken with the recommended surgery. The sister consented to bilateral adrenalectomies.
In this case there were two different stories or viewpoints present, which could have been conflictual in nature depending on the approach taken by the Palliative Care and Ethics Team. In Story One, the attending believed strongly that it was possible the patient could “get well” with more time and encouraged the family to consider the placement of a feeding tube. In Story Two, the Palliative Care and Ethics Team was certain that the patient was dying and believed that the placement of a feeding tube would not add to the longevity or quality of the patient’s life.
1. Douglas Stone, Bruce Patton and Sheila Heen. “Difficult Conversations: How to Discuss What Matters Most.” Penguin Books, 1999.
2. Roger Fisher, William Ury and Bruce Patton. Getting to Yes: Negotiating Agreement Without Giving In.” Penguin Books, 1991. (Wikipedia Link)
2. Roger Fisher, William Ury and Bruce Patton. Getting to Yes: Negotiating Agreement Without Giving In.” Penguin Books, 1991. (Wikipedia Link)
(Edit: (6/16) Added missing fragment "...consultant believed that the patient was dying and spoke with...)
Subscribe to:
Post Comments (Atom)