Case Study: Who Should Have Told Her?
Ms. Thompson is a 48-year-old cigarette smoker with late-onset asthma. Her primary care provider (PCP) was managing the asthma with conventional respiratory treatments (e.g., steroids and rescue inhalers). The respiratory therapist observed changes in Ms. Thompson’s breathing pattern. When she asked the patient about these changes, the respiratory therapist uncovered Ms. Thompson was experiencing some pain when taking deep breaths. In consultation with the respiratory therapist, the PCP ordered a chest radiograph and referred Ms. Thompson to a pulmonologist, who found a mass in her lower right lung on the radiographs and confirmed the presence of a tumor with magnetic resonance imaging (MRI). The pulmonologist referred Ms. Thompson to an oncologist, who performed a biopsy and recommended treating the tumor with chemotherapy. From this point on, the lung cancer treatment was managed by the oncologist. In a follow up 6 months later, the PCP thinks the patient’s condition is worsening; the respiratory therapist’s progress notes seem to reflect the same concern. The PCP asks Ms. Thompson to see the pulmonologist. During her appointment with the pulmonologist, she finds a report in the chart from the oncologist indicating Ms. Thompson’s tumor has grown and spread to the liver. The pulmonologist asks Ms. Thompson, “What other treatment is the oncologist recommending for you next?” Ms. Thompson responds, “Why would I need another treatment? I am doing well with the chemotherapy.” The pulmonologist responds, “You are not doing well. Your cancer has spread to the liver. The chemotherapy is not working.” Ms. Thompson yelled, “Nobody told me that!” The pulmonologist thought to herself, “Someone needs to tell her she is dying.”
Discussion Questions
- Identify the communication problem(s) in this case.
- Who should be responsible for letting the patient know she is dying? What is the ethical responsibility of everyone in the team?
- What could have been done differently to improve the outcome in this case?
