Looking at Patients Through Different Lenses

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

1. 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.
2. 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.
3. 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).
4. 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?

1. Perspectives of Healthcare Providers:
   • Primary Care Physician (Internist): The primary care physician assesses Mrs. Potter’s readiness for discharge primarily through a clinical lens. They focus on managing her chronic conditions, ensuring medication adherence, and arranging a follow-up visit. The internist may be more inclined to discharge if Mrs. Potter’s clinical conditions are stable.
   • Cardiologist: The cardiologist’s perspective is centered around managing Mrs. Potter’s atrial fibrillation and prescribing the injectable anticoagulant. They may emphasize the need for family involvement in administering this medication to prevent complications.
   • Physical Therapist: The physical therapist evaluates Mrs. Potter’s functional status and safety. They recommend the use of a walker for mobility but do not see the need for ongoing physical therapy. Their perspective is based on Mrs. Potter’s physical capabilities and safety concerns.
   • Radiation Oncologist and Medical Oncologist: Both oncologists focus on the cancer diagnosis and treatment options. They view Mrs. Potter’s discharge readiness in the context of her cancer treatment plan. The radiation oncologist is confident in her ability to receive radiation as an outpatient, while the medical oncologist may consider chemotherapy as part of the discharge plan.
   • Nurse (Megan Miller): The nurse takes a holistic approach, viewing Mrs. Potter through a personal and social lens. She is concerned about Mrs. Potter’s living situation, her daughter’s availability, and her ability to perform activities of daily living independently due to vision impairment. She emphasizes the importance of a comprehensive care plan.

   Each provider’s perspective is valuable, as it addresses different aspects of Mrs. Potter’s health and well-being. Collaboration and communication among these professionals are essential to create a well-rounded discharge plan.

2. Communication Tools and Methods:
   • Interdisciplinary Team Meetings: Regular team meetings where all healthcare providers can discuss Mrs. Potter’s case, share their perspectives, and develop a comprehensive plan for her discharge.
   • Electronic Health Records (EHR): A shared EHR system that allows real-time access to patient information, ensuring that all team members are on the same page regarding Mrs. Potter’s medical history, diagnoses, and treatment plans.
   • Care Conferences: Scheduled conferences involving the patient, family members, and all healthcare providers to discuss treatment options, address concerns, and establish a unified care plan.
   • Shared Online Platforms: Online platforms or collaboration tools that enable secure communication and document sharing among team members, ensuring efficient information exchange.
3. Promoting Efficient Communication:
   • In-Person Meetings: For critical discussions or complex cases, face-to-face meetings can ensure immediate communication and foster better understanding.
   • Electronic Communication: Quick updates or routine information sharing can occur electronically through emails, messaging apps, or EHR systems, allowing team members to stay informed without requiring simultaneous availability.
   • Group Meetings: Group meetings can be efficient for discussing general updates and planning, but individual interactions may be needed for more specific discussions or concerns.
4. Using Active Listening:
   • Demonstrate empathy: Show genuine interest in what other team members are saying and acknowledge their concerns or opinions.
   • Ask clarifying questions: Seek additional information to ensure a clear understanding of their perspective.
   • Avoid interrupting: Allow others to express their thoughts fully before responding.
   • Reflect back: Summarize or paraphrase what others have said to confirm understanding and show that you value their input.
   • Encourage open dialogue: Create a supportive environment where team members feel comfortable sharing their ideas and concerns.
   • Be patient and non-judgmental: Listen without making premature judgments or assumptions, and respect diverse viewpoints.

By actively listening and promoting open communication, healthcare professionals can work together more effectively as a team to provide the best possible care for patients like Mrs. Potter.