informed consent in the OR

[njmedstudent87]

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So I came across a question where a patient gives consent for an appendectomy and in the OR the surgeon discovers an ovarian tumor...what should he do?

I thought the answer would be...Perform the appendectomy and biopsy the tumor

However, the Rx says do the appendectomy and do NOT biopsy...what do you guys think.

And where can find cases like these...that UWASH bioethics site does not have this case for under its Informed Consent in the OR.

 

[Ryu02ETL]

So I came across a question where a patient gives consent for an appendectomy and in the OR the surgeon discovers an ovarian tumor...what should he do?

I thought the answer would be...Perform the appendectomy and biopsy the tumor

However, the Rx says do the appendectomy and do NOT biopsy...what do you guys think.

And where can get find cases like these...that UWASH bioethics site does not have this case for under its Informed Consent in the OR.

I had a question from kaplan just like this, and the answer was to proceed with the appendectomy and Bx the ovarian tumor.

 

[taare]

I remember this scenario when I took the live kaplan course. You do NOT touch any other pathology unless given consent. So you patch them back up after appendectomy and when pt conscious, you let them know about the new findings.
You DO NOT Biopsy.

So I came across a question where a patient gives consent for an appendectomy and in the OR the surgeon discovers an ovarian tumor...what should he do?

I thought the answer would be...Perform the appendectomy and biopsy the tumor

However, the Rx says do the appendectomy and do NOT biopsy...what do you guys think.

And where can get find cases like these...that UWASH bioethics site does not have this case for under its Informed Consent in the OR.

 

[hartbot]

I think there is a court case from 1907 that is still the precedent...some surgeons removed a tumor that nobody knew about before surgery. She sued, she won.

 

[IMGUSMLEStep1]

Yea, I agree, don't biopsy the tumor without consent. Almost always, informed consent has greater weight than beneficence.

 

[turkeyjerky]

I think there is a court case from 1907 that is still the precedent...some surgeons removed a tumor that nobody knew about before surgery. She sued, she won.

We learned about that case in our bioethics course. It wasn't just that they didn't have consent to remove the tumor--some surgeons thought a woman had a tumor, they obtained consent to open her up and look, but the patient specifically said not to take it out. Then they went ahead and took it out.


I remember that question too, and it seemed a little fishy--I feel like it's standard practice to obtain a biopsy of the mass during the initial procedure. If this was from Kaplan or UWorld I'd be more inclined to accept it, but who knows who wrote that question?

 

[ddr1212]

There was a UWorld question like this, dealing with a mass on the colon. I do not remember the locations exactly, but the answer was to NOT biopsy the mass. If inadvertently discovered in surgery, you close the pt up and let them know post-surgery about it. They need to consent to a biopsy. Think about it, this patient may not want to know if they have cancer (for many reasons). Once a biopsy is done and sent to path, you are obligated to tell them the results. Consent first is a much better approach.

 

[knuckles]

HY behavioral science has an example of this. In short, unless it's life threatening at the moment, you can't do anything other than what the patient has consented to.

Consent to biopsy the mass must be obtained after the patient wakes up.

 

[PokerDoc]

HY behavioral science has an example of this. In short, unless it's life threatening at the moment, you can't do anything other than what the patient has consented to.

Consent to biopsy the mass must be obtained after the patient wakes up.

this

 

[Eudjinn]

There was a UWorld question like this, dealing with a mass on the colon. I do not remember the locations exactly, but the answer was to NOT biopsy the mass. If inadvertently discovered in surgery, you close the pt up and let them know post-surgery about it. They need to consent to a biopsy. Think about it, this patient may not want to know if they have cancer (for many reasons). Once a biopsy is done and sent to path, you are obligated to tell them the results. Consent first is a much better approach.

agree with everything except bolded part. a patient in their right mind can request that the doc does not tell them the results of their biopsy.

 

[ddr1212]

agree with everything except bolded part. a patient in their right mind can request that the doc does not tell them the results of their biopsy.

Correct! That is also brought up in a UWorld question or two. Sorry for the mispeak.

 

[Eudjinn]

Correct! That is also brought up in a UWorld question or two. Sorry for the mispeak.

not a problem. wasn't trying to be smart about it. just making sure i'm not going crazy myself here... 🙂

 

[username456789]

Well well well, this is just great.

I just got a question on the Kaplan QBank: Woman comes to ER with husband, acute abdomen, they do an appy. No appendicitis is found when they open her up, but they see an ovarian tumor.

The correct answer (according to Kaplan)?:

BIOPSY THE TUMOR AND CLOSE HER UP.


Which, of course, is in direct opposition to what most of you have said, and in direct opposition to what HY BS says. There wasn't even an option to close her up without doing anything and then ask her afterwards.