Resolution of Third Clinical Simulation

Take-home Message

How to overcome an ethical dilemma

(Fictional narrative by the doctor)

James Fleck, MD, PhD & João A de Andrade, MD

Anticancerweb 12 (05), 2019

Peter, still young, with only five years of practice, faced an ethical dilemma. Initially he tried to avoid confronting his prejudices, but soon he realized that the challenge was part of his training. He sought advice from a more experienced physician and, as an observer, made his own critical judgment. He had transferred to Edgar a resentment he had harbored for years against his brother's aggressor. He would have to overcome that feeling. He realized that Edgar had a very sad childhood. Suffering from Tourette syndrome, he had been mistreated and misunderstood. He tried to take refuge in common hallucinogens and dissociative drugs He committed a violent crime in an altered state of consciousness. He had been tried and convicted. 

Edgar was now suffering from a Pancoast tumor and the chronic pain in his left arm was far exceeding his physical and emotional limits. He was actively seeking help, but his neurological disease led to communication challenges. All his life had been marked by prejudice, so he was not surprised when the characteristic pain associated with a Pancoast tumor was not taken seriously by the attending physician in the prison system. He used self-mutilation so he would be transferred to a public hospital and, hopefully, properly diagnosed. Once he felt that his complaints were validated and tended to, he was able to trust his care team and followed their recommendations.

Peter overcame his conflict and was able to meet the personal and professional challenge represented by caring for a patient that reminded of someone that had caused great pain to him and his family. He avoided becoming a prisoner of his dilemma. His experience caring for Edgar reinforced what he had learned in medical school:  prejudice, indifference, arrogance and fear are incompatible with his chosen profession. 

The practice of Medicine cannot be solely grounded in reason but also in profound affection and respect for those who are suffering. We all share common universal basic values and limitations that are part of our essential human nature. Recognizing and living through these principles are what make the practice of Medicine truly magic.  

The story of Peter and Edgar illustrates how two very different personalities can work together, overcoming differences and joining forces to rescue life!

*      Attention: The story 3 was published sequentially from PLOT 1 to PLOT 6 and you will always see the most recent posting. To read Story 3 from the beginning, just click in the numbered links located at the bottom of the homepage. 

Story 4, “Familial bond” is coming soon … 

© Copyright 2019 Anticancerweb

 James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2019 (Editor)

Joao A. de Andrade, MD: Professor of Medicine and Chief Medical Officer, Vanderbilt Lung Institute, Vanderbilt University Medical Center, Nashville, TN – USA 2019 (Associate Editor)