WBR0761

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Will Gibson and Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Ethics
Sub Category	SubCategory::Pulmonology, SubCategory::General Principles
Prompt	[[Prompt::A 62-year-old man presents to his physician's office complaining of dry cough. Following appropriate work-up, he is diagnosed with small cell lung carcinoma. During his first chemotherapy session in the hospital, his oncologist visits the patient to make sure he asymptomatic and has no complaints. Following the visit, the patient's 27-year-old daughter, who has been waiting outside the infusion room, asks the physician what will happen to her father. Which of the following is the most appropriate answer in this situation?]]
Answer A	AnswerA::"I apologize, but I cannot discuss your father's medical issues. You may discuss these matters directly with your father."
Answer A Explanation	AnswerAExp::The physician is legally and ethically barred from disclosing information about the patient's medical issues with other individuals without the patient's consent.
Answer B	AnswerB::"Your father will hopefully recover if he continues his chemotherapy."
Answer B Explanation	[[AnswerBExp::The physician is providing prognostic information by suggesting a recovery is probable with treatment. The reply is problematic from two standpoints: First, it may be provide false hope; and second, it breaches the patient's confidentiality by discussing the treatment he is receiving and his implied prognosis.]]
Answer C	AnswerC::"Your father cannot make it without your continuous support."
Answer C Explanation	AnswerCExp::This reply implies the physician is providing prognostic information and breaching patient's confidentiality.
Answer D	AnswerD::"We should not speak publicly of your father's condition. Please visit me in my office to talk to you confidentially."
Answer D Explanation	AnswerDExp::The physician is not supposed to disclose any information about patient medical information. This includes public or private conversations with other individuals.
Answer E	AnswerE::"Your father's condition will most likely worsen due to the side effects of chemotherapy"
Answer E Explanation	AnswerEExp::The physician is not supposed to disclose any information that pertain to patient medical information.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Patient confidentiality is very important, and physicians are not allowed to disclose any information about adult patients' medical records, their diseases, treatment plans, prognosis, or even their identities as patients to other individuals. Adults are all individuals who are of 18 years of age or older. When confronted with situations where family members inquire about a patient, physicians should politely refrain from giving information without the patient's consent. Alternatively, physicians may ask the family members to speak directly with the patient to allow the patient full discretion in what he/she discloses. Educational Objective: A physician must not disclose any information about adult patients to anyone without the patient's consent. References: First Aid 2014 page 59]]
Approved	Approved::Yes
Keyword	WBRKeyword::Ethics, WBRKeyword::Consent, WBRKeyword::HIPAA, WBRKeyword::Privacy, WBRKeyword::Patient privacy, WBRKeyword::Confidentiality, WBRKeyword::Confidential, WBRKeyword::Medical record, WBRKeyword::Small cell lung carcinoma, WBRKeyword::Cancer, WBRKeyword::Chemotherapy, WBRKeyword::Informed, WBRKeyword::Disclosure
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