Case Study: Looking at Patients Through Different Lenses
Moya Potter is an 81-year-old woman who lives alone in her single-story home since the sudden death of her husband 2 years ago. She has an adult daughter living nearby and remains independent and self-sufficient; she still drives her car and maintains control of her financial affairs. Her daughter noticed that she was becoming forgetful about recent events and seemed confused at times. In addition, Mrs. Potter began complaining about headaches and worsening vision. The day that Mrs. Potter repeated the same story to her daughter four times, her daughter became alarmed and called Mrs. Potter’s primary care physician.
Five days ago, Mrs. Potter was hospitalized related to her worsening vision, cognitive changes (e.g., forgetfulness, repetitiveness, and periods of confusion), and headache. During her hospitalization, she was diagnosed with metastatic brain cancer secondary to previously undiagnosed lung cancer. In addition to a small brain mass, Mrs. Potter showed evidence of having had several strokes that had resulted in changes to her visual field. It was believed that the strokes were related to the intermittent presence of a cardiac arrhythmia known as atrial fibrillation; an injectable anticoagulant was ordered by a cardiologist as a preventive measure. Mrs. Potter’s prognosis was guarded at best. Cancer treatment options were discussed with Mrs. Potter and her daughter by the medical oncologist and the radiation oncologist; Mrs. Potter agreed to “try” radiation therapy, followed by chemotherapy.
In the opinion of her radiation oncologist, Mrs. Potter could be discharged to her home after her first radiation treatment, which was scheduled for the next day. The oncologist trusted her family to manage her transportation to the cancer center for outpatient treatments and follow-up. In the opinion of her primary care provider (an internist), with medications for management of her chronic conditions (atrial fibrillation and hypertension) and an appointment for a follow-up visit, she could be discharged the next day if a family member could administer her injectable anticoagulant. In the opinion of the physical therapist who evaluated her, Mrs. Potter’s functional status was ambulatory with a walker for safety and stability. No follow-up physical therapy was required.
Megan Miller, the nurse caring for Mrs. Potter, is concerned about discharging her too quickly. She approached the internist with her concerns: “Mrs. Potter lives alone and I’m not sure any arrangements have been made for how she will be cared for after discharge. Her daughter works full time and hasn’t been in to visit very much. I don’t know how involved her daughter can be in her care. Mrs. Potter is not able to care for herself and is unable to complete any of her activities of daily living independently since her vision is so severely compromised. I’m worried about us discharging her without a comprehensive plan in place.”
Discussion Questions
- This case study demonstrates how healthcare providers view an individual patient in their care from their own professional perspectives. Each provider has his or her own way of seeing and treating patients, looking through his or her specific “professional lens.” This lens is colored by the specific profession, specialty, experience, and background; it often leads individuals to pay attention to specific patient issues that others may not notice. Their perspective influences how they approach problems. For example, the physician might assess a patient through a clinical lens, focusing on whether the patient meets the clinical criteria for discharge, whereas the nurse or social worker might see the patient through a personal or social lens, considering the patient’s broader support system at home. Each way of seeing a particular issue is important; it is crucial that providers communicate and consider one another’s perspectives when working together to meet specific care needs and planning effective, robust, and safe treatment approaches. Identify the individual perspective of each healthcare provider mentioned in this case study related to Mrs. Potter’s discharge readiness.
- Identify communication tools and methods that could have been used by the interprofessional team throughout Mrs. Potter’s care experience to facilitate team discussions and interactions about her readiness for discharge.
- Considering time constraints of individual team members, explain in which ways efficient communication could have been promoted within the team (i.e., in person, electronically, in a group meeting, in pairs, formally, informally).
- How could you (as one professional on the team) use active listening to encourage the ideas and opinions of other team members to make better decisions during patient care?
