Mrs. Gregory Case Study Stuart J. Farber, MD

1. Mrs. Gregory Case Study Stuart J. Farber, MD

2. Case Study: Mrs. Gregory Mrs. Gregory is a 62-year-old woman who has been complaining of increasingly severe upper abdominal pain and weight loss. An ultrasound by Dr. Minor revealed a mass highly suspicious for primary liver cancer. Mrs. Gregory and the youngest of her three daughters, Gloria, have come to your office to discuss the test results. Mrs. Gregory Age 62 Click image to play video clip.

3. Case Study: Mrs. Gregory Effective Responses(Click the response text to play an audio clip) Empathic:I can appreciate that this has been a difficult discussion.Reflective:I'm confused because I just heard you say two different things;That you don't want to hear any more bad news and also thatyou don't think anything is wrong.Open-ended:Could you share with me more about what you arethinking so we can work together?

4. Case Study: Mrs. Gregory Less Effective Responses(Click the response text to play an audio clip) Empathic:I understand how you're feeling.Reflective:You don't seem to have heard what Dr. Minor has just told you.Open-ended:What is it that you don't understand?

5. Case Study: Mrs. Gregory Nonexamples(Click the response text to play an audio clip) Directive:The doctor says that you need to take these pills.Reflective:They are for your pain.Close-ended:You should take these pills every four hours.

6. Case Study: Mrs. Gregory Family-Oriented Responses(Click the response text to play an audio clip) Effective:You look really concerned. How are you doing?I can tell this has been really hard for both of you. What can we do now that would be of help to you?Less Effective:Your family may have a different idea about this.Nonexample:This is your choice to make. We'll do whatever you say.

7. Case Study: Mrs. Gregory Mrs. Gregory continues to deny that anything is wrong with her. Her daughter, Gloria, wants to help her come face-to-face with her liver cancer as well as the issues surrounding her illness. Gloria Click image to play video clip.

8. Case Study: Mrs. Gregory Effective Responses(Click the response text to play an audio clip) Empathic:This must be really hard for you.Reflective:It sounds like you feel caught in the middle.Open-ended:If your mother agrees, what do you think about the possibility of you and your sisters coming in together for a family conference?

9. Case Study: Mrs. Gregory Less Effective Responses(Click the response text to play an audio clip) Empathic:I know just how you feel, my mother died five years ago.Reflective:This is hard for everyone.Open-ended:What do you want us to do?

10. Case Study: Mrs. Gregory Nonexamples(Click the response text to play an audio clip) Empathic:You'll get over it. Reflective:I talked to the doctor and I know he told her about howseriously ill she is and he wants to refer her to hospice.Close-ended:You and your sisters need to sit down and talk.

11. Case Study: Mrs. Gregory Family-Oriented Responses(Click the response text to play an audio clip) Effective:A lot of families find it helpful to come in togetherand discuss these issues.Less Effective:These things will all work out in the end. Maybe your sisters just need more time.Nonexample:If this is a problem, your mother willneed to call us to discuss it.

12. Case Study: Mrs. Gregory Family conference with Mrs. Gregory’s daughters discussing father’s death Click image to play video clip.

13. Case Study: Mrs. Gregory Mrs. Gregory’s Pain Goals Click image to play video clip.

14. Case Study: Mrs. Gregory Daughters debate Mrs. Gregory care – coma Click image to play video clip.