You go ahead and call, and then you will click. All right, everybody. We'll get this straightened out. Technical difficulties. We're doing this to keep it light. I have no conflicts of interest or disclosures. Okay, so this is how we're gonna organize each case. What we're gonna do is I'm gonna read the case over about a minute, and then you're gonna have seven minutes to work through the case, and you're gonna work through the entire thing. So we're gonna identify the nature of the conflict, including the disputants and what the conflict is about. It shouldn't be terribly hard. You just identify who you think is in conflict and what it's about. And then we're gonna brainstorm positions and interests. So what is it that they're asking for, specifically, in each case? What is that nature of the conflict? And then, oh, go back. And then the why. So begin to think about, in a particular case, why might one disputant be asking for what they're asking for, and why might the other disputant be asking for it? And then consider some avenues for consensus, like how might you approach this? What kind of things would you do relationally if you're talking to someone? And then even practice crafting some language. So if you're gonna initiate a dialogue with them, what's the first thing you'd say? What's the first sentence you'd speak? And what are some other phrases you might use from your experience in healthcare that might help sort of cool down the situation? So we'll do case one. So a 74-year-old patient with terminal cancer is admitted to the ICU with multi-organ failure. He's developed AKI and would require continuous renal replacement therapy as a life-sustaining intervention. The healthcare team feels initiation of dialysis would not change his terminal cancer prognosis and recommend against it. His daughter demands dialysis and states that not starting it would be the same as killing him. So that's case one. So I'm gonna leave the case up, and I'm gonna look at my watch, and we have about six or seven minutes to work through it. Will you click one slide, rather? Okay, sorry. So that's the case, and we're gonna go through case one. These are the questions you're gonna answer. So you guys go ahead. And if anybody ever needs to see the case again or forget the case, just let me know, and we can flip a slide back. But this is what you wanna work through over the next seven minutes, main four bullet points. We're gonna take a couple more minutes and then we're gonna wrap up. Alright, how we doing? All right, folks, start thinking about wrapping it up. I want to make sure that we have time for all five cases. Each get a little more challenging. All right, is it okay if we turn it back to the big room? Awesome. Can I get a volunteer table in the seat of opportunity to share? Otherwise, I'm just going to randomly pick a table. Okay, you don't have to stand up. Yeah, feel free to stay seated. Okay, so table four. So in this case, who are the disputants? Exactly, see? Easy peasy. And what do you think the conflict is about? Yeah, continuation of life-sustaining therapies. And I think that you articulated that really well. You know, one is, like, is this medically appropriate? We could talk a little bit. I heard at table five this conversation about is it really futile? What is futility? I think there's a lot to unpack there. But is it a medically appropriate intervention versus prolonging life? That's exactly right. What do you think are the positions that they're articulating? Yeah. So it really is about like dialysis, yes or no. Right. And you've already started digging a little bit into the why, like a family member not wanting to say goodbye is a really good reason for why someone would say, I want dialysis. And it's very different than I believe dialysis cures cancer. Right. Those are two totally different why's. One requires a little bit of medical redirection. The other one is really much more of a human instinct, like this idea of like pending loss. And then for us as well, not wanting to do dialysis. What are some other why's that you guys came up with? I'm not going to list all the why's that are possible, but we're just going to, I have some that I put in here, but we're going to see what you guys say. Yeah, I love that. So fear, misunderstanding of medical information, maybe it's a cultural thing, maybe it's a religious or spiritual thing. I love that. What about for the team? Yeah, all those things, resource management, allocation of scarce ICU beds, our own time, the fact that we might feel morally distressed that we're causing suffering formation, right? So is it medically inappropriate? Are we prolonging suffering? Is there healthcare, do we have our own healthcare bias that we somehow believe that doing dialysis is not necessarily appropriate? And then this idea for the family, it's an ethical violation. How dare you take away something or not offer something that would keep them alive, right? That goes to sign it kind of like culture, being, have this idea of loss aversion, right? Not wanting to lose their family member and then prognostic uncertainty. Maybe we're wrong, maybe it will help, right? So these are just some examples of the why. How are the other tables doing? You guys feel like you were getting to some of the same things? All right, good. So this is what we're gonna do for each case. So consider some avenues for consensus and collaboration. What did you guys come up with at table four? Yeah. So this idea of time-limited trials, right? So these are some of the ones that I came up with that are very similar to what you said. Well done. Clarifying the medical condition, any medical uncertainty, learning about the patient's values and preferences, why is it that they believe the patient might want something like this, and considering offer a recommendation for a time-limited trial. These are all really great suggestions that you guys came up with. Anybody at other tables want to throw out one or two that were different than what we heard from table four? No pressure. Yeah, yeah, so making sure that that family member has someone from their community, family, friend, otherwise, that supports them, that could maybe be present to help navigate this conversation and offer additional perspective, I love that. So you want to, table four, you guys want to throw out any language that you might use to initiate the dialogue, any phrasing? Love it, yeah, that's great. I love checking ourselves, pausing, doing less of the talking and more of the listening. We tend to talk way too much. So taking a moment to say, you know, tell me about what's going on with you. Tell me about mom, tell me about dad, is really important. So these are just some of the phrases that I thought of when I was putting this together. It sounds like you really care about your dad and are trying to make the best decision for his care. So validating her as an advocate, right, goes a long way to align. Would it be okay, so asking permission is really important. Would it be okay for me to share more about what's going on? Again, maybe there's some misunderstanding about his medical condition, but always asking permission. She may not wanna hear a lot. She may not be in a receiving place right now. It's important that you start with an ask. I'm worried we're in a different place right now. I like I'm worried because it's a very human phrase, right? It's not medical, it's not technical. I'm worried we're in a different place now and that your dad may die even if we start dialysis. She may not understand that dialysis isn't gonna fix the fact that he's dying. And so being able to say, I'm worried, and then state very explicitly, we're in a different place now, right? He's dying regardless, may be helpful. Would it be okay, again, asking permission. Would it be okay to talk about what's important to your dad given how sick he is? Asking permission to hear more about him as the patient. And this one's a long one, but would it be okay if I offer a recommendation? And if she says no, you don't offer. But if she says yes, she's opened the floor for you to be able to say, one option would be for us to try dialysis for a short period of time, perhaps a few days, and see if his condition improves. If it does, that would be wonderful. If not, we could regroup and talk more about focusing on his comfort and stop the dialysis and other treatments that are keeping him alive. How does this sound? So then checking in and making sure that she agrees with that recommended plan. And if not, you need to go back to the drawing board. So just some examples of language that I've used in my practice that I think are, again, very much patient-forward, family-forward in the phrasing and the language zone. Any questions about this case? Okay, let's move on to a second case. I'm gonna swap out with Lynn. Okay, so our second case here is we have a 62-year-old patient, and they had a liver transplant 11 months ago. But since that time, she has been in and out of the ICU four times, she has continuous and repeated transplant complications, and she is continuously dependent upon that hospitalization. At this point, she's gotten to the time where she's sharing with her medical team that she's really weary of being in the hospital, and she really would prefer that she doesn't continue with care and going back and forth to the ICU, even if it means that she knows that she could lose her life because of this. Her only hesitation is she really doesn't want to let down the transplant team, and so you approach the transplant team to talk to them about what she shared with you. You share all of that information, and the transplant surgeon responds, I will never give her the permission to die, that's not my job, and my job is to really ensure that this organ is put to good use. So again, within your groups, discuss the differences that are going on there. Are you clicking? It's working now, OK. So, go through the same type of thing. We have seven minutes, and I'll keep a watch here about going through the conflict, brainstorming different positions that you need to take, and different avenues for consensus, and how you're going to talk through this position. Go ahead. We're going to give you some extra time to go ahead and talk on this case, so you've got about another seven minutes to go ahead. Sorry, I wasn't sure if that was the same. Okay take about two minutes to wrap up your discussions and then somebody think about if their table wants to present their information. Okay, all right, we're gonna go ahead and get started. Who wants to volunteer? Table one. Okay, table one volunteers to present their information. Okay, so what would you identify as the nature of the conflict? Who and the what? The who we decided was where the patient would be transplanted to. You had three. I just want the record to show that the person who said go to the mic is my mentor, Derrick Wheeler. So thank you for that, Dr. Wheeler. I'll turn it kind of this way so that you guys can hear. But yeah, so going back to the beginning, the disputants, we initially, I even brought this up. I was like, this is patient versus transplant team, but then I think we also decided that the ICU team is going to be a big advocate, I think, in connecting these two pieces together. So we listed three. The conflict being the patient wanting to limit their own care and seemingly not wanting to disappoint the transplant team, which we thought was interesting, and we'll get into that. And then the transplant team being focused on what seemed like outcomes. So we kind of said the healthcare team versus the healthcare team, but yeah, if the medical ICU team is supporting the patient, then you could kind of put them together in the same category as opposed to, but if there's a triad of differences there, then you might have three different people that are really coming to conflict at this point in time. But we're kind of looking at it as the medical ICU team was supporting her and taking her information forward. And then yes, you have organ allocation, you have, but you also have supporting the patient and what does the patient want and the patient's right to her autonomy for her medical decision making and what you need to do with that. So those are good discussion points and there's a lot of information with that. A comment, okay. We actually had a possibility of four. One is the patient, him or herself. One is the family surrogate and what that relationship feels like to support a patient who's having so many complications. Plus ICU, the entire ICU team caught in the middle, our nurses and our care team and the surgical team. So there's four disputants, we thought. An additional group in there. So that's going to make the discussions even harder and more robust as you go forward. All right, so brainstorming, what and why? What is the what of the discussion? So we said that the what is the, or the patient is, it seems like there's a focus on the quality of life and limiting their own care and patient autonomy, a degree of that. We said for the ICU team, I suppose in retrospect, this is maybe looking at us in a very kind light that we just wanted what's best for the patient. And then for the transplant team, focusing more on all the effort that was kind of put into the organ transplant and knowing that that's a very scarce resource. So again, you've got the, whether you allow the patient to be autonomous and make their own medical decision making and moving forward with what they really want, or do you consider, continue all the life sustaining treatment or the treatment that she is undergoing continuously as she comes back and forth in the ICU. And then you've got the ICU team and probably again, we're kind of lumping the patient in with the medical ICU team and really supporting her values and what she wants and really thinking about compassionate care for her. And then the transplant team, you've got ethical tensions that can go on with what they want. There's metrics that you look at and looking at how well has she been doing and there is information that we don't have. How critical is she? Does she get back to some quality of life in between these hospitalizations? So we don't have all of the information that might be helpful. The comment there was, what were her expectations getting the transplant and going forward from that? And what did she expect once she had that organ transplant? What was her life gonna be like? And what did she think she was gonna be able to do? And not do? We also thought it was very interesting in the language that the patient used in terms of not wanting to disappoint the surgeon and trying to investigate that why and kind of where that relationship had been so that we can better work with the transplant team to partner with them to come to a good collaborative. Okay, so what are some considerations or avenues for getting consensus between the patient, the medical ICU team, and the transplant team? We thought that meeting with the patient first as the ICU team would be beneficial to better flesh out what our group and then what a lot of people have commented on in terms of trying to determine what their expectations were, what they mean by, you know, what's their definition of the quality of life, how autonomy plays into this, and then try to better explore the relationship that they have with the surgical team with that disappointment being on the mind of why they don't maybe wanna limit their own care. So after getting that and fleshing that out, taking some of that information informed to the transplant team to better understand their relationship with the patient, maybe understand some external pressures that they have in terms of transplant numbers and that sort of thing and how something like this would affect their program, why they, you know, what their relationship is like with the patient, and then trying to have a full consensus meeting with all of the stakeholders to try to come up with a good plan forward. And that's what, you know, again, clarifying the goals on each side of the discussion is gonna be important. What are the goals from the transplant team? What kind of relationship do they have? It's gonna be really important to try to figure that out. And looking at, again, what were her goals after her transplant? What did she think she was gonna be able to accomplish or do with her life that she hasn't been able to do? And how is she getting worse every time she's in the unit and she's not able to really do much of anything that she really was looking for? And then what kind of language would you use to initiate that dialogue? We said some examples starting with a patient, you know, acknowledging that they've had a really rough basic year since their transplant and trying to acknowledge that they've been in and out of the hospital and sick, and that must have taken, it's taken a pretty considerable toll on them. Trying to understand how that makes them feel and trying to gain more sort of a foundational understanding of why they're expressing the desire to limit care. And then for the transplant team dialogue, I think also acknowledging that, you know, although it seems rather gruff in the example, you know, this is a loss for them as well, and trying to acknowledge that and respect the work that they've gone into to get the patient where they are and try to better understand where they're coming from. And starting there just with sort of acknowledging and listening to get their viewpoints and better understand them. There are a lot of different ways that you can approach it with both the patient and then the transplant team also. And part of it might even be, you know, trying to get the transplant team and the patient together. Because if the medical ICU team approach the transplant patient, getting that patient in there and also working with them and making sure that you're acknowledging on both sides. You know what it takes for transplanting that organ, the allocation of the organs, how, you know, how scarce a resource that is and you really want to be able to utilize them as best as possible. I'm going there. Okay, great job. All right, we're going to go ahead for our next case. So I heard some questions about, well, how did it turn out? We want to know what happened in these cases. And so true to form, you're all very concrete thinkers, just like my medical students were in healthcare. We always want to know the answer to the question. In the first case, we did a time limited trial of dialysis. And then ultimately after three days, the patient was getting worse and we withdrew life support and supported the daughter through their parent's death. In the second case, this is actually as much as I can remember from the moment, because it was about five or six years ago, this is the exact language that I used. And I really did see the patient as an extension of, I really did see the conflict as being between the healthcare team. Because we were trying to advocate for the patient and we were very much on the side of the patient. If you believe that the patient's decision-making is valid and accurate and fair, which we did, the real conflict came between this patient just wanting the transplant team who had spent so much time and energy with them to say, we understand your suffering and it's okay to let go. And the transplant team just wouldn't support that. And in the end, I asked if it would be helpful. What they ultimately said was, if she wants to die, she can die, but I'm not going to tell her it's okay. And I said, would it be helpful if I take the lead on conversations with the patient? And they said, yes. And the patient ended up leaving the ICU and then got sick again on the floor and was made come for care, did not come back to the ICU. All right. A 34-year-old patient is admitted with septic shock and multi-urine failure. He's intubated and sedated. You can send to his partner and then place a central venous catheter for resuscitation. The procedure is complicated by a pneumothorax. After an emergent chest tube is placed, you need to share the adverse event with his partner. Once you disclose the complication, his partner becomes angry and accusatory, saying, how could you let this happen? You said you would give him the best care. Did you mess up? Go. Okay. Okay, folks, I'm keeping an eye on the time because we only have until about 945 and I'd like to get us through at least the fourth case and maybe even be able to do the fifth case as a large group. So would it be okay, I'm asking permission, would it be okay to move back to the large group in a minute or two? We ready now? All right, let's take 60 seconds to finish up our conversation and is there a table that would like to take a stab at this one? Table seven, thank you. This is clearly like the brave column here. That's right. All right, maybe we can get somebody from table seven to step up to a mic, make their way up to a mic. Thank you. All right. So why don't you take us through who the disputants are here? So the disputants are the healthcare team and the partner. Yeah, healthcare team versus family, you nailed it. And what's the conflict about? So the conflict is about the medical adverse event or the procedural complication. Yeah. This is an adverse event. This is a medical error. We know that when done correctly under ultrasound guidance, the risk of a pneumothorax from a central line should be virtually zero, but it happens. It's in the consent. We talk about it, et cetera, right? So this is not necessarily a medical error in this case. This is an adverse event, assuming that the technique was good, which we will make that presumption for this case. So what were the positions? So the position is dealing with a procedural complication, essentially. And the why of it from the healthcare team is it's a known complication of a procedure that if it's been mentioned in the informed consent, happens, and then it has to be dealt with. And it was appropriately dealt with putting in a chest tube. And what about for the family member? For the partner, it's the unexpected complication and leading to an added procedure to the patient causing him more harm. Yeah. So for the healthcare team, it's a known complication. We were acting in the patient's best interest. We took appropriate precautions. We did everything right. From the family perspective, despite that, we caused harm. Maybe they've lost some control. They feel like their loved one is now sicker than when we started, and they feel vulnerable. These may be some whys as to why they're reacting so extremely. And maybe it's not extreme. I don't know. If one of my loved ones got a pneumothorax from a central line, I might be quite upset. So these are some of the whys that might result in the conflict. What are some avenues of consensus or collaboration? I think getting back to the partner and talking about the informed consent, and more importantly, from their standpoint, acknowledging, going back to the nurse mnemonic, essentially, to understanding their emotion, and naming it, and then trying to explain to them the nature of the procedure and the possible complications, and hopefully it's been done before in the informed consent. Yeah. I like that. I mean, I think the first part of what you said, I really like. Probably trying to explain that this was in the informed consent, that we told them about it, that they signed the informed consent, that it's a known complication, is not going to bear a lot of fruit. Because hopefully, and I heard one of the groups talking about this, I think it was table five, I heard, are we doing, and maybe even table one, are we doing appropriate informed consent? Are we just handing them the paper, or are we actually going through it? So for this case, let's presume we did a good job and we went through it. You have to remember that a family member signing for a patient for a central line, they're overwhelmed, and they may not necessarily sort of intercalate and digest all that information. It can be very easy to miss something, especially when you say, it's very rare, or one thing that could happen is a collapsed lung, but we take all the precautions, and it's an extremely rare event. And then you come back and say it happened, and they're like, what are you talking about? So I think what you did, leaning into the nurse mnemonic, is great. So you want to go through the elements of disclosure, and for people who haven't done disclosure before, it's a responsibility for, really it's in most, different from state to state. So I can't speak to every state that's in this room. In the state of Pennsylvania, it's a non-delegable duty of the attending physician. So even if I'm at home at night and my resident does the central line, I actually need to be the one doing the official disclosure. So you state the adverse event that occurred, right, make sure that they understand what occurred, apology statement here. So saying I'm sorry, and I'm not going to get in, for the purposes of this course, to partial and total apology states, and whether or not you're protected from apologies legally. The bottom line is, I'm sorry that this happened, is a perfectly reasonable apology statement, no matter where you are. Validate their emotions, super important to say, I can't imagine what you're going through, and anyone in your situation would be upset that this happened. I'm upset too, right? Any expectation to identify why it occurred, that we're going to review the case as part of hospital quality and safety, that we're going to provide good care going forward, we're going to give rapid follow-up, and offer to support the partner. What can we do to try to help you through this? So I love that you're reaching for that nurse mnemonic. Dialogue, language? Starting with something like, you know, I understand the trauma that you're going through, but I think it is important for you to realize that the medical team is actually on your side, and despite their best efforts of doing the procedure, the complication happened, but more importantly, it has been taken care of, and the patient is currently safe, because now the tube has been put in and stuff. I want to highlight two things that you said that I really liked. So one is, your loved one is safe, we were able to address the complication, re-inflate the lung, your loved one is safe, right? And that we're here to support you, and that we're on your side, we're here with you, we know that this is difficult for you, but we are here for you. I really like that. Any other language that you all thought of? Other tables? So I wish, I always start with a headline, and when I use a headline, I always use very simple terms, and I start with a warning shot. So you never just say, there was a pneumothorax, or your loved one died. You always give a headline, I mean a warning shot, right? So I wish I had better news, right? So setting them up for the fact that you're about to deliver bad news, so they're prepared. During the procedure, there was a complication. Stop there. I'm so sorry this happened, or I wish this hadn't happened. I can see how distressing this is for you, he's already going through so much, this must be overwhelming. Again, really, really leaning into supporting them through their emotional distress. Although we took the necessary precautions to prevent an event like this, whenever this occurs, we always review the case to see if there's more we could have done to prevent it from happening. As we learn more, I promise to follow up with you and share what we know. So this is a really sort of elegant way to share bad news, own the bad news, respect their emotions and validate what they're feeling, and not try to deflect it, and then prepare them for what's coming next. All right? Okay. We're going to move into, oh, two more. I can't imagine how hard this is for you, but I promise your partner's health is very important to us. So a demonstration that we really are trying to advocate, like you said, for their loved one. We'll do everything we can to get them better. Is there anything I could do for you right now? How can I best support you? I forgot about those. That's the way I finish. All right. Thank you. Questions about this case? So it went fine, chest tube, pneumothorax, got better. Everybody was understanding, really leaned into, like, yeah, I mean, this is our fault. We took all the precautions, but in the end, this is a complication, and we own that, and we want to do better, and we really would like an opportunity to take good care of you and your family. And they just appreciated the fact that we owned it, that we didn't try to deflect and be like, well, you know, it happens. Like, that just, you know, it would not have helped. All right. Now you get a really hard one. And you got a little less time to discuss it. So we got to kind of go a little bit quickly through here. So we have a 23-year-old woman. She has influenza pneumonia, and she's on 70% high flow, and she continues to develop worsening respiratory failure, and she requires intubation. So she desaturates to 45% during the bag valve mask, and the anesthesiologist begins yelling at the respiratory therapist and berating her for not tilting the head back far enough to open the airway. So he pushes her out of the way and takes over ventilating before successfully putting in the endotracheal tube. After intubation. So the patient has been intubated and has an airway in place. So after intubation is completed, he continues to yell at her, and it continues out into the hallway where there are family members present, and calls her incompetent and useless in front of her other ICU staff and the patient's mother. The respiratory therapist is in tears and visibly shaking. Again. Okay, we're going to do this as a big group so we can kind of get through this. So I guess we'll just start with, we'll just go right to the next one. All right. So nature of the conflict and what's going on here. Respiratory therapists and anesthesia are the ones. Health system. Health system? I was thinking health system as well. Health system? In the sense of, is this part of the culture? Where are you providing? That's true. And that's a very good point about what is the culture of your institution. And probably every one of us in here, we know at least one provider or employee at our institution who fits that description, who does not calmly do anything, and can yell at everybody who's there. So yeah, that could be an institutional problem too that is there. And what about, what is the conflict about? Critique of the problem, what's going on, competency versus professionalism, exactly what was happening, what was going on, just because the patient was desaturating, was the respiratory therapist doing what they were supposed to be doing, but because maybe the anesthesiologist was getting anxious or nervous or worried about the fact that the sat was dropping, and they step right in, and so what's going on with that piece? So brainstorming options or positions. What and why? We did talk a little bit about, but go ahead through there. And so that's, you know, the anesthesiologist doesn't feel like it's being done properly. Again, they are usually in a controlled environment most of the time, and so they do have that feeling about rescue, they need to rescue the patient. You know, there is, she's feeling worse, and she is young. She's a young person, she's not oxygenating well. I need this tube to be in there now. I don't need anybody taking time or not getting it successfully placed. And, you know, we'll give the benefit of the doubt that, yes, thinking about that patient, I need to get that airway in, and I need to make sure we are properly ventilating this person, and respiratory therapy, you know, they're probably defending themselves, or they're really thinking about what were they doing, and how are they functioning going forward. So what are avenues for consensus or collaboration in here? I was just going to say, if I were kind of in that situation, the first thing I'm doing is pulling the anesthesiologist aside in a different area that's private and just trying to de-escalate. I mean, there's a lot of, as you pointed out, there's a lot of things that may have gone into that. But at that moment, right, I also don't think that's going to happen. I think, yeah, definitely. And we don't know whether there was actually a problem with competency of the respiratory therapist or not. You don't know what was exactly going on. But you also want to make sure that the respiratory therapist is safe. You want to get that person out of the conflict area, too, and make sure that you're addressing and making sure that they are okay with what's happening, because they still have work to do going forward. And now, you know, they're feeling berated and having problems, and they still have to take care of that patient. And they are still going to be around that family, like you said, approaching the family and talking to them about what is going on there. So removing them from the situation is important. And I'm gonna move yeah comment just make real quick Almost a debriefing of what happened is what you really need to do It needs to really be debriefed and I think the first important piece of this is making sure that the patient is okay The patient has an airway the patient is being ventilated and we're beyond that step And now we have to intervene with with the rest of what is going on So just in a course of time here because we're running out of time just some of the language that you can do You know, wow, this is happening. I'm sorry to interrupt It sounds like the the conversation is really charged here. And again turning to the respiratory therapist Are you okay and pulling them out and taking them out and then having someone who is going to be dedicated to taking care of The family and approaching the family and making sure that they are talking with them and then depending upon the the culture of the institution how you are going to address the problem with the Anesthesiologist who has been unprofessional in the way they have approached this Through five we're done Okay So I hope through working through these cases It's giving an opportunity to sort of think about how in a systematic way Do you how do you work through a case and how do you construct identify the the individuals? How do you construct language and process around how you can resolve conflict because this is gonna happen all the time and you'll notice that In the four cases we did two of them were family versus healthcare team but two of them were also healthcare team dynamics because we see this all the time and we oftentimes forget about the fact that a lot of our distress in practice comes from Healthcare team interactions and has very little to do with the patients We are up against the end of the session Don Do folks get access to the slides? So this is an interesting case that I had about a patient where there was a hope for a miraculous recovery with two sons who both had a very different perspective on how their their dying mother should be cared for and in this case It was two family members so another wrinkle about whether or not we withdraw life support and it was really about one son feeling like continuing was inconsistent with his mother's values and Withdrawal of life-sustaining therapies would be in his best entry in her best interest while the other son thought it was consistent with their values And had a really strong Spiritual belief system that felt like a miracle was gonna occur and so it really comes down to learning about the patient But also the family's preferences and so just some language when I'm thinking about Family family dynamics is really to turn to each individual family member and and sort of frame it from their perspective so first of all saying I can tell you both care about your mom deeply and neither of you are coming from a place of Anything other than love and compassion? So it's a son one you thought she would not want to be in this condition Tell me more about that and and tell me more about our values into the Sun too It sounds like you're hoping for miraculous recovery and what does a miracle look like to you, which I think is a really valuable phrasing To try to understand and is there anything else that you're hopeful for because sometimes you can hinge on something else like well I want her to get better. I believe she'll get better, but I don't want her to suffer It can be like, okay. Well, let's talk about hope and suffering and miracles, which I think can be really useful. So that's it Thanks for going through the cases with us. I hope this was helpful and We're

healthcare cases

conflicts and resolutions

terminal cancer

end-of-life care

communication

patient outcomes

conflict resolution

healthcare team

patient preferences

professionalism issues