ethic question

[MudPhud20XX]

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One of Kaplan ethic questions:

Which of the following would be an acceptable site for a conversation with a physician colleague about one of your patients?

A. Alone in an elevator in the hospital, going to see the patient
B. At breakfast in the hospital cafeteria
C. At lunch at a private club for physicians in the hospital
D. In your colleague's medical office
E. While sitting next to each other waiting for the start of a Grand Rounds presentation

The answer is D.

I wanted to say none of the above since I thought confidentially is absolute and physicians cannot tell anyone anything about their patient w/o the patient's permission. Any thoughts/opinion on this particular question?


Here's another Kaplan ethic q:

A man recently diagnosed with prostate cancer asks that his wife not be informed of his diagnosis. A week later the wife calls the physician's receptionist and asks to speak with the physician about her husband's medical condition. The physician's best course of action would be to do which of the following?

A. Have the receptionist say the physician is busy and cannot come to the phone
B. Suggest that the wife talk with her husband if she has any questions
C. Tell the wife that the husband has a simple inflammation that is being treated
D. Tell the wife that the physician can discuss the husband's condition only if she accompanies him on his next office visit
E. Tell the wife that the physician is not at liberty to discuss her husband's condition

Answer: B

I chose E. Again I thought confidentially is absolute! Any thoughts/opinion?

 

[Bancrofti]

For the first, you're assuming that the person is consulting the other physician. HIPPA laws forbid you to speak about the patients to others who do not need to know about the patient. It also forbids speaking about any patient, even if to someone who is also responsible for care of the patient, in any public setting. Classically used in the HIPPA videos they always showed for certification in the hospital was doctors speaking about a patient in the elevator or even just having the chart in their hand with the name exposed.

For the second I don't know the actual logic, but I would have chosen B as well. In my experience with ethics and the questions, when you're responding to patients, you NEVER give your reason for doing or not doing something as anything along the lines of "I'm just following the rules." So "I am not at liberty to discuss it" falls under that category.

 

[Brain Bucket]

a valid message.

 

[NeuroLAX]

For the second question, I think B can be seen as the best answer because it 1) encourages communication between the wife and husband while upholding proper physician handling of patient information and 2) addresses the wife's concerns without brushing her off.

 

[notbobtrustme]

Confidentiality isn't absolute, but has major restrictions on it. For example, a nurse is treating a patient and the patient tells him that his penis is hurting. Does confidentiality prevent the nurse from telling the doctor that the patient's penis is hurting? Of course not, since pertinent health information is disclosable for treatment purposes. The other major one is billing. Billers/coders are allowed access to pertinent health information in order to file insurance/medicare claims and this is not a violation of confidentiality or HIPAA.

So yea, for the first one, discussing a patient with another doctor in a private setting is definitely appropriate. The second question requires you to not be a dick basically, you haven't disclosed anything but you also are facilitating the relationship between husband and wife instead of stonewalling her. E isn't wrong, per-se, but for boards, don't be a dick.

 

[dyspareunia]

A lot of ethics questions are difficult because there are usually two answers that seem equally correct, but these two questions are just plain common sense. Sorry to sound like a jerk.