Beyond winning: mediation, conflict resolution, and non-rational sources of conflict in the ICU
1 Standardized Patient Program, Faculty of Medicine, University of Toronto, 88 College Street, Toronto, ON M5G 1L4, Canada
2 Divisions of Critical Care/Respirology and Palliative Care, University Health Network, 200 Elizabeth St 9N-926, Toronto, ON, M5G 2C4, Canada
3 University Health Network, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada
Critical Care 2012, 16:308 doi:10.1186/CC11141Published: 19 June 2012
A 55-year-old woman with widely metastatic breast cancer was admitted to your intensive care unit (ICU) because of a decreased level of consciousness and respiratory failure. She had documented cerebral and meningeal metastases that were progressing despite chemotherapy and radiotherapy. The admitting physician met with her family and suggested a palliative approach, making them very upset. The family insisted that the team 'do everything' and now they refuse to discuss any change in the plan of treatment. They maintain a constant presence at the bedside, taking notes and questioning everyone who enters the room. They have threatened legal action toward several of the nursing staff, and hospital security has been called twice because of shouting matches between family and staff members. As the physician taking over care for the ICU, you would like to resolve this conflict.