This case uses two important examples based at the Stanford Hospital. In the first, Joe Kelly is diagnosed with fast-growing lung cancer and must quickly go through a series of chemotherapy. Joe's path includes discussions with his wife, son, and doctor about his prognosis and treatment. While Joe believes he is cured after the first round of chemotherapy, the doctor must communicate that the chance of relapse is high. In the second example, Tina and Beth, graduate students at Stanford Medical School, compete for their Chief Resident's attention. Beth believes Dr. Rivas favors Tina and a great deal of conflict is created in the fight to win over Dr. Riva. After some time, it is noticed that this conflict greatly affects the two's care of their patients and Dr. Rivas must sit down and discuss solutions.

Bernie and Ruby Merwald live in Menlo Park, California during their retired ages when Bernie falls ill to dementia and Alzheimer's. This causes him to have significantly complex medical problems that result in familial conflicts, violence and avoidance of the doctor's orders. When Bernie has a heart attack on top of his failing health, siblings want to pull the plug, but their protective and isolating mother disagrees. Because of a California law, the mother is responsible for all medical decisions and continues to subject her husband to over-medication and worsening of his condition against the doctor's orders.

Dr. Curley is an obstetrician that deals with a very difficult birth of the new Santorini child. The Santorinis have been through a stillbirth, and upon getting pregnant again, extreme cautions are taken to ensure the safety and health of their new child. This case takes the reader through the difficult decisions that must be made by the doctor and family as "a perfect storm" of birthing complications ensues. The Santorini's son is born with down syndrome and heart problems that require difficult surgeries. To add on to the strain, the family is tied down by significant financial problems. The doctor must decide how to tell the family their options before they expose their newborn to highly risky surgeries, with the added financial difficulties.

Dystonia is a disease that most of the Marvis family suffered from. Not only this, but mother Stephanie Marvis also was a single mother working hard to finance her four person family. Stephanie and her son David especially had symptoms of dystonia, which forced Stephanie to frequently take her son to the hospital. After much research, Stephanie found the Stanford Hospital's Dr. Fields, who helped implant a device that would halt some of the dystonia symptoms. When the device breaks, David suffers for many months because Stephanie doesn't feel it is necessary to go to the Stanford Hospital. However, when they finally reach the hospital, Stephanie becomes very combative of her situation, defending her choice to not uproot David earlier. The doctors and hospital staff must determine how to communicate with her, while arguing amongst themselves about the appropriate way to address the situation.

A Brief Note on Difficult Discussions Between Doctors and Patients provides students with a framework to help them think about how to have such discussions. The framework has three parts: 1. The contextual realities of a given case. Two categories of contextual realities exist. First, there are the factual components that surround a case. Without a full understanding of all the facts, a doctor will be handicapped in a difficult discussion. Second, there are complicating factors - the "invisible" obstacles that can create unnecessary tension or otherwise compromise a difficult conversation. 2. The goal(s). What is success in a difficult doctor-patient discussion? 3. Guidelines for difficult discussions. The specific steps to take during the discussion to create the best odds for success.

This case is centered on Stanford University's Palliative Care program and covers difficult conversations physicians must have with patients and their families. Situations include dealing with the angry family of a terminally ill patient, and how to legally and ethically respond to a patient's request for assisted suicide.

This case is about the diagnosis of Alzheimer's at a relatively young age, at a time when the patients are forced to juggle jobs, family, and dementia. The case is based on the article When Alzheimer's Hits at 40 from the Wall Street Journal (November 14, 2008). While most people who get Alzheimer's are over 65, Andy Smith, the protagonist in the case, is one of about 500,000 Americans living with Alzheimer's or other dementias at an atypically young age. Alzheimer's takes a long time to develop - usually, it isn't diagnosed until 10 years after the first symptoms appear - but more Americans are identifying it early, thanks in part to aggressive screening programs pushed in recent years by groups including the Alzheimer's Foundation of America, a national alliance of caregivers. This case has three vignettes that focus on different difficult conversations between Dr. Henderson and Andy and Cindy Smith. Dr. Henderson is there at the beginning of this ordeal as he attempts to inconclusively identify the cause of Andy's initial symptoms. Finally, after several years and many different treatments, Dr. Henderson diagnosed Andy's condition as Alzheimer's.