GP Stage 3 Simulated Consultation - Relative 12
You are an SHO in Medicine, and Alan Matthews has asked to speak to you about his mother Bernadette, who is nearing end of life. Bernadette was admitted with suspected influenza and has responded poorly to anti-virals and supportive measures. She has an increasing oxygen requirement, and has been deemed unsuitable for high dependency or intensive care admission. Bernadette is an ex-smoker who was otherwise well with no significant past medical history prior to admission.
You are Alan Matthews, the son of Bernadette Matthews who was admitted one week ago with flu. Your mother has deteriorated since admission and it is possible that she may not make it out of hospital. You have arranged a meeting with the doctor to discuss this further. You are emotional and upset by any suggestion that your mum may pass away, especially given that she was extremely well and independent pre-admission with no medical conditions.
As a side point, you would like to know what the doctor intends to write on mum’s discharge/death documentation should this occur. In particular you would like to know if they will be mentioning the fact that Bernadette was an ex-smoker. You feel that this is unnecessary and will tarnish your mother’s reputation unfairly especially given that smoking was not known to be harmful in ‘her day’. On further probing, you also report that Bernadette’s smoking history has not been declared on her life insurance policy, and if this were to be mentioned on the medical documentation, this would likely result in the policy being void.
Personally, you have recently been made redundant and are struggling financially. The thought of losing your mother’s life insurance capital is extremely worrying and causing you to lose sleep. At home, you live with your partner and young child. You are otherwise well with no additional concerns.
This consultation has two main components. The first part involves providing emotional support to an upset relative. This is followed by a challenging conversation regarding the contents of a potential discharge/death notification. Whilst it would be uncommon for smoking to be mentioned on either of these forms, reassuring Mr Matthews that there would be no mention of this would be inappropriate. Further empathetic support regarding Mr Matthew’s social circumstances is important as well as suggesting alternate solutions for example exploring additional funding sources, and potentially mentioning Bernadette’s smoking history to the insurance company as whilst this may reduce the total capital, this would help to ensure that the whole policy is not made void.