Illustrative Cases

Illustrative cases (Radiation Therapy):

These cases are intended to start conversations about professionalism in the workplace, classroom, or clinical space. They are examples of situations that many of us may find ourselves in, or identify with, in some way. They can be used as stems for educational conversations about professionalism, in one-on-one sessions or group settings. The goal is not to find the 'perfect solution', but rather, to be aware of the nuances at play, and to become aware of each person's perspective, in order to make the best decision, for that moment in time.

1A. Commitment to Patients: Student
"Her story is just so sad, I need to talk to someone about it…"

It has been a long week on the treatment floor. You and your fellow radiation therapy students head out after work to decompress. While there, one of your peers tells the story of a 30-year old patient who is on treatment for glioblastoma multiforme, which was discovered while she was pregnant. The patient has a very poor prognosis, and her baby is in NICU having been purposefully delivered early so the patient could begin treatment.

Guiding questions:
How is the confidentiality of the patients threatened?
What sort of support can peers provide in this situation?
How do time and place affect the appropriateness of this student's storytelling?
What is the role of storytelling in gaining social support in the workplace?
How could the student cope with this sad situation in a more professional manner?

1B. Commitment to the Patients: Faculty
"I'm just too busy right now to find another option…"

You are in the midst of midterm performance evaluations, organizing a conference with your professional association, and finishing a paper with a colleague. Your car doesn't start that morning, and you arrive to the clinic late, feeling guilty that you've missed a meeting with one of your students and unsure when you will be able to reschedule. While walking to the treatment floor to find her, you run into a former patient who is in clinic for follow-up. You remember that this patient owns a garage, and you stop to ask him for advice on what you should do with your vehicle. He tells you that he's "cancer-free" and offers to fix your vehicle as a thank-you for the care you gave him while he was on treatment.

Guiding questions:
Does it make a difference if the car repair is free, or if the patient charges for it?
Why does that make it different?
How could you respond to this situation in the most professional manner?

2A. Commitment to Society: (Student)
"Is it SO wrong to help a family friend?"

You are a radiation therapy student. A good family friend, a busy family doctor, has recently been diagnosed with an early lung cancer which has been deemed inoperable and she requires a course of radiation therapy. She has been given an initial CT simulation date of 4 weeks from now. Over dinner with your parents, this close family friend mentions her anxiety at having to wait for 4 weeks. Your mother says "Maybe you can get her CT simulation appointment bumped up . . . could you do that, dear?".

Guiding questions:
Is it 'alright' to bump up someone's appointment, like this? What circumstances might make it okay? Is it never okay?
What might be the impact on others (eg patients, other radiation therapists, yourself) of such an action?
Do you have any strategies for managing/addressing the expectations of family and friends?

2B. Commitment to Society: (Faculty)
"But if she can't work, it is bad for her patients…"

You are a radiation therapist. Your good friend, a busy family doctor, has recently been diagnosed with an early lung cancer which has been deemed inoperable and she requires a course of radiation therapy. She has been given an initial CT simulation date of 4 weeks from now. Over dinner, your friend mentions her anxiety at having to wait for 4 weeks. You think "Maybe I can get her CT simulation appointment bumped up . . . after all, her anxiety could impact her dealings with her patients".

Guiding questions:
Is it 'alright' to bump up someone's appointment, like this? What circumstances might make it okay? Is it never okay?
What might be the impact on others (eg patients, other radiation therapists, yourself) of such an action?

3A. Commitment to the Profession: Student
"Wow. That was so inappropriate. What do I say?"

It is the end of yet another LONG teaching session! As is often the case, student Jaime has left 30 minutes early…leaving you feeling a little envious! As the remaining attendees exit, you, the teacher, and the divisional administrative assistant are left in the room.
Your teacher launches into a 5 minute rant, directed at you, about how inappropriate student Jaime' behaviour is, and how unprofessional it is that he routinely arrives late and leaves early. He then turns to the admin assistant and says "Isn't that BS? I mean, seriously, we all have to show up."

Guiding questions:
What questions might you want to ask Jaime?
How might you express your discomfort to the preceptor? Would you express it, at all?

3B. Commitment to Profession: Faculty
"You're basically a therapist. Go ahead and do it."

It's your last week of clinical practicum before graduation. You have been working on the same treatment unit for four weeks and know the patients very well. The workload is demanding and the radiation therapists are short-staffed on the unit today. You have sat down to operate the console, an activity you still require direct supervision for by both therapists. However, one of the two therapists on the unit is distracted by an irate patient at the counter who is demanding to be seen by an oncologist. The other therapist verifies the treatment parameters with you, and says, "Go ahead and treat, it's fine. You're going to be one of us next week anyway."

Guiding questions:
Have you been in a situation like this before? How did you respond then?
What is the Health Professions Act, and how does it regulate scope of practice?


4A. Commitment to Self: Student
"I really want to support my scared patient, but my family misses me…"

You are on a treatment unit responsible for delivering treatment and care to a 14 year old patient. She began treatment on Monday, and is now scheduled to have treatment over the weekend in an effort to slow the growth of her aggressive sarcoma. The patient does not speak much, and you are concerned that she may be fearful and untrusting of the treatment team because of past negative experiences.
On Friday afternoon you are explaining to her and her parents that there is treatment scheduled Saturday and Sunday mornings. You have an on-call therapist come to the treatment unit to meet them, to try to ease the transition for the patient to the weekend treatment team. The patient begins to cry openly in the waiting room, saying, "I don't want different people, only you." The parents look at you pleadingly, waiting for you to say something first.
Your weekend plans included a hike in the Rockies with a friend you haven't seen in six weeks due to conflicting schedules. You have arranged to leave at 7am Saturday morning.

Guiding questions:
How would you want to respond in this situation?
What do you consider healthy professional boundaries?
What might the impact be to the patient if you choose not to treat her on the weekend?
What is your opinion on the value of work-life harmony? How do you achieve it?

4B. Commitment to Self: Faculty
"It's just dinner. What's the big deal?"

You are a new radiation therapist in Edmonton, and had a very busy day on the unit. There were breakdowns, emergency add-ons, and several difficult cases, and the student on the unit picked up a lot of slack because you are still getting to know the processes and resources to call for these sorts of problems. As you are cleaning up at the end of the day, you offer to take your partner and the student to the restaurant down the street for dinner...your treat. The radiation therapist isn't able to go, but the student can.

Guiding questions:
What considerations are there for determining if this is an appropriate social encounter?
How important do you perceive professional reputation to be?
How could this situation be perceived from an outside view?