nisha
lil monkey
Topics: 146
Posts: 919
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You are called to meet with a patient's family on the oncology floor. The patient is a 60-year-old
Caucasian man who is on the board of trustees of the hospital where you are employed. His family
describes the patient as an extremely controlling and arrogant, yet emotionally vulnerable person. The
results of a recent metastatic work up indicate that the patient has disseminated colon cancer and he
has been told that the chances for 'cure' of his cancer are 1-5%. The patient's family requests that, even
if the patient asks, he not be told of the results of his testing as it will only "depress him". On the
patient's previous mental status examination, he is found to be fully oriented, meticulously groomed,
and well related. His attitude is noted to be dismissive; he frequently asks why you are assessing him
without a surgeon present and writes down your name for credentials verification. There is no evidence
of any psychotic process, and the patient laughs when asked about depressive symptoms or suicidal
ideation. During his hospital course, he has frequently asked that he be kept fully informed of all
pertinent details of his medical testing. The most appropriate response to give to the patient's family
regarding their request would be that you
A. are going to comply with the patient's wishes given his rights as a competent
person with self determination of care
B. feel that, given the patient's personality, chemotherapy should be initiated promptly with the
family consenting in lieu of the patient
C. recognize the personality traits described by the family in your interaction with the patient
and will comply with their request
D. will begin a titration of antidepressant medication for approximately 1 week prior to
revealing the patient's prognosis to him
E. will discharge the patient imminently given that nothing acute needs to be done and you will
let the patient's family divulge whatever they feel is appropriate
___________________
IM resident
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| catmd
Forum Senior
Topics: 7
Posts: 129
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A.
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| drkpp
Forum Guru
Topics: 45
Posts: 882
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A too
___________________
"Where there is a will there is a way!"
-Anonymous
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| nisha
lil monkey
Topics: 146
Posts: 919
|
The correct answer is A. The patient described does have personality traits that suggest a possible
narcissistic personality disorder. He is extremely haughty during interaction with someone he feels
does not have sufficient training to take care of a man of his importance, is described as arrogant by
his family, and seems to make demands for special treatment while hospitalized. However, the patient
clearly demonstrates an ability to participate in decisions pertaining to his health. He is not psychotic,
nor gives any evidence of dementing illness or severe depression. Therefore, if his request is to know
exact details about his diagnosis and prognosis, then that wish must be honored. Telling them that you feel that, given the patient's personality, chemotherapy should be initiated
promptly with the family consenting in lieu of the patient (choice B) is also incorrect due to the
patient's competence and rights to decide appropriate treatment for himself. Telling them that you recognize the personality traits described by the family in your interaction with the
patient and will comply with their request (choice C) is incorrect due to the fact that the patient is
competent and should therefore be allowed to know his diagnosis, treatment options, and prognosis. Telling them that you will begin a titration of antidepressant medication for approximately 1 week prior
to revealing the patient's prognosis to him (choice D) is incorrect for two primary reasons. The first is
the patient's obvious competence. The second is that the patient does not appear to be clinically
depressed, and even if he were, the patient has the right to decide whether he receives
pharmacologic treatment for depression. Telling them that you will discharge the patient imminently given that nothing acute needs to be done
and you will let the patient's family divulge whatever they feel is appropriate (choice E) is incorrect
due to the fact that the patient is competent and has asked that his condition be explained to him in
detail by a medical professional.
___________________
IM resident
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