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2 01 Case discussion

Mrs Leela Patel, a 45-year-old Indian lady who has breast cancer, attends your surgery to discuss her treatment following a recent hospital appointment. Her oncologist has informed her that the cancer has not responded to the latest course of chemotherapy and has suggested that she should consider further treatment with a new drug. She informs you that she had a terrible time with the chemotherapy and she does not wish to have any more treatment.

She says that she would like to see an Ayurvedic doctor who specialises in cancer treatment. She says that she does not mind paying for this treatment if you are unable to refer her on the NHS.

Questions for reflection

To help you understand how the GP curriculum can be applied to this case, ask yourself the following questions:

Fitness to practise

  • How do I feel about this request?  How might this affect my judgments and actions in the consultation?

Maintaining an ethical approach

  • How would I balance the conflicting demands of the patient's right to choose her treatment (respecting her autonomy) with the doctor’s duty to protect the patient from harm?

Communication and consultation

  • What open-ended and sympathetic questions would I use in order to establish the facts and reasons for Mrs Patel seeking a referral to an alternative practitioner?
  • Are there possible language/cultural difficulties and how could these be managed (e.g. using an interpreter)?

Data gathering and interpretation

  • What are Mrs Patel’s health beliefs, cultural norms and concepts regarding her health issues?

Making decisions

  • What are the various potential benefits and harms that might result from different courses of action?

Clinical management

  • What do I know about the regulation of complementary medicine, its availability on the NHS and, if not available, where it could be accessed?

Managing medical complexity

  • What are the implications of Mrs Patel’s request and need for support in terms of service provision and time management?

Working with colleagues and in teams

  • Which health and social care colleagues could help Mrs Patel and how can I draw on their expertise?

Maintaining performance, learning and teaching

  • What do I know about complementary medicine and the evidence base for it compared to the chemotherapy regime being offered by the oncologist? Do I need to find out more?

Organisational management and leadership

  • How can I use Mrs Patel's records during the consultation to facilitate high-quality patient care?

Practising holistically and promoting health

  • Do I understand Mrs Patel’s personal views regarding complementary medicine?
  • Do I have sufficient understanding of Mrs Patel’s cultural perceptions relating to our healthcare system and her health?

Community orientation

  • How would I ensure support and reassurance regarding continuity of care, primary care team support and assessing support for the carers?


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