You are a doctor on the ward. Mrs Smith is 55 years old and has smoked for most of her life. She is widowed and lives alone. She has recently become increasingly frail. She was admitted with a suspected chest infection but has had a chest X-ray that is highly suggestive of a lung cancer in the peripheral lung field. She needs investigations to determine further management.
You have been told by the nursing staff that her son has said that he does not want his mother to know the diagnosis. He has also said that he does not want his mother to have any more investigations or treatment, but to be kept comfortable. Discuss and address the patient’s concerns.
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The ideal candidate will: • be empathetic to the son, but clear that he cannot deny his mother the opportunity of being informed of the diagnosis • inform the son of management steps, including scans and bronchoscopy, and explain consent • recognise their limit in dealing with a problem and know when, and from where, to seek further advice and support • explain informed consent and the legal requirement of this.
This is a scenario of talking to a relative about his mother’s potential diagnosis of lung cancer and the need to consider further investigation and potential treatment. There is an issue of confidentiality to consider here. Whilst the patient initially states he does not want his mother told about the diagnosis, equally, she may not want her son involved. The candidate shows good empathy towards the son’s experience with his father’s care, but perhaps this could have been explored a little more to understand the background of his anxieties.
The candidate, however, does offer that his mother maybe in a totally different position and could potentially be eligible for curative treatment which we will only know if she agrees to investigations.
It is rightly explained that the candidate’s duty of care lies with the patient, and he clearly states this is his legal duty. He advocates joint decision-making with the son involved but acknowledges his mother’s right to refuse any further investigations if she has the capacity to do so. A summary action plan is made, and agreement in this is offered to the son which will enable the scenario to move forward in real life.
Relatives disagree - examiner roleplay.pdf