CSC Communication & Stakeholder Relations 3 — Questions and Answers
Question 1: A referring primary care physician disagrees with a cardiologist's recommendation to defer elective catheterization in a stable patient. What is the best approach to resolve this disagreement?
- Proceed with the referring physician's preference to maintain the referral relationship
- Send a written letter citing current guidelines and recommend deferral without further discussion
- Schedule a direct phone or virtual discussion to review the evidence and reach a shared clinical decision (Correct answer)
- Ask the patient to advocate to the referring physician on behalf of the cardiologist's recommendation
Correct answer: Schedule a direct phone or virtual discussion to review the evidence and reach a shared clinical decision
Direct collegial dialogue between providers improves care coordination and allows evidence-based discussion to resolve clinical disagreements.
Question 2: During rounds, a cardiology fellow notices a senior attending makes a diagnostic error but hesitates to speak up. Which framework best supports a culture where the fellow can safely raise concerns?
- The fellow should document the concern in the chart instead of speaking up directly
- CUS words ('I am Concerned, Uncomfortable, this is a Safety issue') provide a structured escalation tool (Correct answer)
- The fellow should wait until post-rounds and submit an anonymous safety report
- Hierarchy should be respected; attendings bear sole responsibility for errors
Correct answer: CUS words ('I am Concerned, Uncomfortable, this is a Safety issue') provide a structured escalation tool
CUS words are a TeamSTEPPS-validated tool that gives team members at any level a structured, assertive way to escalate patient safety concerns.
Question 3: A patient with atrial fibrillation on anticoagulation therapy is non-adherent because they are afraid of bleeding. What communication technique would be most effective in addressing this barrier?
- Reassure the patient that bleeding risk is negligible and emphasize stroke prevention
- Discontinue anticoagulation temporarily to build trust before restarting
- Use motivational interviewing to explore the patient's specific fears and collaboratively discuss risk-benefit balance (Correct answer)
- Refer to pharmacy for counseling and avoid revisiting the topic to reduce patient anxiety
Correct answer: Use motivational interviewing to explore the patient's specific fears and collaboratively discuss risk-benefit balance
Motivational interviewing is the evidence-based approach for exploring ambivalence and supporting behavior change around medication adherence.
Question 4: A patient with limited English proficiency is admitted for acute coronary syndrome. No professional interpreter is immediately available. What is the most appropriate action?
- Use the patient's bilingual family member to interpret to expedite care
- Delay communication until a professional interpreter is available regardless of urgency
- Use a certified telephone or video interpreter service immediately, even in urgent situations (Correct answer)
- Rely on written translation materials and non-verbal cues until the patient stabilizes
Correct answer: Use a certified telephone or video interpreter service immediately, even in urgent situations
Professional interpreter services, including telephone and video options, are legally required and clinically superior to using untrained family interpreters, even in urgent situations.
Question 5: A cardiologist is informed by a nurse that a patient is repeatedly pressing the call light due to uncontrolled chest discomfort and feeling ignored. What does this scenario represent from a communication and safety perspective?
- A minor service complaint that should be addressed after rounds
- A potential failure in rescue communication requiring immediate clinical reassessment (Correct answer)
- An indication that the patient has an anxiety disorder and needs sedation
- A nursing workflow issue unrelated to the cardiologist's responsibilities
Correct answer: A potential failure in rescue communication requiring immediate clinical reassessment
Repeated calls about chest discomfort may signal a rescue communication failure that requires immediate cardiologist reassessment to prevent adverse outcomes.
Question 6: When obtaining informed consent for a transcatheter aortic valve replacement (TAVR), which element is most critical to ensuring the patient's consent is truly informed?
- Obtaining a witness signature from a family member
- Ensuring the consent form is signed at least 24 hours before the procedure
- Verifying the patient understands the nature of the procedure, alternatives, risks, and benefits in terms they comprehend (Correct answer)
- Documenting that the cardiologist reviewed the consent form with the patient
Correct answer: Verifying the patient understands the nature of the procedure, alternatives, risks, and benefits in terms they comprehend
Legally and ethically valid informed consent requires demonstrated patient comprehension of the procedure, alternatives, and material risks, not merely a signature.
Question 7: A patient's adult children contact the cardiologist, insisting that their parent — a cognitively intact adult — not be told about a new diagnosis of cardiac amyloidosis. How should the cardiologist respond?
- Honor the family's request to preserve the patient-family relationship
- Agree to delay disclosure until the family consults with other specialists
- Respect the patient's autonomy and disclose the diagnosis directly to the patient as the primary decision-maker (Correct answer)
- Involve the ethics committee before disclosing or withholding any information
Correct answer: Respect the patient's autonomy and disclose the diagnosis directly to the patient as the primary decision-maker
A cognitively intact adult has the autonomous right to receive their own medical information; family preferences do not override patient autonomy.
CSC Communication & Stakeholder Relations 3
A referring primary care physician disagrees with a cardiologist's recommendation to defer elective catheterization in a stable patient.
What is the best approach to resolve this disagreement?