Uncertainty, Decision-Making and Team Work in High-tech Healthcare

The Relational Medicine project is growing. In 2014 we published our practice framework 'Relational Medicine Personalizing Modern Healthcare: The Practice of High-Tech Medicine As A RelationalAct'. Building on this foundation, we now present a cutting-edge and fully developed single case recording analysis of consecutive encounter interactions in a dramatically accelerating life-and-death decision-making situation in the high-tech medical practice of Advanced Heart Failure during which practitioners, patient, and family face multiple uncertainties as the decision-making process unfolds and the patient's condition deteriorates.

We show how a multi-professional team including a cardiologist, cardiac surgeon, critical care unit nurse and fellows discuss life-prolonging options with their patient and family. We make visible the essential roles of each multi-disciplinary team member in helping frame for the patient and family what is going on and the changing options while attending to the patient's PERSON-soul-mind-body-HOOD.

In bringing different data, perspectives, and facets of understanding to bear, this book offers a novel approach to studying high-tech medical care grounded in Federica Raia's Relational Ontology framework of understanding everyday practice. Using a micro-ethnographic data analysis and a participatory research strategy, we unravel a heretofore unrecognized universe of practice themes and present suggestions for medical education and training aimed at continuous practice improvement.

Contents:

• Introduction:

  • Introducing the Case

• Conceptual Framework:

  • Breakdown of Familiarity
  • Caring for the Other
  • Framing
  • Framing as Care for the Other
  • Facing Uncertainty
  • Research Methodology

• Framing the Options:

  • A Rollercoaster
  • Evidence-Based Reasoning
  • Framing from the Beginning
  • Changing Conditions and Evolving Options
  • Framing Uncertainty: A First Discussion

• Interactions with Doctors in Training:

  • Multiparty Conversation
  • Creating Obstacles by Ignoring Uncertainties
  • Reframing by Using Caring Power

• The Iterative Nature of Decision-Making:

  • Multiparty Perspectives Building the Team
  • Questions, Ambiguities, and Explanations
  • Projecting into the Future with Transplantation
  • December 31

• Increasing Urgency:

  • Meeting the Surgeon
  • Urgency-Related Tension in the Team
  • Backstage and Frontstage Communication

• Transitioning from Urgency to Emergency: The Role of the Existential Dimension:

  • Professional Visions
  • A Bridge to a Bridge to Transplantation
  • Another Professional Vision in the Room
  • Affordances in Teamwork

• Conclusion:

  • Becoming a Team
  • Learning to Care for the Other
  • What Happened to Mr Spencer?
  • Our Approach to Concluding This Book

Readership: Healthcare professionals: cardiologists, physicians, nurses, social workers, psychologists, financial workers; these professionals in teaching/education settings; interested lay public.
Key Features:

• This book offers a novel research approach to study high-tech medical care grounded in the actual everyday practice
• It translates the results of these analyses into groundbreaking Medical Education/Training Modules
• By doing so, it has the potential to radically change the practice of hig

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