Question

CASE STUDY

Pamela is a patient of Muslim faith, living in Boston MA, with late stage melanoma. She is experiencing a variety of issues that impact her health. When you meet 45 year-old Pamela, she informs you that she is a lesbian and has been in a committed relationship with Elizabeth for 15 years. Pamela and Elizabeth are the primary parents for two children, George who is 20 and Laura who is 18 from Pamela's previous marriage, both whom are living at home with Pam and Elizabeth when they are not in college. Pamela is an owner of a restaurant, very active in her religious community, and enjoyed dancing prior to the onset of her illness. She enjoys walking her Labrador retriever along the Charles River with Elizabeth.

Pamela’s illness has now progressed at a rapid rate and it appears that she is entering into a stage that will require extensive treatment and therapy. Pamela and Elizabeth have discussed together the type of treatment and care that Pamela wants and will agree to. The children strongly disagree with what Pamela and Elizabeth have decided regarding future treatment (to terminate treatment if there is not a positive result within three months and to only receive medication and care that will minimize pain and discomfort in Pamela’s final days.) The children feel that Pamela has been persuaded by Elizabeth to terminate treatment rather than making the decision herself. They do not want Elizabeth to be involved with Pamela's medical care or decisions and are seeking legal help in order to get this accomplished.

It appears that there is not a written medical directive about her wishes and she has not designated her healthcare proxy. Pamela remains aware of the medical issues facing her and appears to be competent to make medical decisions at this time but this could change at any given moment.

Pamela’s case is being discussed by a multidisciplinary team at your hospital. She is currently receiving chemotherapy and radiation therapy to combat the melanoma.

Pamela’s case is being discussed by a multidisciplinary team at your hospital. She is currently receiving chemotherapy and radiation therapy to combat the melanoma. The team consists of a primary care doctor, an oncology physician assistant, a nurse, a physical therapist, a social worker, an occupational therapist, a recreational therapist, exercise physiologist, dietitian, and a psychologist.

PLEASE ANSWER FOR ALL 3 PROFESSIONALS!

dietitian, a recreational therapist, and an exercise physiologist

4) How would you approach these concerns with others on the team?

5) Where could disagreements between your profession and the other professionals arise? How would you handle those disagreements?

6) Describe any additional types of care the patient might need.

Answer 1

(4-). For the best care provided to our patients pramela , we have to concern for another specialist fir another health concern. Interaction between patients and medical practitioner can sometimes be challenging . We have all had consultation where the Interaction was not optimal , either as Medical practitioner or as a patient ourselves . Communication and listening skills are essential for every consultation but in particular , for situation where the Interaction may become difficult.

Concerning with the others doctor helps in finding the best solution of the problem , by which we get least error in the results.we can discuss on the complications and side effects on the particular therpy. Discussing history of the patients , so that individual doctor's experience also gave a huge effort to get best outcome .

(5-) An interpersonal conflict is a disagreement between two oerson or subgroup of an organisation involving significantbitterness and dissatisfaction.Heath care professional , who understands each other's role and can work effectively together , have been shown to provide higher quality care and hence , to achieve desire outcomes in the patient care, it is essential to have good interpersonal relationships in terms of cooperation, collaboration, listen and respect the values or positions of each others. Strong and effective leadership styles are key component to any of tge health care success.

Conflict management is the kind of complex process. Which demands time and energy. The management and the subordinates must be concerned and devoted to resolving conflict among coworkers by being willing to listen and to find accurate solutions.

To overcome interpersonal conflict in the health care setting requries accurate knowledge and skills fir Health care professional to reduce the occurrence of conflicts.

(6-) Treating the last stage of melanoma patient the , as in this stage melanoma is already spread ( metastasised ) to distant lymp nodes or other areas of the body .

The treatment of widespread melanoma has changed in recent years as new forms of immunotherapy and targeted drugs have been shown more effective than the chemotherapy.

Immunotherapy drugs called checkpoint inhibitors such as pembrolizumab or nivolumab .

Immunotherapy by using interleukin -2 ( IL -2 ) can help a small number of people with stage IV melanoma live longer, and it might be tried if immune checkpoint inhibitors aren't working.

In about half of all melanoma , the cancer cells have changes in the BRAF gene . If this gene change is found , treatment with newer targeted therapy , drugs----- typically a combination of aBRAF inhibitors and a MEK inhibitors --- might be agood option.. these melanoma might be helped by targeted drugs such as imatinib and nilotinib , .