WBR0761

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Will Gibson)]]
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 and requires chemotherapy. During his first session of chemotherapy in the hospital, his oncologist visits the patient to make sure he is doing well and has no complaints. After the visit, the patient's 27 year old daughter, who is 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 I discuss your father's medical issues. You can discuss these things directly with your father."
Answer A Explanation	AnswerAExp::The physician is not supposed to disclose any information about the patient's without the patient's consent.
Answer B	AnswerB::"Your father will hopefully recover if he continues his chemotherapy."
Answer B Explanation	[[AnswerBExp::This reply implies the physician is providing prognostic information, by suggesting a recovery is probable with treatment. This reply is problematic from two standpoints: 1. It may be providing false hope and 2. 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 about patient medical information.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Patient confidentiality is very important in medicine. 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 18 years of age or older. When confronted with situations where family members inquire about a patient, physicians are expected to 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 2015 page 58]]
Approved	Approved::No
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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