Resident Dr. A is called to speak with the family of a patient in the neuro-intensive care unit who has malignant left middle cerebral artery syndrome and is close to brain death. Resident Dr. A has many competing obligations that day, but realizes how important the discussion will be. As he stood outside the family conference room where anxious loved ones waited, he contemplated what he was going to say and how. Having done this before, he felt confident that he could do it well. What he did not realize was that on the other side of the door were 20 frightened family members who speak a different language, have many different beliefs, and have no idea that their family member is dying. Resident Dr. A's confidence was based on sufficient knowledge of the patient's illness and prognosis, but despite decades of formal education, he was never taught how to effectively communicate with patients and their families in this situation.
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