Yulia
Forum Elite
Topics: 19
Posts: 240
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19 y.o. schizophrenic pt presents in your dermatology office with non-healing lesion, 4 mm in diameter on his left posterior hand. You look at the lesion and suspect skin cancer (BCC or SCC you can't tell). You are thinking that you could do punch biopsy and hopefully remove the whole thing, but patient refuses and requests conservative treatment, and you fail to convince him to consent. At this point which of the following would be most appropriate:
a. ignore his wishes and do the biopsy
b. call his parents and get their permission
c. schedule follow up appointment.
d. tell his you can't treat him if he doesn't follow your recommendations
e. get court order and treat him
f. refer pt to the radiation therapy
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| Anno Domini
Moderator
Topics: 293
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I think d
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| guest
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i think refer the patient to the radiotherapy
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| Ouli Maty
Forum Elite
Topics: 33
Posts: 275
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c. schedule follow up appointment
-to respect the" patient rights" law because his mental illness doesn't preclude obtaining informed consent if he is legally competent, understands the informed consent process and capable of decision making.
-It will give you time to reassess his lesion.It could be a cancer or just a benign lesion that wasn't treated well.
-And finally, you will have time to pursue further why he refuses the procedure and if he really understands the consequences.
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deep breathing...
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| Yulia
Forum Elite
Topics: 19
Posts: 240
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Maty is absolutely right! We should assume patient's competence, unless there is a clear evidence of opposite.
You cannot refer this particular patient to the radiation therapy, because you have to do the biopsy first. No biopsy - no diagnosis of cancer. It could be just an inflamed wart, and you don't know for sure.
You cannot tell him that you won't treat him, it's unethical. Never abandon your patient, never even talk about it.
You can't discuss his problems with the parents (patient's confidentiality) and you do not go to court for something like this.
So, the best you can do is schedule a a follow up and go from there. You could also spend couple more hours trying to convince him, but it's not one of the choices 
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| EMI777LY
Forum Senior
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Whith the exeptions of life-threatening emergencies, physicians must obtain consent from competent, informed adult, patients before proceeding with any medical or surgical treatments
according this only D
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Emily
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| Yulia
Forum Elite
Topics: 19
Posts: 240
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That's exactly why follow up is the only good choice. You cannot tell your patient that you won't treat him. It's UNETHICAL and therefore wrong.
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thank you
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| usmleasr
Forum Guru
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:P
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| usmleasr
Forum Guru
Topics: 105
Posts: 970
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8)
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| dr.shar
Forum Elite
Topics: 38
Posts: 236
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very very good question, i like it very much. Informed consent is emphasized beautifully
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