darkhorse
Forum Elite
Topics: 56
Posts: 275
|
A married 64-year-old man comes to the office because of a purple lesion on his nose. He says that the lesion started out as a "small dot" about 3 months ago, and it has been "growing exponentially" ever since. He is a retired physician who has been married to his high school sweetheart for 42 years. Physical examination shows a 3-cm reddish-purple nodule on the right side of his nose and generalized lymphadenopathy. You suspect that the lesion is Kaposi sarcoma and the lymphadenopathy is due to an HIV infection. You gently approach the issue and he reluctantly admits to "visits" with prostitutes. After a long discussion he finally consents to HIV testing. The results of the ELISA and Western Blot, which return in 2 weeks, show that he is infected with HIV. His CD4 count is 158/ml. He comes into the office to discuss the results and begs you not to tell his wife, who is also your patient. He says that hearing what he has been involved in "will kill her". You remind him that HIV may also "kill her." The most appropriate first step is to
A. contact his wife anonymously and tell her that she has been exposed to HIV
B. contact the appropriate government health agency and report your findings
C. promise him that as his doctor you will respect his privacy and maintain confidentiality
D. promise him that you will keep the results confidential if he agrees to use condoms with his wife
E. try to persuade him to voluntarily discuss the issue with his wife
___________________
When going gets tough, the tough gets going
|
| me007
Forum Guru
Topics: 72
Posts: 803
|
e.
|
| plastic_surgery
Forum Junior
Topics: 2
Posts: 135
|
E.
|
| drdg
Forum Senior
Topics: 31
Posts: 176
|
But on the other hand, AIDS is a reportable disease, which means you need to report it to the appropriate government health agency and report your findings first. I will go for B.
|
| chemamr
Moderator and PGY2
Topics: 703
Posts: 4,442
|
tricky, agree with drdg's point of view. you could choose more than 1...
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| cool doctor
Forum Junior
Topics: 1
Posts: 226
|
I go with E
|
| darkhorse
Forum Elite
Topics: 56
Posts: 275
|
The correct answer is E. Physicians must violate confidentiality and warn third persons about the danger of HIV infection if the patient is unwilling to inform the person himself. Before informing third parties, the physician should try to do everything possible to persuade the patient to voluntarily discuss the issue with their partner. If the physician believes that an individual may really be saved from a deadly infection, confidentiality should be violated.
It is inappropriate to contact his wife anonymously and tell her that she has been exposed to HIV (choice A). First, it is best to try to persuade him to voluntarily discuss the issue with his wife. If this is unsuccessful, the physician has the duty to violate confidentiality.
It is necessary to contact the appropriate government health agency and report your findings (choice B) so that they can track patient contacts. However, it is best to first try to persuade the patient to voluntarily discuss the issue with his partners himself. It is still necessary to notify the appropriate health agency, even if the patient agrees to tell his wife.
You cannot promise him that as his doctor you will respect his privacy and maintain confidentiality (choice C) or promise him that you will keep the results confidential if he agrees to use condoms with his wife (choice D) because you have the duty to warn third parties about HIV infection. HIV and AIDS are infectious diseases designated as notifiable at the national level
___________________
When going gets tough, the tough gets going
|
|
| |
| | | | | | | |
