Mrs. G. is a 60-year-old female who just received the news that her squamous cell carcinoma is progressing rapidly, and she is referred to a specialist for urgent, surgical intervention.

Read the following excerpt of an Imaginary Case Study and answer the questions in parts 1- 4 below in your own words: 

“Mrs. G. is a 60-year-old female who just received the news that her squamous cell carcinoma is progressing rapidly, and she is referred to a specialist for urgent, surgical intervention. She appears unphased by the news, says she won’t be sharing the diagnosis with family so as not to worry them, and refuses your offer to make an appointment with the specialist”. 

Part 1: During your brief encounter with this patient, how could the Ladder of Inference be a useful tool to (a) better understand her perspective and (b) advocate that she takes indicated next steps in her treatment plan? 

Part 2: Understanding Mrs. G’s perspective: Backing down the Ladder 1. In this case her action is basically a decision for inaction. 2. What are some beliefs she might have that are leading to that decision toward inaction? 3. What aspects of her personal background and experience might have led her to develop these beliefs? 4. What else might she need to pay attention to change her beliefs? 5. What in her experience might make that noticing more difficult? 

Part 3: Examining your own perspective of the case. 1. Do you agree or disagree with Mrs. G.’s choice at this moment in time? 2. What data are you paying attention to that leads you to that conclusion? 3. What in your experience allows you to “see” that information? 

Part 4: Taking Action 1. As a systems thinker, what are some next steps that you might take with Mrs. G? 2. With a more thorough understanding of both Mrs. G’s perspective and your own, what might you say to see to help move her to action? What questions might you ask? 3. How can you help her connect her past experiences to her current choices? 

References: 

The Ladder of Inference was originally developed by Chris Argyris out of Harvard and was popularized by Peter Senge in his book, The Fifth Discipline. On page 91 of We Can’t Talk about that at Work: How to Talk about Race, Religion, Politics and Other Polarizing Subjects the Ladder of Inference, as adapted by Kleiner, Roberts, Ross and Smith, is presented as a series of steps.

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