DocCom module 13

Which of the following is false regarding clinician emotional self-awareness? A. With increasing maturity and skill, the clinician may learn to suppress her/his own emotions. B. Clinician emotional self-awareness leads to improved patient care. C. Our colleagues may be a valuable resource in preventing burnout. D. When personally distraught by a particularly upsetting patient interaction, taking some "time out" may be the best immediate choice.

A

A 45 year old patient of yours was treated for localized breast cancer with lumpectomy and radiation two years ago and had a strong belief that she was cured. New onset headaches prompted an MRI and you have just informed her that several likely metastatic lesions are present in her brain. She immediately breaks down in loud sobs: "Oh my God, my children!" Depending on how you read the moment, any of the following could be appropriate except: A. Placing a hand on her arm while saying nothing. B. Saying, "I'm so sorry. I wish it were different." C. Saying, "Your husband is completely devoted to you and your family." D. Doing nothing.

C

Emily, age 12, recently received a kidney transplant. Emily is a sweet child; the favorite of everyone on the transplant team. However, her parents are harsh, judgmental, and rejecting of their daughter, and their behavior upsets the clinical team. As the team leader, what is the recommended response to the team's distress? A. Gather the team and together ask Emily about possible emotional distress due to her parents. B. Gather the team and encourage them to be more balanced in their response to both Emily and her parents. C. Gather the team and explore the emotional impact on them, of both Emily and her parents. D. Gather the team and explore the utility of a consultation from a child behavioral specialist. E. Gather the team and explore with Emily's parents how their parenting might impact Emily.

C

During morning rounds the husband of one of your patients blocks you from entering her room, saying, "You said you would change my wife's diet yesterday, and I want to know why you didn't!". You recall the conversation but you had a lot of sick patients and forgot to write the order. Which of the following is the recommended way to de-escalate this situation? A. I apologize for not doing what I agreed to do when we spoke together I'll write the orders as soon as I finish this visit. B. I apologize for not doing what I agreed to do when we spoke together. I appreciate your concern for your wife and attentiveness to the situation. I'll write the orders as soon as I finish this visit. C. Tell me a little more about your concern. I'll write the orders as soon as I finish this visit. D. I apologize. Dietary orders are often lost or delayed. I'll double checkthe orders and make certain that we carry through this time. E. I apologize for not doing what I agreed to do when we spoke together. Your blocking my way and raising your voice with me is not helpful.

B

Mr. Jenkins, age 29, is in the ICU following extensive surgery necessitated by an automobile accident. His recovery has been by complications. Unable to sleep and in pain he "fires" his surgeon because he perceives him as arrogant, uncaring, disrespectful, and unresponsive. Although still in considerable pain Mr. Jenkins welcomes you, his new physician, and expresses concern that you will view him as a difficult patient, "because doctors seem to stick together." The recommended intervention is which of the following: A. I'm sorry you are in so much pain. . B. I'm sorry your recovery is so slow and painful and that you are unhappy with Dr. Surgeon. How shall we proceed now? C. Dr. Surgeon is very careful and did do all the right things for you. I'll be certain that you get optimal care from now on. D. Dr. Surgeon is very careful and did do all the right things for you. I'm sorry your recovery is so slow and painful. E. I appreciate Dr. Surgeon's careful work on your behalf, and I appreciate how much distress you are in at present.

B

A hospitalized teen dies from injuries and on hearing the bad news the family is very expressive, sobbing, crying out and begging you to say the news is incorrect. As you, the senior clinician, listen you notice that your trainee, Mr./Ms/.Dr. A, abruptly leaves the room. Which of the following is the recommended response? A. Encourage the family to continue to express their strong feelings and say, "I'm sorry that Dr. A had to leave." B. Encourage the family to continue to express their strong feelings and say, "Excuse me, I'm going to look after Dr. A." C. Encourage the family to continue to express their strong feelings and say, "Excuse me, I'm going to look for Dr. A and bring her/him back." D. Encourage the family to continue to express their strong feelings and say nothing about Dr. A. Talk with him/her at another time. E. Encourage the family to continue to express their strong feelings and say, "I'm sorry that Dr. A had to attend to an emergency."

D

Mr. Morse, age 45 and divorced, comes to your office for the first time and tearfully states that he wants to get help for depression. The court denied Mr. Morse permission to spend time with his two school age children and he reports he does not want to live. He is too upset to get out of bed, eat, or go to work. As you listen, Mr. Morse finally tells you that his visitation rights were denied because he had an intimate relationship with a 15-year-old and charges are pending. In this setting. Which of the following is the recommended reflective statement? A. "Have you talked with a lawyer about how you might be able to get visitation re-instated?" B. "I am sorry about your children; I guess you are learning that there are consequences for such actions." C. "I understand how terrible you feel. Killing yourself would result in you never being able to see your children again." D. "The situation with your children is causing you a lot of sorrow and pain and you are wondering if you want to live if you can't see them." E. "You are understandably very depressed and things could get worse; I think an antidepressant medication may be helpful."

D

When a patient with a history of violence raises his voice and looks "out of control", the recommended response is to: A. Warn the patient that becoming violent will have serious consequences. B. Contact the patient's psychiatrist to see what measures have worked in the past. C. Get a male colleague to accompany you into the room. D. Leave and call security.

D

You are seeing a patient for the first time and you find yourself arguing with him. The patient is yelling and you notice that your voice is much louder than usual. Which option is recommended? A. "Maybe it would be helpful to take a little time out, so you can figure out why you are so angry with me." B. "You are pretty angry with me. For this situation, perhaps I could find a better doctor for you." C. "I could better partner with you if you could lower your voice in this conversation." D. Stop talking, listen, and reflect on your own emotional response. E. "Anyone would be angry when facing your situation."

D

A patient with a very poor prognosis tearfully says, "I know I will die soon, and with death so near I am afraid to be alone in any room." Her expression of fearfulness is uncharacteristic and you hope she will be able to maintain her usual self-efficacy. Which is the recommended response to her emotional distress? A. I'm eager to help you through this. What would be most helpful at this time? B. It's pretty normal to feel sad at a time like this. How would you like to proceed from here? C. I see how much suffering you are feeling. New treatments are constantly being developed and there is still hope. D. I'm eager to help you through this. Would it be right for you to seek spiritual counseling? E. I hear and see how terribly distressed you are right now, and how much you are suffering. What does it mean to you to feel you may die soon?

E