mytime
Go Marching in!
Topics: 40
Posts: 3,177
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BUSY I SEE and keeping it cool for us all! Take care and work hard. When did u discuss the NBME.....I wanted to too.  Never mind with someone else then. 
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Hi Shwe, I thank you again for your posts here  Am now going thru the ethics cases. Here it is:
Case # 34
Should a bus driver hide history of epilepsy from his employer?
Answer No.
He has requested his physician not to mention his epilepsy to the employer because this would result in the loss of his job. The physician is obligated not only to his patient but to the community. The patient should notify his employer and try to find a non-driving job in the company. If the patient disagrees, physician may notify the appropriate authority for the safety of the patient and the community.
Now what if you got one like this--Employer of your EtOH-loving pt rings you up, says job requires heavy machinery operation, highly dangerous to pt and co-workers, wants to know if pt can still do job, knowing he's an alcoholic.
a. Doc tells employer nothing--pt/doc confidentiality
b. doc tells emp to call if he notices anything strange w/pt
c. doc tells emp to talk to pt about the job and his EtOH problem
d. doc tells employer to give pt temporary reassignment for next 3 months
Someone had one like this, picked A. Discussion, please Shwe? Anyone?
Kity!!! Good to see you, always Thanks & you're welcome!
KG, I checked the vid...wow!!! Nice one, thank you Angels of the elements, very interesting. Good stuff!
MT, I am still here, we can discuss it still. Am down for form 1 and form 3 discussion, but for form 3 still have yet to finish 3rd and 4th parts, will do tomorrow.
Hey Med, have fun with your visit today
Edited by edie on 08/18/07 - 02:18 PM
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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OK, need to break for the day, going out with the hub. Last minute thing, but it will be good for me, re-fueling, re-charging...but this is it, no more until after step 1!!!
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| mytime
Go Marching in!
Topics: 40
Posts: 3,177
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That thing u mentioned about EPILEPSY!!!!!!!!!!!!! I was asked in CS and I gave the correct suggestion coz u see the response of "OH GOOD! " In the patient's eyes. I guess not great actors after all we are better! 
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Hmm? What? What thing about epilepsy? Well, whatever that was, I am glad that it got you points on your CS
Oh my goodness, you are referring to the case above  See what happens when I come on here BEFORE my coffee 
Edited by edie on 08/19/07 - 06:52 AM
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Good morning, Journal and Step 1 Slayers.
Had a really very nice day with my better half yesterday, and now, back to work. I really need to get that last two parts of form 3 done, I see New_n_Lost has already started discussion for it in the Path forum. I have read other exam experiences that underscore how helpful doing and knowing those questions was for them, and so far, I see why. But since it helped me before, I am going to do another pass of the HY notes beforehand.
I leave you with this ethics situation:
You have a patient who finds you attractive. The feeling is mutual, but you act professionally and stave off flirtations. You happen to run into this patient in public, and find that you are very attracted to them. On your next visit with this patient, they ask you out on a date. The proper response would be to
a. Express that you are flattered and decline the date. You continue to be the patient's doc.
b. Tell the patient that you are attracted to them also, but a romantic relationship will never happen. You continue to be the patient's doc.
c. Tell the patient that since the attraction is mutual, you can no longer be their doc, give them a referral to a colleague, and begin a romantic relationship with the patient.
d. Have a discrete relationship with the patient as you continue to be their doc.
e. Express that you are flattered, decline the date, and refer the patient to a colleague. You do not begin a relationship with the patient.
What you do for step 1? What would you do in real life?
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| medocuk
IM-RES
Topics: 26
Posts: 1,467
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A Express that you are flattered and decline the date. you continue to be their doc.
I think from where I stand now I would do what I chose for step one answer. Some how I don't see myself getting thaat attracted to my patients.
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Hahaha, you never know, babe!
Option 'd' has "Fatal Attraction" written all over it. 'B' is just crazy, asking for trouble. 'C' is bittersweet and romantic, but leans toward unethical. If my patient were my husband before we started dating, I would have to go with 'e'. I just wouldn't have been able to stand it! For step 1, leaning towards 'a', too.
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| ShweHope99.9998
Forum Fanatic
Topics: 12
Posts: 2,686
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e .. then c ,
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Here's another before I go:
You have a 17-year-old pt that has a severe spinal deformation since birth that greatly impedes her quality of life. You learn that a new surgical procedure with a 65% success rate would benefit the patient, but her insurance will not cover it, and it is extremely expensive. You decide to anonomously donate the money for the surgery. Is this unethical?
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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LOL, Shwe, I like your thinking
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| ShweHope99.9998
Forum Fanatic
Topics: 12
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Oh have not see Ed & MDU answer while I answer e.. then c , since ...... a also possible, so will go for a or e but not sure which , but .. will go... e ... for exm.
What's the answer yang-barone ??
GL
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Correct answer is e. Got this one from a friend, an attending doc, whom in real life, did C, and had been married over a decade to his former patient (though now divorced), even though he will say it was unethical, and says to me to NEVER get involved with a patient no matter what--hypocritical, right? He said 'a' is not correct because of your attraction to the patient. If you are not attracted to the pt, 'a' is correct, and according to him, the most common of the 'real world' scenarios. So Med and me right on that account But Shwe, you are right for Step 1. Correct answer is e = run for the hills and don't look back!!!
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| ShweHope99.9998
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Posts: 2,686
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I am right, I am right , thanks Ed .
Ed... I am still at the bottom of the hill , I feel my water bottle not even fill yet or feel that not have enough food clothing, sleeping bag, tent, robe, stuffs to go up hill & survive , win the battle & put the victory flag on top of the hill with my signature on .
Am I trying to carry too much to the hill , may be I will only need my confident brain after refresh my knowledge , with happy up beat to run to the hill & I will not need to look back at all .
GL GL GL happy success study to us, all 
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| ShweHope99.9998
Forum Fanatic
Topics: 12
Posts: 2,686
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ED , will come back to discuss case 34 & other later , still week end fun, tmr work, then work .
So MAy be Wednesday will be back, but will see can pop in in between .
Have a good study or not week end sis & friends
GL
ps Ed .. with Papi, Mr. B . I am very sure...... u're looking , actually I am looking at the very C. Yang with flying color especially in the patho, physio that a good foundation for ur clinical .. to st 2, CS, st 3 & in your practice too .... money sound ... ca..ching, ca.. ching , so amy lives have been saved ...... by Edie Yang-Papi-BArone like long tittle after MD, fellowship, etc
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Here is a similar from cases:
Case # 74
A physician became sexually involved with a current patient who initiated or
consented to the contact. Is it ethical for a physician to become sexually involved?
Answer No.
Sexual involvement between physicians and former patients raises
concern. The physician should discuss with a colleague or other
professional before becoming sexually involved with a former patient. The
physician should terminate the physician-patient relationship before
initiating a romantic or sexual relationship with a patient.
Hmmm, last sentence like option 'C' 
Have a good Sunday, Shwe, do pop-in if you can!
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Another ethics quickie:
A doc who is anti-abortion does an ultrasound on a pt who has 5 kids, learns she is now 7 weeks pregnant, and says she does not want to have any more kids, wants an abortion and tubal ligation done. The doc tells here that he would not be able to do the abortion, but can refer her to another that will. He visualizes the image of the fetus and turns the screen toward the patient and points out the fetal heartbeat to her and the observing 3rd-year medical student. Is this unethical?
This is one I got from a friend on her ob-gyn rotation. Her attending did this to a pt. Opinions?
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| mytime
Go Marching in!
Topics: 40
Posts: 3,177
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Hey btw they don''t ask abortion cases in ethics coz it's a cotroversial issue in US.
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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mytime wrote: Hey btw they don''t ask abortion cases in ethics coz it's a cotroversial issue in US.
Thanks, MT, I didn't know that.
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| ShweHope99.9998
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Posts: 2,686
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But , that OG , I do not think is unethical, unless ........
1. pt said .. she did not want to see it , then OG sh Not show as point it to pt but... then OG can show it to student , but not pt, but if pt face same direction , no way student can move around to see it, then OG sh request pt for teaching purpose with her close her eyes or , pt not agree I think , no choice [ only in North America, not in country we came from, ie no issue, Qs re teaching or , pt right .. no pt do use their rt strongly or do not know to use or do not bother ] , no student can get to see the U/S . But even in here north america , pt are usually cool if for teaching, but some do refuse ... so student cannot evn get the case for study or ask Qs, Hx.
2. OG , show U/S to pt to persuade her or push her or blame her directly or indirectly to let the baby live, so no abortion to happen ...... that will b unethical ?? or only after pt.. OG discuss well, pt has final word .. for abortion .. then .. OG still pushing to have no abortion than ,that is truely unethical , i guess.
But for sure OG will, sh transfer pt to other if OG do not want to do abortion.. but not sure is ethical or not, but v. funny is re... ethical all are mostly on side of pt .... like consumers always rt , we provider have no rt .......... like pt abuse us , we have no rt or sue back [ not money , it's moral, respect, reputation , good name to maintain], but not the case if the other way around pt compliant to Drs to sue DOCS .
Really not the way we come from, no one sue each much , all in trust & respect .
Anyway , got to go .
GL
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| ShweHope99.9998
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Ed , here may b ok, in real life better keep self ur believe of re abortion or not, very touchy & untouchable that already killed so many physician ..... bigger than Euthenesia ?? [ Dr Death ] spelling pl.
The abortion clinic get destroy , etc, OGs do abortion got killed, life threatening etc, in here also ralley or demonstarion or strike as regularly with heavy police in between 2 groups with different strong sensitive believe.
So stay away from that crowd & inbetween & stay away discussing it openly loudly in public I guess for safety , avoiding the unwanted danger .
GL
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| medocuk
IM-RES
Topics: 26
Posts: 1,467
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No there is nothing un ethical about donating the money. The intention behind the donation would have to be taken into consederation. Is the physicians research paper involved.Is he advocating the new procedure to be incultated in the system for his monetary benefits.
Or so I would think.
edie wrote:
Here's another before I go:
You have a 17-year-old pt that has a severe spinal deformation since birth that greatly impedes her quality of life. You learn that a new surgical procedure with a 65% success rate would benefit the patient, but her insurance will not cover it, and it is extremely expensive. You decide to anonomously donate the money for the surgery. Is this unethical?
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| medocuk
IM-RES
Topics: 26
Posts: 1,467
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I don't think physicians should impose their personal beliefs choices or preferences on their patients according to step one. Also to turn down a patient because of one's belief would be considered abandonment.
I agree with MT we wouldn't have such a question but yes it is unethical
About the previous answer between a and e...I rememeber reading because u too are attracted to the patient it would be best to give up the patient.
But yeah I get a handsome bloke wanting to fall over me.. I willl really have to rethinks my ethics. :P
edie wrote:
Another ethics quickie:
A doc who is anti-abortion does an ultrasound on a pt who has 5 kids, learns she is now 7 weeks pregnant, and says she does not want to have any more kids, wants an abortion and tubal ligation done. The doc tells here that he would not be able to do the abortion, but can refer her to another that will. He visualizes the image of the fetus and turns the screen toward the patient and points out the fetal heartbeat to her and the observing 3rd-year medical student. Is this unethical?
This is one I got from a friend on her ob-gyn rotation. Her attending did this to a pt. Opinions?
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| edie
I can, and I will.
Topics: 26
Posts: 1,202
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Shwe, my friend felt that the doc showed the patient with bad intentions, and considered the move unethical, as Med pointed out. As far as the referral, that was not considered unethical, and was not a Catholic hospital, but public university one.
Managed to finish up part 3 of form 3, scored 34/50. Didn't get to part 4, had to help hubby with something earlier. Am now fed, watered and ready for the next leg in the studying. Will do part 4 tomorrow. Now am about to listen to Barone's respiratory lecture, with Goljan on the desk, of course
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| ShweHope99.9998
Forum Fanatic
Topics: 12
Posts: 2,686
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Ed, as I explain b4 if OG has the hidden agenta, intention of harm pt's feeling as blaming her for to have abortion, that is unethical , does not matter OG's believe . Since this is real life, with real person at side as ur friend feel like that, pt will too, & OG self will too, like .. when some one speak of sweet voice, word but that voice even u can sense it it is true or not so, u will sense as human instict as it is rt r wrg . So I'm sure if ur friend felt like that it must b like that .
Now is just the abortion case , but in real life , so many Drs, health care staffs in any part of world will do .. no harm to pt , but here also will do no harm to self like this conflict believe by refer pt to others eg here is abortion, some other are like smoking pt not listen to u to stop smoking , & pt or Doc believe in herbal or naturalopath or traditional in ethinic med health practice, spiritual way etc.
Ed , one thing I cannot understand is, that pt preg one why she go to the OG disbelieve in abortion practice at the 1st place to get choose abortion if she is pregnant, abit tricky u think . Anyway , NOT in exm , so will stop it here .
Re: abandon pt from ur care MDU , if pt is not in life & death situation , I think, pt's belives or ur believes not agree pt or u will move on to another, so be it .
But like study, books, courses choices, we all has own believe , choices but as a Physician we usually , not show any , & will do care , do No harm in ethical point of view .
Has so many romantic story even among Doc to much younger med student , some are XY in the younger one & they all still live happily together at their beyond golden age .
Ed , see u have a very fun study by having Papi, Barone side by side as ur left & right person . Great , show them whose the boss
GL
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