Preview of Third Clinical Simulation

Take-home Message

Graphic representation of emotional flow and turning point

(Fictional narrative by the doctor)

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

Anticancerweb 28 (03), 2019

Peter, a young physician with only five years of practice, faced his first ethical dilemma. Ten years earlier, Peter's older brother was kidnapped by a junkie and, although he survived without any physical harm, there was a lot of emotional distress. Peter became very protective of his brother, actively helping him overcome the trauma, which seemed to be over now. 

While working in the ward of a public hospital, Peter met Edgar, a 47-year-old inmate. Edgar was a drug addict who had killed a man during a robbery. Peter realized that Edgar was seriously ill. He had been diagnosed with advanced lung cancer and suffered from Tourette's syndrome since childhood. As a child, Edgar had been a victim of parental abuse, which, in combination with Tourette's syndrome, made him a social outcast. 

Peter was invaded with mixed feelings. Edgar’s history brought back the suffering he faced when his brother was kidnapped. It was impossible for him to not identify Edgar with his brother’s kidnapper. He sought the advice of his senior physician. He wanted to fulfill his duties, but was unable to move on and felt paralyzed by his mixed feelings.

The exposition (PLOT 1) takes place in a jail cell, where Edgar, an inmate, was experiencing such intense pain that he began banging his head against the wall. The raising action (PLOT 2) reveals Peter’s ambivalence in dealing with Edgar’s case brought up by his personal trauma.  The conflict (PLOT 3) was a consequence of Peter's sense of professional duty. The climax (PLOT 4) was reached when Peter had an open discussion with his chief physician about his mixed feelings. After a deep reflection Peter decided take care of Edgar. During the falling action (PLOT 5), Peter committed himself to providing the best care, explaining the interventions and supporting Edgar in shared decision-making. Medicine provided a healing opportunity for both the patient and the physician. The resolution (PLOT 6) will be presented by the storyteller in a comprehensive biopsychosocial approach.

The graph presented below is a simplified depiction of the story 3 emotional flow. At each PLOT element the patient-physician relationship leads to emotions that occur along distinct time intervals (△t). The actions are responsible for the emotional flow, which is unique to each story. The continuous sinuous blue wave represents the protagonists’ changing emotional status, with the larger inflection representing the “turning point”.

To be continued in PLOT 1…

Attention: The story 3 will be 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. 

© 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)