At 10:00 a.m. the intern presents her case of an elderly man with a pulmonary mass and enlarged lymph nodes, as delineated by computerized topographic scanning. The intern's presentation of Mr. M.'s case takes about ten minutes and covers his chief complaint (cough), present illness (description of how symptoms developed), past medical history, and findings on physical examinations and tests. The issue at hand appears to be that Mr. M. may have a type of lung cancer that is potentially treatable by intensive chemotherapy, but he refuses the recommended biopsy of the lung mass.

The attending physician leading the team now considers several teaching strategies. Using the blackboard in the conference room, he could lecture on lung cancer, its diagnosis, and treatment. He could curtail the lecture to leave time to visit the patient briefly with the team to demonstrate key features of the examination. He chooses a third option: going straight to the bedside with the team to address Mr. M.'s refusal of the biopsy.

Mr. M. is a man of few words; his sister, in the room with him, does most of the talking. From the two of them, the team learns that Mr. M. has strong religious beliefs that lead to a somewhat fatalistic acceptance of the outcome: the result should be "whatever God wills," as Mr. M. puts it. He does not want chemotherapy, which he views as potentially toxic. He understands the possible benefits of chemotherapy, but is unwilling to risk its possible side effects. His sister indicates that these feelings are consistent with his long-standing beliefs and values. The attending physician suggests, and the team agrees, that they should accept Mr. M.'s decision while offering to return to answer questions that may come up later and also offering to provide a second opinion from an expert oncologist. Mr. M. is assured that he may change his mind at any time and still undergo biopsy and treatment.