NBME F5 S4 informing pt of dx

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NBME F5 S4 informing pt of dx

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10 Posts

clar697
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07/08/08 - 09:33 AM

A 74-year-old woman is brought to the physician by family members who are concerned because she has been losing weight. She has a history of chronic anxiety and dysthymic disorder. An x-ray of the chest shows a large central mass. Unresectable lung cancer is diagnosed. The woman is capable of making an informed decision, but her family asks that she not be told the diagnosis because they feel the news will hasten her death. Which of the following is the most appropriate response?

A) Tell the family it is uncomfortable continuing as her physician under these circumstances and suggest alternative physicians they might consult

B) Tell the patient about the x-ray findings, refer her to an oncologist, and consult with a risk management attorney

C) Tell the patient that her test results are available for discussion if she wishes

D) Tell the patient that she should be referred to an oncologist for a second opinion and inform the oncologist of the dilemma

E) Tell the patient that the x-ray is abnormal and that she should see a specialist

I chose E. Any suggestions?

SpeaksSoftly
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07/08/08 - 09:49 AM

This has always been a tough one because I found contradictory responses. In the rare event that it will cause the patient more harm by telling them they have a terminal illness (unresectable tumor) then the USMLEWorld said to consult with another physician and if it is deemed more harmful then do not disclose the information. (beneficience vs malfience)

But I see that is not an option. Since she is competent and her family feels it will do her harm I would think C would be the correct answer. That was the patient can decide if she wants to hear bad news or not. Sometimes the patient would prefer to remain in the dark and this gives her the option to chose. This also would let you off the hook in the case of the family because the competent patient directly tells you if she wants the results or not.

atulkalanuria
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07/08/08 - 01:19 PM

yeah C looks to be correct

drms
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07/08/08 - 03:18 PM

C

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cool02
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07/12/08 - 09:45 AM

ans to this is C.
100% sure
coz it offers a competent pt a choice whether she want to know bout her test result or not.
this way u r neither hiding any info from her nor disclosing the info without her consent.

yousefreda
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07/13/08 - 11:29 PM

wow all the options are referrals to other physicians.. u should never ever choose any of those choices when you are competent enough to make the decision on ur own.. here c seems like the only normal option

yousefreda
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07/13/08 - 11:31 PM

"unresectable cancer has been diagnosed" that tells u theres no needs for refering to other people if u knwo the dx cool

DRFP
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10/27/08 - 01:25 PM

yousefreda wrote:
"unresectable cancer has been diagnosed" that tells u theres no needs for refering to other people if u knwo the dx cool

That would be wrong, you never ever assume that something is not treatable when you are not the specialist, it is clear you are not in this case.

Referring would be correct but for this I think C is correct too, the patient needs to decide about what to do too.

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a3112
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10/27/08 - 01:27 PM

i also think C

vaibhavbora
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11/22/08 - 11:12 AM

#10

c ,, pt has right of what he wants to know

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