Ethics Question

[Southpaw]

I had a practice question about a kid with EBV Mono who wanted to play in a football game, and you were asked what you should do. The answer said don't let him play because of a possible splenic rupture, and that confused me a bit. EBV is not a reportable disease, and if you're worried about a rupture of the spleen, you could apply the same principle to many many viral, protozoan, bacterial, etc. diseases that could potentiall cause danger, yet are not reportable diseases. So is there a clear cut answer as to why you should tell someone so that the kid can't play?

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[cdql]

If you're referring to the UW question, I think they're talking about merely declaring a kid uneligible to play. It doesn't say you have to go into further detail about his disease with the coaching staff. It's also the "most appropriate answer" as we're supposed to care for our patients without regard to the wants of the fans/coaching staff/etc... etc...

 

[Taus]

I'm pretty sure it has nothing to do w/ the reportable nature of the disease here.....its just the EBV causing massive proliferation of B's (and T's->the atypical lymphos) in the spleen pre-dispose it to rupturing wayyyy more then your standard infection

 

[Southpaw]

It was confusing because another answer choice said that the patient ultimately makes the decision about his health care and the physician should not inform team administration. I thought this to be true. The correct answer words it as the physician should RESTRICT the player from playing. How exactly would he do that if we was not going to report the player? Had the correct answer said something to the effect of "strongly advising against playing" along with watching out for his best interests of health, I'd thought it to be more correct.

I don't see the situation much different from spousal abuse. We don't report that, we simply support the patient, refer her to a shelter if wanted, and advise her to go to law enforcement. Yet we don't RESTRICT her from going back home to an abuser, which is the wording used in the correct answer by UW.

I know it's very nit-picky, but I've heard these questions are very nit-picky on the real exam, so I think the wording is important.

 

[justsomeguy]

It was confusing because another answer choice said that the patient ultimately makes the decision about his health care and the physician should not inform team administration. I thought this to be true. The correct answer words it as the physician should RESTRICT the player from playing. How exactly would he do that if we was not going to report the player? Had the correct answer said something to the effect of "strongly advising against playing" along with watching out for his best interests of health, I'd thought it to be more correct.

I don't see the situation much different from spousal abuse. We don't report that, we simply support the patient, refer her to a shelter if wanted, and advise her to go to law enforcement. Yet we don't RESTRICT her from going back home to an abuser, which is the wording used in the correct answer by UW.

I know it's very nit-picky, but I've heard these questions are very nit-picky on the real exam, so I think the wording is important.

I was confused, too, because I remember learning that people have the right to refuse life-saving treatment as long as they are competent and they understand what will happen by refusing treatment. At first I thought that this was the same principle being described here: that as long as the player was competent and understood the risks, the doctor could not do much to restrict the player from playing (other than strongly advising against).

But, I think I have an interpretation of this question, but I am not sure that it's correct. From the way the explanation was written, I think that the answer to this question applies to the very specific situation of a doctor in charge of taking care of athletes (sports doc). It's like getting a physical before playing and if the physical turns up something bad (e.g. heart condition), you don't get to play until it is taken care of. The sports doc's number one job is to ensure the safety of the players. If the player were to go on the field and die from a ruptured spleen, the doctor would have failed his duty as the team's physician. Besides, back in my high school sports days, I remember the coach would always ask the trainer if injured so-and-so was fit to play, and if the trainer said "no", then that player didn't play.

I could be dead wrong in this thinking, though, so any other input would be greatly appreciated.

 

[ginger60]

I'm assuming this question is referring to a high school kid in a school sports program, in which case the kid is most likely not legally competent (as he is a minor) and thus can't really refuse treatment on his own. I think the previous poster is right about thinking of this as a sports doc kind of thing, or a pcp clearing the kid for a sports physical. In that case the doc has a duty to restrict the kid from playing because of a potentially life-threatening complication, which presumably is accomplished by declaring him ineligible to play contact sports. In reality I don't know how far you can take this--whether you just give the kid/parents a note and expect him to show it to his coach, but in theory the kid should be restricted from playing.

 

[SoCuteMD]

The doctor was the TEAM doctor, not the kid's personal physician. That explains it.