An elderly widower considering starting a new family (full video)

Background  (116-030-07-0) Ted and Sivan

The patient, a professor of history was born in 1949 as the only child of holocaust survivors. His father’s first wife and their son did not survive the war and the patient has lived his whole life in the shadow of that half-brother. The patient and his wife had no children and his wife passed away ten years ago.

The patient has been in good health but recently had a few attacks of atypical chest pain for which he was extensively investigated and found to be free of any cardiac disease.

He has scheduled this visit to share the results of his cardiac tests with his family doctor and to discuss a plan for his future care.   He also reveals to the doctor that he plans soon to marry a younger woman from work, and then asks if in the doctor’s opinion he is healthy enough, at the age of 69, to have a child with his new wife- something that he wants very badly both in order to experience fatherhood and to provide his dead parents with a continuation of their line.

The action

The good rapport between the doctor and patient is evident throughout the interview.

She gives enough space in the intro to allow him to share some personal background as a historian of the Holocaust and a second generation survivor.

The doctor deals appropriately and efficiently with the cardiac issue and shows warmth and empathy in dealing with his stated desire to start a new family. On the issue of the marriage she is supportive but on having a child she is more restrained, offering him some ideas to think about.

Educational opportunities
  • Discuss, with specific examples, how the doctor manages to follow the standard format of the consultation by identifying the milestones the handing-over and safety-netting.Counseling:  You might discuss what the patient was asking the doctor in revealing his plans?

    What should have been her role, and did she respond appropriately? How and why did her responses differ in regard to marriage and fatherhood at his age?

    Where might she have used “reflection” [to what cues?] and to what purpose [for example “connecting” and helping him understand his own motivation better thus helping him choose an action on his own.]

    How is counseling different than a giving advice?

    Connecting: Can you identify what it is that allows her to connect so well with this patient?

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