How would you answer this question?

[RussianJoo]

A 71 year old female is brought to the hospital by her relatives because of recent weight loss and shortness of breath. A CXR shows a large central mass. It's identified to be squamous cell carcinoma that's unresectable. The family asks you to not tell the patient of your diagnosis, because it will only upset her and quicken her death. What do you do?

A) Tell the family that you can no longer be their physician due to the ethical complication and offer a referral.
B) Tell the patient about the lab result findings and refer her to an oncologist, and also call up the ethical committee and inform them of the situation.
C) tell the patient that her lab results are available and you can discuss them with her if she wants to.
D) Schedule a referral to an oncologist and explain to him the family wishes.


Which would you guys pick? I chose C. I know that we should fully disclose all info to our patients, but i read somewhere that if there's no treatment for the disease and the family feels that it will only quicken the patients death that you shouldn't tell the patient the diagnosis.

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[superoxide]

A 71 year old female is brought to the hospital by her relatives because of recent weight loss and shortness of breath. A CXR shows a large central mass. It's identified to be squamous cell carcinoma that's unresectable. The family asks you to not tell the patient of your diagnosis, because it will only upset her and quicken her death. What do you do?

A) Tell the family that you can no longer be their physician due to the ethical complication and offer a referral.
B) Tell the patient about the lab result findings and refer her to an oncologist, and also call up the ethical committee and inform them of the situation.
C) tell the patient that her lab results are available and you can discuss them with her if she wants to.
D) Schedule a referral to an oncologist and explain to him the family wishes.


Which would you guys pick? I chose C. I know that we should fully disclose all info to our patients, but i read somewhere that if there's no treatment for the disease and the family feels that it will only quicken the patients death that you shouldn't tell the patient the diagnosis.

It's C. You have to tell the patient the diagnosis, no matter what the family thinks or what the prognosis is. Now if the PATIENT decides herself not to hear the diagnosis, then you have to respect their wishes.

 

[DragonWell]

I'd say "C" as well. Kaplan Behavioral rule #3 - "Tell the patient everything." Info should flow from patient to family, not vice versa.

 

[RussianJoo]

cool thanks for the replies..

But answer choice C doesn't really tell the patient the diagnoses or the results of the labs, that's why i was slightly hesitant at picking it but the other choices are wrong..

Another Kaplan Rule was never refer your patient to anyone else...

 

[RMJD3]

you don't HAVE to tell a patient a diagnosis in this situation. Legally and morally you are not always required to. If the patient's family feels that this will worsen the situation, it is common to not tell the patient their diagnosis.

 

[hasha100]

Choice C is definitely the answer. It's up to the patient to decide whether or not he/she wants to hear the results.

 

[bgreet]

you don't HAVE to tell a patient a diagnosis in this situation. Legally and morally you are not always required to. If the patient's family feels that this will worsen the situation, it is common to not tell the patient their diagnosis.

Only if the patient consents to not knowing... otherwise I'm pretty sure you're legally obligated to inform the patient. You can't withold information from a patient on the sole notion that his/her family does not wish for them to know.

 

[Pemulis]

You CANNOT withhold info from the pt just because the family wants you to. However, if the pt requests to not know the dx, then you must respect their wish. It's the principle of pt autonomy. Choice c is the only choice that gets to the heart of this principle, by allowing the PATIENT to decide whether or not they hear their results.

 

[Lee580]

I agree that the best answer in this scenario seems to be C.

On a related note, what do you do when a patient doesn't want to know, but you need a decision? I seem to recall that if there is a decision to be made, then you are obligated to inform the patient, whether they want to know or not. In other words, a legally competent patient is not allowed to defer consent to others.

 

[Tiger26]

C--no question

 

[ReidSternberg]

Break it down A.KA. It aint easy being cheesy

First be objective.. Give the patient the info i.e. the lab results... the patient may or may not need time to further their discussion. But you should first have a discussion with the patient. Then, from there, the patient can decide what he/she wants to know. If the patient chooses to know more, you tell them more. If they are not ready, then you are there available until they are ready. If they decide they do not want to know at all now or later, then you have to respect their wishes. Therefore, if the cancer is unresectable, why would you immediately refer to an oncologist? The patient may not even want to know more than the lab results much less being referred to an oncologist where you take the decision out of your patient's hand.f You put the decision in the patient hand. NOw, if the patient (not in this scenario) is a danger to someone or self, then you can make the next immediate decision.

Straight forward "C"

Oh yeahh... Break it down

 

[Blesbok]

A 71 year old female is brought to the hospital by her relatives because of recent weight loss and shortness of breath. A CXR shows a large central mass. It's identified to be squamous cell carcinoma that's unresectable. The family asks you to not tell the patient of your diagnosis, because it will only upset her and quicken her death. What do you do?

A) Tell the family that you can no longer be their physician due to the ethical complication and offer a referral.
B) Tell the patient about the lab result findings and refer her to an oncologist, and also call up the ethical committee and inform them of the situation.
C) tell the patient that her lab results are available and you can discuss them with her if she wants to.
D) Schedule a referral to an oncologist and explain to him the family wishes.


Which would you guys pick? I chose C. I know that we should fully disclose all info to our patients, but i read somewhere that if there's no treatment for the disease and the family feels that it will only quicken the patients death that you shouldn't tell the patient the diagnosis.

AFAIK the patient can tell you that they don't want to hear the results, in which case you would ask them who you should talk to about their medical decisions, but I don't think the family can tell you not to tell the patient unless the patient is a minor, in which case they have the right to ask you not to tell them.

 

[Blesbok]

I agree that the best answer in this scenario seems to be C.

On a related note, what do you do when a patient doesn't want to know, but you need a decision? I seem to recall that if there is a decision to be made, then you are obligated to inform the patient, whether they want to know or not. In other words, a legally competent patient is not allowed to defer consent to others.

That isn't true. They are very much allowed to defer consent, but if a patient tells you that, your next question should be who do they want making decisions for them.

 

[sanche60]

i think first aid has a similar scenario and says decide if telling the patient will cause harm and if not then you tell them. page 62 in the 2007 edition. Given the prognosis of unresectable squamous cell carcinoma wont be drastically affected by being upset, i would say c is a weak answer. id put b, just cuz its unresectable doesnt mean you cant try chemo. It seems like everyone before would disagree with me though....

 

[Blesbok]

i think first aid has a similar scenario and says decide if telling the patient will cause harm and if not then you tell them. page 62 in the 2007 edition. Given the prognosis of unresectable squamous cell carcinoma wont be drastically affected by being upset, i would say c is a weak answer. id put b, just cuz its unresectable doesnt mean you cant try chemo. It seems like everyone before would disagree with me though....

Like someone else above you said, it is about patient autonomy. If the patient doesn't want to talk to an oncologist then they won't. Also, why would you call up an ethics committee if you already told the patient? If you don't know anything about the subject, you NEVER pick the answer where you are putting the patient off and passing them into someone else's hands.

 

[hasha100]

i think first aid has a similar scenario and says decide if telling the patient will cause harm and if not then you tell them. page 62 in the 2007 edition. Given the prognosis of unresectable squamous cell carcinoma wont be drastically affected by being upset, i would say c is a weak answer. id put b, just cuz its unresectable doesnt mean you cant try chemo. It seems like everyone before would disagree with me though....

The one thing i've learned from studying behavioral science for Step I is that you never refer your patient to somebody else and you never get the ethics committee involved. This is why I wouldn't choose B.

 

[sanche60]

The one thing i've learned from studying behavioral science for Step I is that you never refer your patient to somebody else and you never get the ethics committee involved. This is why I wouldn't choose B.

i see what everyone is saying but i just didnt look at referring as such a bad thing. thats what specialists are for right? I wouldnt want my gp treating my lung cancer, but if you guys are certain its B then alright, i guess i would've got that one wrong. Guess ill be studying behavioral sciences as soon as finals are over...

 

[superoxide]

The FIRST thing you do is (C) - tell the patient that her lab results are available and you can discuss them with her if she wants to. If she wants to discuss them, THEN you do (B), but without the "call up the ethical committee and inform them of the situation" part.

(B) is only partially correct, and therefore the INCORRECT answer. The best answer is (C)

 

[DragonWell]

i see what everyone is saying but i just didnt look at referring as such a bad thing. thats what specialists are for right? I wouldnt want my gp treating my lung cancer, but if you guys are certain its B then alright, i guess i would've got that one wrong. Guess ill be studying behavioral sciences as soon as finals are over...

you mean "certain it's C", eh?

In real life, you might be right. But for this test, per Kaplan, referral is ALWAYS the wrong answer. Seems to be true based on all the practice questions I've seen.

 

[Blesbok]

i see what everyone is saying but i just didnt look at referring as such a bad thing. thats what specialists are for right? I wouldnt want my gp treating my lung cancer, but if you guys are certain its B then alright, i guess i would've got that one wrong. Guess ill be studying behavioral sciences as soon as finals are over...

C

And it isn't that you don't want a specialist treating it, but you have a duty to discuss the disease and all the options (or at least those that you know about) with your patient before you pawn them off on someone else.