Physicians
Investigate, diagnose and treat complex medical conditions chiefly concerning internal human disorders and diseases using specialist testing, diagnostic and medical techniques, and provide medical input into managing public health issues and infectious disease outbreaks and control measures.
Ward round in the older persons' unit
You are a physician who specialises in the care of older people, leading a ward round with a junior doctor, a nurse and the patients' families. It is 8am. You have twelve patients to see, a bed manager waiting for a call, and a family meeting booked at eleven. Some of the decisions today will not be easy.
Choose what you would do. Then see what happens. There are often good reasons for each choice.
I want every test done for my mother. She's eighty-nine and she's tired, but I can't bear to think we missed something. She says she's had enough, but she isn't thinking clearly. Please do everything.
Order the tests the daughter asks for, since she is the one speaking up
Your patient is wheeled to test after test, exhausted, in order to calm her daughter's worry. The results change nothing and she is more tired and unhappy.
Speak with the patient first, then the daughter, about which tests would change the plan
Your patient says she wants to be comfortable and at home. The daughter, hearing her mother in her own words, cries and agrees. You plan care that fits what she wants.
Tell the daughter the patient has the right to decide, and move on to the next bed on the round
You are right in principle, but the daughter feels dismissed. She doesn't hear her mother's wishes, only your refusal, and she raises a complaint.
Mr Kelly's family keeps asking me when he can go home. His results look okay, but he seems more confused than yesterday. I don't want to hold up the bed. Do you think it's fine to discharge him?
Say it's fine to discharge, since the results are okay and the family and the bed manager are asking
The results looked fine, but a new confusion needs explaining. He returns two days later more unwell, and the readmission is harder for everyone.
Go and see him together, work out why he is more confused, then decide on discharge
You find a new problem that has been missed, and treat it. Dr Pham learns to look at the patient and not just the numbers. He goes home safely three days later.
Tell him that it's his decision and he should do what he thinks is best
He isn't confident enough to make the call alone, and he discharges the patient to ease the pressure. It's a hard lesson for both of you.
We have six people in emergency waiting for a bed upstairs. Can you tell me which of your patients could leave today? I need names. I know it's not easy, but we're desperate.
Go through each patient with her and say who is safe to leave today, who needs a day, and who needs more time
She gets a realistic list, with reasons. It takes a few minutes of your round, but the beds move in a way that's safe.
Tell her that you can't release anyone until the full round is done
You protect the round, but the emergency department waits longer than it needed to. A partial answer early would have helped.
Give her the names of the three most likely to go, so the pressure comes off
One of the three isn't safe to go without support in place. He leaves in a hurry and is back in a week.
How it went
The ward round runs late, and the family meeting goes well. A physician who cares for older people has to combine medical judgement with careful listening, and weigh up what a person wants against what their family fears. Would you be comfortable guiding those conversations?
This is a simplified, fictional situation to help you explore. It is not professional instruction or a test of your ability.
Case study: Going home to the house with the stairs
A fictional case set in a hospital ward and outpatient clinic where specialist physicians see older adults.
The situation
Dr Amara Eze was a geriatrician, a specialist physician who cares for older people. Mr Hoang, eighty-six, had been in hospital for two weeks after an illness, and he was ready to leave. He wanted to go home to his own house, which had steep stairs. His two adult children disagreed. His son wanted him in a residential home. His daughter wanted him to move in with her. Mr Hoang sat between them, tired, and said very little. The ward needed the bed, and a decision was expected by Friday.
What they did
Dr Eze asked to speak to Mr Hoang on his own first. She asked what mattered to him most and what he was afraid of. He said he wanted to be near his garden and his neighbours, and did not want to be a burden. She then brought the family together and shared what he had said. She asked the therapist and the social worker to assess the house, and explained to the family that there was an option in between, which was to go home with support and a trial period. She was open about the risks of each choice.
How it turned out
Mr Hoang went home with a few visits each week and a review in a month. His son was not fully comfortable but agreed to try. Dr Eze said the decision belonged to Mr Hoang, and that her job was to make sure everyone could hear what he wanted.
What would you do?
- Why did Dr Eze speak to Mr Hoang on his own first?
- How would you feel if your family made decisions about where you should live?
- What are some things that matter to a person besides being safe?