Psych
Case
After you interview an 18 YO female about her history of depressive symptoms, you and your attending come to the conclusion that she meets the criteria for Major Depressive Disorder. You recommend starting therapy and an SSRI, but she expresses that her parents do not approve of her starting either. Her parents have expressed that, in their culture, mental health matters should be dealt with within the family, and do not need medication. The patient wants the recommended treatment, but would not feel comfortable starting a medication and therapy without their parents knowing.
Discussion Questions: Applying the LEAD Model
Use critical thinking and patient-centeredness to consider the following:
Emotional intelligence: How would you summarize the main concerns of the patient and the patient’s family? What would be the risks for the patient if they proceeded with therapy and SSRIs?
Teamwork: How would you approach decision-making and planning with the patient to ensure she feels empowered moving forward?
Integrity: Discuss how the patient could navigate staying true to their desires (starting treatment) while staying true to their values (openness with family and connection to culture).
Selfless Service: How can a medical student in this situation show respect for her family’s cultural beliefs if the medical student disagrees with them?
Internal Medicine
Case
You are a MS2 on Gen Med 1 caring for Mr. Wayne. Mr. Wayne is a 53 yo M from rural Alabama who has been hospitalized repeatedly for therapeutic large volume paracentesis and has recently had a bout of SBP. He has cirrhosis that has progressed to liver failure and is being seen by the transplant team for consideration of a liver transplant. However, during this hospital stay, the transplant team has decided that he is not a good candidate for transplant due to his comorbidities, which include ESRD. The team thinks that he likely has less than a year to live. The transplant team has briefly discussed this with Mr. Wayne, but you are tasked with broaching this conversation with him in more detail.
Discussion Questions: Applying the LEAD Model
How do you approach this conversation with Mr. Wayne? What are the most important things you can do? What strategies will you use?
What socioeconomic factors may have played into Mr. Wayne’s condition? Do you think something like this is more or less likely to happen for a patient living in the Triangle?
Mr. Wayne’s progression to ESRD likely could have been prevented or delayed if caught earlier. Do you bring this up with him in your discussion? How do you approach this if you do?
Are there other care teams you want to involve in this conversation? Who should be present?
Family Medicine
Case
You (a second year medical student) are in the Family Medicine Clinic today. You enter a patient room to begin a history and physical exam on CS, a 67 year old Korean War Veteran. He is here today to follow up on his hypertension. His prior visit was with a Nurse Practitioner in the group. When you ask him how he’s been since his last visit 2 months ago he states, “I’m fine, but those pills that chink doctor gave me are making me feel terrible. I don’t like them and I don’t trust her”.
Discussion Questions: Applying the LEAD Model
Considering the principles of integrity and respect, what are some ways you could respond in this scenario?
What kind of emotional response does this interaction invoke, and how should we precede?
Are there actions you think the clinic/practice should take?
How might this change or bias the way we treat this patient?
Neurology
Case
You are rounding in the Neuro ICU with a team of fellows, residents, attendings, and nurses. The first patient you see that morning is a 25 y.o. Male (Mr. Short) who was admitted for TBI complicated by elevated intracranial pressure after a car accident. As the team goes through his medical problems by system using a lot of medical jargon, you notice a woman who is likely his mother come up and start to listen to rounds. She looks confused and increasingly distraught; however, the team does not notice her standing there for a while until she finally interrupts to ask the team to explain what is going on to her.
Discussion Questions: Applying the LEAD Model
Consider how you would have responded to Mrs. Short in this circumstance?
How would you have interacted with her as you noticed her approach the team and become increasingly upset?
What would have been the ideal way to handle a situation like this?
How would you (if at all) talked with the team about this incident afterwards?
OBGYN
Case
You are currently tending to an obstetrics and gynecology clinic in the inner city of Baltimore, MD. A 17 year old female is in your clinic today to discuss her recent pap smear results and contraceptive options. When you enter the room you observe a young African American female who appears much older than her stated age. She is scantily clad wearing high heels and is actively scrolling on her phone. You introduce yourself and begin your standard line of inquires (what brings you in today? Etc. etc.). Your Attending joins you shortly after you begin. The patient tells you and your Attending that she is visiting today for a follow-up secondary to an abnormal Pap smear and to discuss contraceptive options. The patient had had an abnormal pap smear of HSIL two weeks prior and you know, after having read her medical records that she is G4P0 4 dilation and curettage procedures since the age of 13. After discussing the Pap smear results, you begin to discuss contraceptive options, however, no sooner do you begin speaking does the patient stops you and says “I am not interested in anything that is going to make me fat!”
Discussion Questions: Applying the LEAD Model
How would you approach this encounter with the patient?
What emotions might this is bring up for you as a provider?
What is the ultimate goal of the encounter?
What barriers exist between you and the patient that may complicate this visit?