Medical communication skills challenge — Breaking bad news, challenge 2

physiciansapply.ca orientation

18 Jun 201804:33

Summary

TLDRIn the script, Dr. Alvarez introduces herself to Sebastian, a patient with a history of ovarian cancer, who has been experiencing bloating and bowel issues. The doctor reveals the unfortunate news that the cancer has returned, despite previous assurances of a complete removal. She explains the severity of the situation, the limitations of available treatments, and the absence of a cure. The patient is left in shock, requesting time alone before discussing further support options with a social worker.

Takeaways

👩‍⚕️ Introduction: Dr. Alvarez introduces herself as a new resident who will be looking after Sebastian.
🤝 First Meeting: Sebastian and Dr. Alvarez meet for the first time, acknowledging the frequent change of doctors.
🏠 Personal Life: Sebastian mentions being divorced with children living out of town, indicating no immediate family support.
🏥 Previous Condition: Sebastian had ovarian cancer two years ago and underwent an operation, believing it was fully removed.
📋 Medical History: The script reveals that Sebastian has been experiencing bloating and bowel problems for the last six months.
🔍 Recent Tests: Sebastian has undergone recent tests, including CT scan, ultrasound, and laparoscopy.
😔 Difficult News: Dr. Alvarez informs Sebastian that the cancer has returned, which was confirmed by the laparoscopy.
💊 Treatment Options: Dr. Alvarez mentions the existence of drugs for treatment but clarifies there is no cure for the current state of Sebastian's cancer.
🚫 No Surgical Option: It is explained that the cancer has spread too much for surgery to be a viable option.
🤔 Emotional Impact: Sebastian is surprised and confused by the news, expressing a sense of betrayal by her previous recovery.
👫 Support Offered: Dr. Alvarez offers the support of a social worker and other staff to help Sebastian process the news.

Q & A

Who is the speaker in the transcript?
-The speaker in the transcript is Dr. Alvarez, a resident doctor who has recently started looking after the patient.
What medical issue has the patient been experiencing?
-The patient has been experiencing bloating and bowel problems for the last six months.
What was the patient's previous diagnosis?
-The patient was previously diagnosed with ovarian cancer two years ago.
What was the outcome of the patient's previous surgery?
-The patient was told that the ovarian cancer was completely removed during the surgery.
How has the patient been feeling since the surgery?
-The patient has been feeling quite good since the surgery, with no major health issues reported.
What is the current situation with the patient's health?
-The current situation is that the patient's cancer has returned, as revealed by the laparoscopy.
What does Dr. Alvarez suggest about the nature of ovarian cancer?
-Dr. Alvarez suggests that ovarian cancer can sometimes recur, indicating that it can be unpredictable and difficult to cure completely.
What is the patient's living situation?
-The patient is divorced, and her children live out of town, meaning she does not have immediate family at home to support her.
What is the prognosis for the patient's current condition?
-The prognosis is not good; the cancer has spread throughout the abdomen, and there is no cure or surgical option available.
What treatment options are mentioned by Dr. Alvarez?
-Dr. Alvarez mentions the use of drugs, which are very toxic, but also states that there is no cure for the patient's condition.
How does the patient react to the news of her condition?
-The patient is initially shocked and requests some time alone to process the information before discussing further support options.

Outlines

00:00

🏥 Initial Meeting with Dr. Alvarez

The script begins with an introduction between the patient, Helen, and Dr. Alvarez, who is a new resident taking over her care. Helen expresses confusion about the numerous doctors she has seen and her upcoming discharge after completing tests. Dr. Alvarez informs her about her medical history, including a previous operation for ovarian cancer two years ago, and inquires about her current living situation, revealing that Helen lives alone.

📋 Discussing the Return of Cancer

Dr. Alvarez discusses Helen's recent CT scan and laparoscopy results, which indicate the unfortunate return of her ovarian cancer. The doctor explains the nature of the disease and its tendency to recur, despite previous successful treatment. Helen is understandably upset and confused, questioning the doctors' earlier assurances that the cancer had been completely removed. Dr. Alvarez clarifies that the recurrence is not due to deception but the unpredictable nature of the disease.

💔 Facing the Reality of Incurable Cancer

The conversation turns to the grim reality that Helen's cancer has spread throughout her abdomen and is incurable. Dr. Alvarez is candid about the lack of a cure and the limited treatment options, which include toxic drugs. The possibility of another operation is ruled out due to the extent of the cancer's spread. Helen is given the opportunity to have someone by her side for support, but she requests some time alone to process the news.

🤝 Offering Support and Next Steps

In the closing part of the script, Dr. Alvarez offers to return with a social worker to provide further support and discuss the implications of the diagnosis. Helen agrees to this, indicating her need for some time to be alone before engaging in further discussions about her condition and potential next steps.

Mindmap

Keywords

💡Resident

A resident in the medical context refers to a doctor who is undergoing specialized training, usually after graduating from medical school. In the script, Dr. Alvarez is introduced as a resident, indicating their role in the hospital and their interaction with the patient is part of their professional development.

💡Bloating

Bloating is a feeling of fullness or swelling in the abdomen, often associated with discomfort. In the video, the patient mentions experiencing bloating and bowel problems, which are symptoms leading to medical consultation and investigation.

💡Bowel Problems

Bowel problems refer to a range of issues that affect the large and small intestines, including constipation, diarrhea, and irritable bowel syndrome. The patient's mention of bowel problems is a key element in the script, as it is the initial reason for medical attention and subsequent diagnosis.

💡Ovarian Cancer

Ovarian cancer is a type of cancer that begins in the ovaries, which are part of the female reproductive system. The patient's history of ovarian cancer is central to the script, as it provides context for the current health situation and the emotional impact of the news of the cancer's return.

💡Laparoscopy

Laparoscopy is a minimally invasive surgical procedure used for diagnosis or treatment of conditions within the abdomen. In the script, the laparoscopy reveals the recurrence of cancer, which is a critical turning point in the patient's understanding of their health.

💡CT Scan

A CT scan, or computed tomography, is an imaging procedure that helps doctors diagnose and treat medical conditions by providing detailed images of the body's internal structures. The CT scan is mentioned in the script as one of the tests used to investigate the patient's symptoms.

💡Ultrasound

An ultrasound is a diagnostic imaging technique that uses high-frequency sound waves to create images of structures within the body. In the script, the ultrasound is another test mentioned, contributing to the medical investigation of the patient's condition.

💡Cancer Recurrence

Cancer recurrence refers to the reappearance of cancer after a period of remission. The script revolves around the difficult news that the patient's ovarian cancer has recurred, which is a significant and emotional revelation in the narrative.

💡Chemotherapy

Chemotherapy is a type of cancer treatment that uses one or more drugs to kill cancer cells. In the script, Dr. Alvarez mentions chemotherapy as a potential treatment, but also explains its limitations given the advanced stage of the patient's cancer.

💡Support Staff

Support staff in a hospital setting includes a range of professionals who provide care and assistance to patients, such as social workers and clergy. In the script, the offer of support staff is an important aspect of the patient's care, indicating the holistic approach to dealing with the emotional impact of the diagnosis.

💡Social Worker

A social worker is a professional who helps individuals and families cope with problems in their everyday lives, including medical and emotional issues. In the script, the social worker is mentioned as a resource to provide support and guidance to the patient following the difficult news of the cancer's return.

Highlights

Introduction of Dr. Alvarez as the new attending physician.

Patient's confusion due to frequent doctor changes and uncertainty about her doctor.

Patient's expectation of going home soon after completing tests.

Revelation of the patient's history of ovarian cancer and successful operation two years prior.

Patient's current symptoms of bloating and bowel problems for the last six months.

Dr. Alvarez's concern about the patient's living situation and lack of support at home.

Breaking the news of cancer recurrence to the patient.

Patient's disbelief and confusion about the cancer's return despite previous successful treatment.

Explanation of the nature of ovarian cancer and its tendency to recur.

Discussion of the current lack of a cure and the limitations of available treatments.

Patient's inquiry about the possibility of another operation similar to the previous successful one.

Dr. Alvarez's clarification that the cancer has spread and surgery is not an option.

Offer of support through social workers and other support staff.

Patient's request for time alone to process the news.

Dr. Alvarez's intention to return with a social worker for further discussion and support.