The Internal Enemy

If you know the enemy and know yourself, you should not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory you will also suffer a defeat. If you know neither the enemy nor yourself, you will lose all battles...

Sun Tzu: The Art of War, 4th century BC

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

Anticancerweb 1(12), 2018

Ruth's Clinical Report

(Fictional narrative)*

Summary of the Story

Ruth, a 35-year-old divorcee and mother of two young daughters is suddenly diagnosed with breast cancer. She is a high school teacher whose natural inquisitive behavior will help her better understand the disease and all the treatment options. The story demonstrates how an empathetic relationship with the physician stimulates the patient's independent thinking while strengthening her coping skills.

Emotional Flow

Overview of the emotional flow and decisive moments in the care of a very questioning lady. The case shows the importance of cognitive approach in clinical practice. Here you will find the plot segmentation, describing how the doctor coped with the challenges presented by Ruth's clinical case. The exposition (PLOT 1) took place at the physician’s office during Ruth’s first appointment. The physician’s approachable attitude was responsible for the first turning point. The rising action (PLOT 2) revealed Ruth’s inquisitive behavior, asking for more information about cancer. The conflict (PLOT 3) was expressed by Ruth’s difficulties in coping with unexpected treatment-related toxicities and the changes in her body that were affecting her self-esteem. The climax (PLOT 4) was reached when the physician consensus-building attitude brought us to the second turning point, engaging Ruth in a shared decision-making process. In the falling action (PLOT 5) Ruth had already built up her coping mechanisms with the internal enemy and was able to face more complex challenges, seeking genetic counseling to better understand the risk that her daughters might face the same problem in the future. The resolution (PLOT 6) was presented by the storyteller in a comprehensive biopsychosocial approach.

Illustration

The graph presented below is a simplified depiction of the story 1 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 status, with the larger inflections representing each of the major “turning points”.

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

 Authors Info & Affiliations:

 James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil (www.jamesfleck.com)

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

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