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TEACH 2013 Track 1

A 63-year-old Jewish female presents to the emergency department with sudden palpitations. Her daughter reports previous occurrences that were unresponsive to medication, urging for electrical cardioversion so the patient can attend her grandson’s Bar Mitzvah. The patient expresses urgency and frustration with traditional treatments. This case highlights the differing perspectives of the patient, family, and medical staff regarding appropriate care decisions. Employing the PACT tool can facilitate understanding and collaboration among all parties to effectively address the patient’s needs while adhering to medical standards.

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TEACH 2013 Track 1

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  1. TEACH 2013Track 1 Problem Delineation

  2. CASE • 63 year old Jewish female brought to ED by family for sudden onset palpitations. • Daughter states this has happened before, medications did not work, and patient needed to be “shocked”. • PMH: HTN; no structural heart disease • Afebrile, HR 140-160, BP stable, RR 15, SpO2 97% RA • Normal mental status • Tachycardic, irregularly irregular • Lungs clear, no JVD • No peripheral edema

  3. CASE • Patient and family want her to be electrically cardioverted and discharged from the ER in order to attend grandson’s Bar Mitsvah.

  4. Perspectives “I don’t want to miss the Bar Mitsvah. Medications seem to be a waste of time. Shock me so I can go home.” “Hospital practice is to admit. Do I prioritize rate or rhythm control? Which drug should I use?” “Why can’t we just do what the family wants?”

  5. What’s happening? • The patient, her family, medical and nursing staff have different understandings of the problem. • Under time pressures, clinical approaches may not always reflect due consideration of the different perspectives. • When this happens, information skills may serve to inform care decisions that fail to adequately address patient’s concerns and interests • The PACT tool is a vehicle for systematically considering different perspectives in the course of delineating a clinical problem.

  6. PACT • Define the following perspectives at play: • Patient perspectives • Practitioner perspectives • Within these perspectives, consider how much emphasis is on issues of: • Therpy • Diagnosis • Prognosis • Harm

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