Common scenarios that you will face at the hospital

- A 24-week pregnant presented to your office for her monthly pregnancy follow up. Your
office was full of patients. The pregnant patient has been waiting for 30 minutes now
and you as a doctor were busy with an urgent case that required an admission. The lady
started screaming at the nurse about the waiting time and that the doctor should be
always on time. After you finished with that urgent case, you are free now to go and
examine that pregnant patient. What should you tell the patient and how?

Zabbetha b tareegtak al case, al mohem enu the doctor should say sorry for the delay and start
the conversation by how the patient is doing. “I am so sorry for letting you wait; how can I help
you today?”
never ever explain why the delay happened.

- Breaking bad news (one of my favorite cases)

A 65-year-old male presented to your clinic to update him with the results of his colon
biopsy. The patient has a long-term constipation and he is having a fatigue all the time. His
biopsy results and the following workup confirmed stage 4 colon CA. the patient doesn’t
know about the diagnosis and he has his 33-year-old son with him. How should you break
the bad news to the patient?
SPIKES
S: setting and starting the convo, lazem tjahez setting mratab tga3ed feeh al mareed, ykoon
makan private, makan moreeh, fi tissue if he needed to cry, fi privacy mafi hada besma3 w
bedal yodkhol w yetla3 w mn hal haki
P: perception, tshoof shu wade3 al zalameh, what is he expecting, ya abu mohmmad kefak
al yoom shu akhbarak, keef al se77a, inta 3aref enu kan m3k long trem constipation w
sawaina fhosat w mn hal haki. W ihna al yoom bl 3eyadeh 3shan nehki bl nata2ej w shu plan
al 3elaj inshallah. Habeb hada ykoon m3k mn wladak? Habeb hada mn 3ailtak ykoon m3k
3shan nehki bl results?
I: invitation, hoon btbalesh tehkeelo enu inta ya abu mohammad 3aref shu m3k? aw habeb
te3raf shu al tashkhees? L2nu fi patients behkoolak la ya doctor msh habeb a3raf khalas inta
3alejni b ele bdk eyah
K: knowledge, in small pieces, ballesh ihki lal zalameh shu m3o, “abu mohammad bsaraha
ihna tel3at nateejet al khaz3a w lel asaf al nateejeh msh mneeha, tele3 m3ana bl nateejeh
enu fi cancer bl colon (Stop for 10 seconds here to make the patient process the news),
hoon moomken yebki, yensadem, ysarekh, deny the facts, momken kolshi yseer m3k al
patient. W had mjahzeenlo ihna mn al setting bs jebna al tissue w hatainah b makan mneeh
E: emotions, let the patient express his emotions about the case
S: strategy and summary, bnhki hoon 3n plan al 3laj w 3n summary kolshi hakainah

Saraha breaking bad news is a skill that everyone here should learn it well. Spikes heye al
tareega ele kol al professional world bestakhdemha (3nnna bekhalo kol al ordon te3raf ela
al mareed, aw behko lal mareed 3l mashi enu 3ndo cancer).
 - DNR
One of the most interesting cases to encounter is DO NOT RESUSCITATE case.
Many terminally ill patient write their direct wish (wertheh, waseyeh, shu bdo yseer bs
ymoot w mn hal haki), and DNR is one of the things that should be discussed with the
patient and his family if the patient is lacking capacitance (if he is in a coma or doesn’t
understand well what’s going on or has a dementia).

79-year-old terminally ill patient is at the ICU. His GCS has been declining for the past couple
of days. The medical team is expecting the patient to get into a cardiac arrest in a couple of
hours. The patient has expressed his feelings many times about DNR and has signed a
document stating that he doesn’t want any resuscitation measures and wants to die in
peace. After a couple of hours, the ECG of the patient showed that the patient heart is
deteriorating, and the oxygen saturation has begun to drop. Intubation and cardiac
intervention is indicated to save his life. The patient’s sons are screaming at the medical
team to do something to save the patient’s life. What should you do as the chief resident?

Hoon lazem nrod 3l patient wish as he documented that he doesn’t want resuscitation,
explain to the family that we should respect the patient wishes.

- Doctor-patient relationship:
A 36-year-old woman with well-controlled asthma and hypothyroidism comes to the
office to review recent thyroid function tests with her primary care physician.  She has
been his patient for the past 8 years.  During the visit, she mentions that she is recently
divorced and has had difficulty meeting "smart and interesting" men.  The patient,
noticing the physician is not wearing a wedding ring, asks if he is single.  The physician
responds, "Yes, why do you ask?"  The patient replies that she was wondering whether
he would consider going out for dinner now that they are both single.  The physician has
always found the patient attractive and would like to accept the invitation.  Which of the
following is the most appropriate response to the patient's request?

 A. Accept the invitation as it was the patient, not the physician, who initiated it
 B. Accept the invitation as the romantic interest is mutual
Accept the invitation but suggest that the patient change providers if she is uncomfortable
 C.
continuing under his care
 D. Decline the invitation, explaining that going on a date with her would be unethical
 E. Decline the invitation, explaining that it is inappropriate for the patient to ask for a date
 F. Decline the invitation, explaining that the physician-patient relationship must be
terminated before going on a date

A romantic or sexual relationship between a physician and a current patient (as in this

scenario) is always considered unethical due to potential exploitation and/or interference
with the physician's objective clinical judgment.  Such a relationship may be ethically
acceptable provided the physician-patient relationship is terminated well before initiating a
personal relationship.  However, it would also be inappropriate to suggest termination of
the physician-patient relationship solely for the purposes of dating, as physician-patient
continuity is associated with better patient outcomes; furthermore, the patient should not
be forced to choose between having the physician be a treatment provider or a romantic
partner