Yulia
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You are a Dermatologist doing free clinics in a teaching hospital for few hours a week.
A week ago you saw 54 y.o. alcoholic male patient with non-healing lesion on his left upper cheek, you did a biopsy and it turned out to be a Basal Cell CA, extending to the lower lesion of specimen...
Patient presents today for follow up to be seen by one of the residents. First year resident working with you and going to assist you with the procedures, discussed treatment options with the patient and obtained an informed consent for an excision, and you have time to do it today. But you discover that resident didn't mention anything about MOHS (another treatment option available - very effective, excellent cosmetic results, very expensive too). Now you're supposed to:
a. Ask nurse to go talk to the patient
b. Go ahead and start the excision
c. Go back to patient an obtain the consent yourself
d. Send resident to obtain the consent
e. Tell pt's wife who is waiting for him in a waiting room
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| guest
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d
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| Yulia
Forum Elite
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d is the right option in this case.
You always have to get informed consent, patient has a right to know ALL alternatives. There are many things besides treatment options that are supposed to be discussed with the patient. You can't discuss anything with the relatives without Pt's permission. And options a and c would not be appropriate, because that would complicate the relationship with the Pt and wouldn't be good for resident either.
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| Capricious
Forum Newbie
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 d
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| SILVER
DoWhatYouGotToDo!
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d. Send resident to obtain the consent
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| titly
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| doc179
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I think its C, in USMLE you are supposed to do it yourself.
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| Luckyall
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is CCCCCCCCCCCCCCCCCC for sureeeeeeeeee
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| usmle4me
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All posible options must be given to the pt before he choses the option.
Answer should be C
Here the doc doing the surgery is finally responsible for everything...can't blame it resident!!!
Edited by usmle4me on 05/11/07 - 08:56 AM
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| tompat
Forum Elite
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ans should be D
ur suppose to send ur resident and ask him to mention about the procedure he didnt mention.
this would increase the confidence of resident in these matter.
by taking the full informed consent urself u will be compromising the residents relations with pt.
guys there is similar q in kaplan last page behav science notes
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| lq2006
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Send resident to obtain the consent
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| paheli
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this does not answer the qn, but shouldn't the dermatologist have otained consent in the first place. even asking the resident to get it the first time - isn't that delegating it to someone else. but since the resident has done it the first time around, he should do it now too
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| paheli
It'sAllAboutGoodKarma
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this does not answer the qn, but shouldn't the dermatologist have otained consent in the first place. even asking the resident to get it the first time - isn't that delegating it to someone else. but since the resident has done it the first time around, he should do it now too
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Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows.
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| paresh1225
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I will go for C coz.. its clearly mention in the book that its only physician who takes the consent.. neither resident not nurse or any other staff.. so its C
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| drduck
Forum Guru
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very easy Q........
answer has to be C........
its ur work dude the fella is just assisting u.......what if he do some mistake in taking consent or if he doesnt explain this new therapy well.
it was u who knows well about this new modality of treatment....so u have a better chance of making the patient understand the advantages of the treatment over the classical one......u will be able to please him better even when he asks u any leading Q...
remember its always advisable to do ur work urself....cos if something goeswrong u are screwed in both cases....lesser chance of course when u do it actively i mean urself
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| Dr Penny Cillin
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The most appropriate answer is D, with the word 'most' being the operative word. The resident can obtain the consent, but if the physician deems that it is not comprehensive, then he/she has the right to send the resident to inform the patient and re-obtain the 'informed consent'. The rationale here is to teach the resident the proper method and not to reprimand him/her or undermine his/her relationship with the patient. The question stem did mention that it is a teaching institution which I think is relevant in this case. In a private practice setting I believe that this would be the responsibility of the physician, but I have not confirmed this so please be mindful that this is only my opinion. As someone pointed out earlier, there is an identical question in the Kaplan Behav. Sci. text.
Edited by Dr Penny Cillin on 07/04/07 - 11:01 AM
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