Story 7: Defense mechanisms

Preview of Seventh Clinical Simulation

Take-home Message

Graphic representation of emotional flow and turning point

(Fictional narrative by the doctor)

James Fleck: Anticancerweb 18 (01), 2021

Clara, a physician and professor of a recognized school of medicine, used to express authoritarian, dominant and rigid behavior. She recently faced a divorce, but kept the children, who were raised under an overprotective dome and became infantilized. Unfortunately, they were not prepared for adulthood and reacted with the expected emotional immaturity when facing maternal illness. Despite being well informed, Clara expressed denial. History shows how the doctor must understand family dynamics and respect patient's defense mechanisms.

The exposition (PLOT 1) took place at the doctor’s office. Surprisingly, it was Clara’s children who came for the first consultation. Despite not having consent, they had looked at their mother's exams and found that she had an ovarian tumor. The rising action (PLOT 2) occurred when Clara agreed to attend the first consultation, just to satisfy the children's appeal. She was not comfortable and expressed denial. The conflict (PLOT 3) occurred after the physical examination, when the doctor explained the findings and the need for surgical intervention. The doctor did not try to modify the denial behavior expressed by Clara, which was responsible for the turning point. Clara was feeling safe and confident and the climax (PLOT 4) was marked by a tacit acceptance of the treatment. In the falling action (PLOT 5) Clara faced her treatment with no major complications and had a chance to reorganized the family dynamics.The resolution (PLOT 6) was presented by the storyteller in a comprehensive biopsychosocial approach.

The graph presented below is a simplified depiction of the story 7 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 oscillating patient’s emotional state, with the larger inflection representing the “turning point”.

*       Attention: The story 7 will be published sequentially from PLOT 1 to PLOT 6 and you will always see the most recent posting. To read Story 7 from the beginning, just click in the numbered links located at the bottom of the homepage. 


© Copyright Anticancerweb 2021

 James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2021