You sit with the patient’s daughter privately and she shares with you some of her recent discussions with medical providers.
“They told me his kidneys are functioning very poorly, and if they worsen anymore he would need dialysis. His heart is also failing, and they said the two make each other worse. The doctors told me all about how dialysis cleans the blood and puts it back into the body, and that patients usually get it three times a week. The doctors said he probably wouldn’t do very well, but some people think it might help him live a bit longer. I’m just not sure what to do.”
How might you respond to the patient’s daughter? There is no perfect way to handle a difficult conversation such as this, but some strategies are better than others!
It seems you have been doing a wonderful job advocating for your father and navigating this difficult situation.
Showing respect for a patient or caregiver is a good way to respond to and validate emotion.
It does seem you know a lot about the topic of dialysis. If it’s alright with you, though, I will give you a bit more information.
Be careful not to go into information-overload. This patient’s daughter feeling “unsure” is likely more an expression of emotion rather than a request for more medical facts.
I don’t want you to worry about this, your father is going to be just fine.
Although it is tempting to tell patients and families that everything will be A-ok, it is important not to provide false reassurance or brush over concerns.
This helps me understand where we are now in this process. Could you tell me more about feeling unsure?
Expressing understanding while not claiming to know everything a patient or caregiver is going through is an important strategy. Exploring her feelings both acknowledges her emotion and may help you find out more.
As the discussion unfolds, she explains that her father, when his dementia was less severe, had said he didn’t want to go through invasive procedures and tests in his old age. She says she tends to think dialysis falls into this category and might reduce the quality of the time he has left.
You listen attentively. Based on this discussion, you ask permission to tell her more about conservative management and to introduce the concept of palliative care.
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Case 14 Index
Case 14 Introduction
Case 14 Physical Exam