Sigh...Ethics

[Apoplexy__]

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NOTE: Possible UWorld question spoilers (for one question)

Alright, so I just had this question:
A QB for a football team gets mono. You tell him that his spleen will 'splode if he plays the upcoming game. He tells you not to tell anyone of his diagnosis and that he needs to play in the game or else his team will lose.

Wrong answer = Do all possible Tx, but don't restrict the player if he wishes
Right answer = Restrict the patient from playing, your duty is as a patient advocate, don't be swayed by surrounding people depending on patient

I mean yeah, the right answer sounds all kumbaya and stuff, but I don't see how it's a better answer. You can't MAKE your patient do anything (unless an immediate threat to himself or others, etc.). Tx against the patient's will is unethical and though you're the patient's advocate, you can't stop a patient from refusing life-saving Tx -- so why can you suddenly stop him now?

And the right answer involves breaking patient confidentiality and autonomy...

All I can think of is that he's an immediate threat to his life. Can someone help me understand how you would have known that splenic rupture in a case of mono qualifies as that immediate threat exception?

 

[ChessMaster3000]

Alright, so I just had this question:
A QB for a football team gets mono. You tell him that his spleen will 'splode if he plays the upcoming game. He tells you not to tell anyone of his diagnosis and that he needs to play in the game or else his team will lose.

Wrong answer = Do all possible Tx, but don't restrict the player if he wishes
Right answer = Restrict the patient from playing, your duty is as a patient advocate, don't be swayed by surrounding people depending on patient

I mean yeah, the right answer sounds all kumbaya and stuff, but I don't see how it's a better answer. You can't MAKE your patient do anything (unless an immediate threat to himself or others, etc.). Tx against the patient's will is unethical and though you're the patient's advocate, you can't stop a patient from refusing life-saving Tx -- so why can you suddenly stop him now?

And the right answer involves breaking patient confidentiality and autonomy...

All I can think of is that he's an immediate threat to his life. Can someone help me understand how you would have known that splenic rupture in a case of mono qualifies as that immediate threat exception?

Is there a "threat to life" or "immediate threat exception" doctrine somewhere that you are referring to? I have your same reservations about the answer. Especially the way they worded the "dont be swayed by....staff, fans" like why is that even in the answer response? Anyway, in their explanation they made a decent case for their answer, but it was a tough one. If I remember right, the correct answer had a pretty high %correct which shocked me. If you could hit me with the qid I'll take a look at the question again

 

[Apoplexy__]

Is there a "threat to life" or "immediate threat exception" doctrine somewhere that you are referring to? I have your same reservations about the answer. Especially the way they worded the "dont be swayed by....staff, fans" like why is that even in the answer response? Anyway, in their explanation they made a decent case for their answer, but it was a tough one. If I remember right, the correct answer had a pretty high %correct which shocked me. If you could hit me with the qid I'll take a look at the question again

Yeah, I'm referring to how if a patient tells you he's going to kill someone after he leaves, or is depressed then suddenly has a calming change in affect (and/or says some ominous suicidal thing), then you can legally FORCE them with restraint. Basically just pg. 60 of FA 2014 in the "Confidentiality" section.

I was totally surprised at the %correct too -- 69%. QID = 1238. Observing the averages, I'm doing comparatively worst in Biostats/Ethics lol...I could really use a dedicated source if you have one to recommend. Mostly I just need more examples (especially practice Q's).

 

[ChessMaster3000]

Yeah, I'm referring to how if a patient tells you he's going to kill someone after he leaves, or is depressed then suddenly has a calming change in affect (and/or says some ominous suicidal thing), then you can legally FORCE them with restraint. Basically just pg. 60 of FA 2014 in the "Confidentiality" section.

I was totally surprised at the %correct too -- 69%. QID = 1238. Observing the averages, I'm doing comparatively worst in Biostats/Ethics lol...I could really use a dedicated source if you have one to recommend. Mostly I just need more examples (especially practice Q's).

OK, thats what I thought you were getting at--suicidality/homicidality. No, that is not the principle you need to derive for that question, definitely not. I know how you got there, but no. It'd be another thing if he was like depressed and was like, yeah, if my spleen ends up getting ruptured in the game and I die, that wouldnt be so bad...

I'll take a look at the question but I dont think I'll have much more to add. I know ethics is tough, and everyone says they had one or two wtf ethics ?s on their real test. However, I've done all the NBMEs and I thought ethics was really super straightforward on those. Maybe I just was in the right mindset (ultimately, that's what it's all about right?). I bet once you do the nbme's youll find them a lot easier. UW just likes to screw around

 

[Apoplexy__]

Alright, well that's encouraging at least.

I was using suicide/homicide as an example of "imminent/serious physical harm to self/others", which I do feel like is the rule they were testing with the question. If you don't think that's what it is, I'm completely mystified. If you get a chance to look at the Q, I'd be interested in knowing what the singular rule they were testing was.

 

[ChessMaster3000]

Yeah, I'm referring to how if a patient tells you he's going to kill someone after he leaves, or is depressed then suddenly has a calming change in affect (and/or says some ominous suicidal thing), then you can legally FORCE them with restraint. Basically just pg. 60 of FA 2014 in the "Confidentiality" section.

I was totally surprised at the %correct too -- 69%. QID = 1238. Observing the averages, I'm doing comparatively worst in Biostats/Ethics lol...I could really use a dedicated source if you have one to recommend. Mostly I just need more examples (especially practice Q's).

And no, I didnt use a dedicated source

Alright, well that's encouraging at least.

I was using suicide/homicide as an example of "imminent/serious physical harm to self/others", which I do feel like is the rule they were testing with the question. If you don't think that's what it is, I'm completely mystified. If you get a chance to look at the Q, I'd be interested in knowing what the singular rule they were testing was.

Sorry, you're right, they were testing that imminent harm rule, but I thought you meant in the context of psychiatric illness--which you weren't.

Looking at the question, the reason I personally missed it was the bit in the second paragraph of the explanation about how team physicians are an exception to HIPAA because a university is not a covered entity since the team physician is not billing the student/insurance plan (the physician works for the university, not the student, and is simply paid by the university for his services), and therefore is allowed to communicate with the coaches. If I had known that, I would have been less inclined to pick an answer that involved not informing the administration.

Hope that helps

 

[ulikedaggers]

NOTE: Possible UWorld question spoilers (for one question)

Alright, so I just had this question:
A QB for a football team gets mono. You tell him that his spleen will 'splode if he plays the upcoming game. He tells you not to tell anyone of his diagnosis and that he needs to play in the game or else his team will lose.

Wrong answer = Do all possible Tx, but don't restrict the player if he wishes
Right answer = Restrict the patient from playing, your duty is as a patient advocate, don't be swayed by surrounding people depending on patient

I mean yeah, the right answer sounds all kumbaya and stuff, but I don't see how it's a better answer. You can't MAKE your patient do anything (unless an immediate threat to himself or others, etc.). Tx against the patient's will is unethical and though you're the patient's advocate, you can't stop a patient from refusing life-saving Tx -- so why can you suddenly stop him now?

And the right answer involves breaking patient confidentiality and autonomy...

All I can think of is that he's an immediate threat to his life. Can someone help me understand how you would have known that splenic rupture in a case of mono qualifies as that immediate threat exception?

Restrict the patient from playing just means tell him he is not allowed to play. It doesn't mean lock him up or follow him around to make sure he actually listens to you. At this point in the course of illness the patient isn't facing imminent death without treatment. In other words, if you don't do any Tx, the patient likely won't die. Restricting him from playing is, in a sense, life-saving Tx.

 

[notbobtrustme]

yea, this is similar to when players are diagnosed with concussions in real life with the NFL. They aren't cleared to play regardless of their own wishes. It's similar to this question. I had the same dilemma as you did, but ultimately, I erred on the side of patient safety rather than patient wishes.