kukaus
Forum Junior
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i just did NBME2 and i had a question about doctor-patient confidentiality. can't reproduce exact words but here you go :
A married man comes to see his physician after 2 week trip with dysuria and purulent urethral discharge. You diagnose STD and prescribe treatment. next day his wife calls to your office and says " My husband saw you yesterday, does he have an STD?" what is your best reply?
a. i advice you to see a GYN doctor asap
b. i can't tell you without your husband's permission
c. ask your husband
don't remember the other options but i'm sure it's one of these. i answered b but since STD is one of the exceptions where you break patient's confidentiality i was not sure i did right. your opinion please?
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| shazbaz
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of the 3..i would've gone with B too...i think by picking A..the doctor is telling by not telling directly...and c is basically b more rudely. I think for STD you do have to tell..but not over the phone..and i think when both are present. thats my opinion
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| iskos
Forum Newbie
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kukaus you did not do that right.
In this case you can break confidentiality of your patient ,because doing so you will prevent harm to others. DOCTOR HAS TO SAY TO HIS WIFE ABOUT STD without asking any permission of his patient.
From these 3 i would pick A, becouse if you advice to see gyn. it means you let her wife know about her husband condition.
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| kukaus
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agreed. the only thing that stopped me from picking choice A is that it was over the phone. i think you don't tell news like this, especially to obviously upset wife over the phone. and that "see gyn asap" kinda made it sound too hysteric. anyway thank you for your opinion, i appreciate
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| iskos
Forum Newbie
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but it does not matter it was or not ,it was someone who is sleeping with patient,so has to tell her ,b/c she might have disease too
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| dream2liv
Forum Newbie
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it shud be a ..or a better option wud be the physician answering the wife directly that she may be having and that her husband has ..for the std comes under the exception of confidentiality ..as foremost is u have to prevent harm to others thru the patient ...
 may be i am right
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| match2010
Forum Senior
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i would go with B ....cuz the patient privacy is doctors ultimate job and the patient here is the husband and not the wife ....
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| maoudoody
Forum Guru
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" b"
your patient comes number one.....choose ur patient comfort overeveryone else
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| sigh
Forum Elite
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I did chose answer B too on my NBME. If you look at FA you will find exceptions for confidentiality...I think, you need to report STD to local Health Department and maybe they will follow up with pt's wife...
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| SpeaksSoftly
Forum Senior
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I was just reviewing this one the other day. No matter if the patient has HIV or a treatable STD patient confidentiality superceds all. I disagree on a personal level but even if the patient is married you cannot tell the spouse, frankly I think the law needs to be amended on this.
Different states have different practices once the information is reported to the CDC ( in mandatory reported cases such as HIV). Some will inform the partner(s) they should be tested but will not disclose why. Some states only reports the case to the CDC and othewise the unsuspecting victims (partners) are at risk. Mandatory reporting does not mean mandatory disclosure to the sexual partners, it means you have to report the numbers but not the personal identifying information.
One of the options was to counsel the patient to disclose the information to the spouse and to advise the spouse that information cannot be shared. Totally sucks but there you have it.
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