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End of Life Online Curriculum - Modules

 

Communication: Breaking Bad News

Common Communication Error:

Time dyssynchrony: Clinic Example 2

 

Dr. Smith is seeing Mrs. Deborah Tanner for routine follow-up. Labs done during last visit reveals a new diagnosis of diabetes. Dr. Smith has noted that Deborah has been losing weight and suspected diabetes. He has already formulated a care plan for her involving further testing, diet, and exercise.

Dr. Smith: “Do you remember we ran some tests on you last month?”

Mrs. Tanner: “Yes.”

Dr. Smith: “Your blood sugar was 344”?

Mrs. Tanner: “344? Is that bad?”

Dr. Smith: “ Yeah! I think you may have diabetes.”

Mrs. Tanner: “Diabetes? But I don’t even like sweets!”

Dr. Smith: “Yeah. I have ordered some other tests.”

Mrs. Tanner: “Does that mean insulin shots for the rest of my life?”

Dr. Smith (hurriedly): “Maybe…. I have ordered a Glucose Tolerance Test and....”

Mrs. Tanner (still in mild shock): “But no one in my family has diabetes.”

 

What was not addressed: “You have a life altering chronic illness. How are you reacting to this?”

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©End of Life Curriculum Project, a joint project of the US Veterans Administration and SUMMIT, Stanford University Medical School.
Funded by a grant to the Veterans Administration Nationwide Palliative Care Network by the National Library of Medicine. VJ Periyakoil, MD, Director.