ethics questio

[rs76]

80 yr old woman family member bring her to physician for weight loss. doctor finds out she has cancer. family members say dont tell her or it will speed her death. Lady is competant. what to do?

a. tell pt xray finding, refer to oncologist, and consult wiht risk managemnt attorney

b. tell patient the results are available if she wants to know

i picked b but my friend tells me its a .

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[pseudoknot]

I think I had a question like this in UW or someplace. It's B, more or less. You don't withhold information from the patient, but if she is competent, she can decline to be told results and you shouldn't force her to hear them. In such a case you'd want to talk to the pt about setting up someone with power of attorney so that someone is making informed decisions about care.

 

[MedLover25]

agree with above poster.

It's B

 

[Slide]

Answer is B; patient autonomy is valid if the patient is functional and competent. Her wishes overrule whatever her family wants for her in this case.

 

[rs76]

thanks for the clarification

 

[DizzyNT]

what about the pt wants you to pray with them questions??

 

[alphaholic06]

I actually did this question. It was an NBME I think. The correct answer is A.

 

[Knucklehead]

what about the pt wants you to pray with them questions??

Always participate in your patient's religion if appropriate. medessentials has a great set of rules for these WWJD questions.

 

[SomeDoc]

80 yr old woman family member bring her to physician for weight loss. doctor finds out she has cancer. family members say dont tell her or it will speed her death. Lady is competant. what to do?

a. tell pt xray finding, refer to oncologist, and consult wiht risk managemnt attorney

b. tell patient the results are available if she wants to know

i picked b but my friend tells me its a .

Yes, I second that the answer is A. This is because of two critical factors: the PT is competent, and is not a minor.

What would the family [who are a) not the patient, and b) non-physicians; psychiatric or oncologist, respectively] know about the clear impact of knowing about the disease on the patient's mortality, or the effect of treatment on mortality, to suggest that treatment or information be witheld?

When a PT is fully competent, and is not a minor, family members do not get to decide on the release of information to the patient.

Given that the patient is competent, she is legally considered to be able to give informed consent on all available treatment options, up to, and including, the withholding of therapy.

 

[pseudoknot]

Yes, I second that the answer is A. This is because of two critical factors: the PT is competent, and is not a minor.

What would the family [who are a) not the patient, and b) non-physicians; psychiatric or oncologist, respectively] know about the clear impact of knowing about the disease on the patient's mortality, or the effect of treatment on mortality, to suggest that treatment or information be witheld?

When a PT is fully competent, and is not a minor, family members do not get to decide on the release of information to the patient.

Given that the patient is competent, she is legally considered to be able to give informed consent on all available treatment options, up to, and including, the withholding of therapy.

No, the answer is B. In B you are letting the patient choose whether to find out the results. In A you are making the choice for the patient.

 

[SomeDoc]

No, the answer is B. In B you are letting the patient choose whether to find out the results. In A you are making the choice for the patient.

Ah, good point. That makes sense. I should read the answer choices more carefully next time.

 

[Cliff Huxtable]

what about the pt wants you to pray with them questions??

ideas?

 

[cgscribe]

Re: praying.

There's a Uworld question about this. If it goes against your personal beliefs, you're not held to a standard of having to pray with the patient, etc., so you can respectfully decline or keep the focus on the patient. However, in a life-threatening situation (ie pt being taken to cath lab or to emergency surgery), you put those beliefs to the side as to not endanger the patient's outcome, so answer would one along the lines of "I'll keep you in my prayers."

 

[rabbitsfeet777]

B seems like the best answer, I thought I had read that once results come in, you cannot with hold test results, unless the patient is seriously suicidal. However, I wasn't sure if giving the patient an option to know the results is really completely valid. I mean what the hell are you supposed to do if the patient doesn't wanna know and their test was negative and you need to tell them to head home? Or even if they were positive and you need to know if they want palliative care.

 

[nlax30]

Was that how the actual question was worded? I think it's kind of a pretty poor question. Kaplan in their behavioral notes/videos does a decent job of laying out ~20 rules when answering questions concerning Dr-Patient relationships.

 

[FutureChiDoc]

Not that this is the end-all/be-all by any means:

But at our school's "Giving Bad News" workshop, we seemed--by default, really--to always ask the patient if they wanted to get the news. So this leads me to say "B."

The caveat to that is when i took NBME Form 5 (where you can find this question), my BS score was rather low.