Clinical Role

  • How do you gain trust with a family you don’t know and deliver catastrophic information?
  • What are our obligations as we obtain informed consent? The process can seem cruel.
  • How do you break devastating news (e.g., relapse and terminal condition), be there for them, and not let it get to you?
  • How do you make the transition from curative to palliative care?
  • The father wants to do everything, the mother doesn’t – she (patient) is going to die and it’s not going to be pretty. How do I handle this conflict in the family?
  • What if the family takes the stance that they will only work with certain providers?
  • (1st meeting of the academic year) Does anyone else feel stupid?

Research Role

  • I’ve never done any basic research – how do you choose projects? …how do you know what to bet on?
  • The first year was demanding – but rewarding, but now I am going into the lab and I know less than the technicians. How do you make this transition from being a clinician to a researcher?
  • What do you do when your research project is stalled and your mentor appears unconcerned?
  • I don’t think I’m cut out for basic science. If I don’t pursue this, can I still have a worthwhile career in academic medicine?
  • Should we tell families we get money from NCI for enrolling patients?

Academic Role

  • We have discussed how to manage night call. How can we bring these issues forward in the program?
  • It was suggested to me that I bring up the issue that the transplant team has outgrown the one-fellow position. How do you negotiate change from a position of less power?
  • How do you judge and respond to behavior of colleagues that you consider to be, if not strictly unprofessional, unhelpful for the organization and/or morale? Also – how does one address such issues from a position of relatively lower authority?

Personal Role & Professional Boundaries

  • We don’t really hear about how our respective families are reacting to our work. How is this work affecting our families?
  • ...It’s hard to keep a perspective on ...your life. Like, how could my child’s piano recital compare to a child who might die?
  • Do you attend the funerals of patients? ...What are the implications?
  • How do we deal with a family who puts excessive demands on us – a family who expects you to be there all the time?
  • How do you manage the impact of grief on yourself (as a provider) and on your family?

Image credit: Winslow Homer – The Signal of Distress Credit: The Art Renewal Center