- 58-yr old man
- Lorry driver, background hypertension
- Father to 2 children (19, 21)
- Woke up with dense left-sided weakness, neglect and homonynous hemianopia (signs of large right-brain stroke)
- CT Brain scan – showing large area of infarcted tissue with no swelling yet.
- You are worried that he may die in the next 24 hours. It is possible that he may require a hemicraniectomy
- He is very unwell and there is a possibility that he might die
- It is possible that an operation may be required- this may allow him to survive, but it is likely that he will be left with severe disability
Key points to address:
- He is very unwell and may die whatever happens
- He may need an operation that may stop him from dying but leave him severely disabled
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Video notes
0:54 The clinician is acknowledging the wife’s distress here.
1:04 Note the pause here to allow the wife to consider what has been said.
2:10 Note the empathy communicated here by the doctor saying “I am worried about him.”
3:03 Note that although the doctor has communicated the possibility that this man is unwell and might die, he also emphasises that the team is going to do everything possible for him – so offering his wife some hope.
4:39 Rather than saying he could be disabled (which could be interpreted as a range of disability), the doctor has painted a clear picture of what this might mean in practice.
5:21 Note the doctor is not asking the wife to make a decision here but trying to explore what the person would want if he could express his views.
7:18 It is helpful to remind Mrs Jones of your name. It is easy for relatives to forget this even though the doctor has introduced himself at the start of the conversation. This avoids the need for families to say “And what did you say your name was?” at the end of the conversation. Note there is a clear plan for reviewing this man and for speaking to his wife again. This can be reassuring when relatives are stressed. They may not remember everything that has been said but they will remember how they were treated and how they felt when speaking to staff.
- The key goal is to discuss the possible need for hemicraniectomy. In younger patients with extensive middle cerebral artery territory infarction, it is sensible to raise the possible need for hemicraniectomy at an early stage and explore what the patient’s views would be if he/she could express them.
- Note the open stance, leaning forward whilst talking to the patient’s wife, unhurried in his manner and maintains eye contact throughout.
Page last reviewed: 16 Jan 2023
