dr.shar
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An 80-year-old Asian woman is hospitalized with weight loss, generalized weakness, and a pulmonary mass. Work-up reveals that she has pulmonary tuberculosis. Her family approaches the physician and asks that the patient not be told, stating that in her upbringing in mainland China tuberculosis was considered fatal and to tell her would be like giving her "a death sentence."
Should you respect the family's concerns?
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| aash
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no
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| suchi
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yes
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| dr.shar
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yes is probably correct, i dont know why...
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| ardae
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I think not. Patient has the right to know.
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| docarjun
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even i think the answer should be know.Patient should be explained all the things.
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| docarjun
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even i think the answer should be no.patient should be exaplained all the things in detail.nothing should be hidden.
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| Bela
Forum Guru
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How could the answer be YES?
As the others are saying, the dr. cannot hide any information from the patient. And to be quite honest, the family is not supposed to know the diagnosis before the patient does or allows them to get the info.
My answer is NO.
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| ghcristina
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Knowing that she has a "fatal" disease would do more harm to the patient than knowing that she has to rest and to take several drugs. It seems that she "cannot take it". So, do NOT tell her.
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| PsychDr2B
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The answer could be yes, because on the exam you are not to reject a patient's folk medical practices and beliefs. Secondly, the physician should weigh the risks and/or benefits of what should be done for the patient. If the risk for harming the patient by telling her she has TB is higher than the benefits, then the answer becomes clear.
HOWEVER!!!!!
Please see page 218 in BRS Behavioral Science 3rd Edition (Copyright 2000, Lippincott, Williams & Wilkins) by Barabara Fadem. To paraphrase: There are special situations related to Informed Consent. While all... medical findings are... provided to patients, a doctor does not have to relay findings immediately if doctor believes such knowledge will adversely affect the patient's health. The doctor can delay telling the patient the diagnosis until the patient indicates that he or she is ready to receive the news. The opinions of family members as to whether to tell the patient the diagnosis and prognosis ARE NOT RELEVANT.. So I think to answer the question "Should you respect the family's concerns?" I would now say NO! You should ask the patient if she is ready for her diagnosis, NOT the family members.
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| ambreen
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the answer is no
pt. should be explained
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| GS
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I too feel the answer is no
firstly u cannot tell the family the diagnosis before the patient.patient decides whther his family should know and not vice versa
secondly u can ask the patient if he is ready for the diagnosis and withheld till the patient is ready but that does not mean that u tell the family the diagnosis and look out for their opinion .their opinion does not matter since the patient is an adult
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| indianf81
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i think the pt shudnt be told. i agree with dr.psych.
its clear that telling the pt the diagnosis wud b detrimental to her health.
in such case, delaying the process of telling the pt till absolutely neccessary wud b a option
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| Renegade
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"indianf81" wrote:
its clear that telling the pt the diagnosis wud b detrimental to her health.
Clear?! Oh for crying out loud... what makes you think that's so hard for the pt to understand that she's not in China anymore, and in the US they have great chances to heal such diseases? Don't treat her like she's dumb. If explained properly, there's nothing to worry about.
I admit that if the pt is old, and has proven to be very, huh, supersticious :?: and stubburn, she might not believe her own doctor, and get scared, which would jeopardize the treatment (especially TB, where the pt mustn't give up at all costs). But those must be faced as exceptions.
How do you expect your pt to trust you, if you don't trust her in the first place?
Sorry if I got a bit nervous here. It's just that, unless the question specifically tells you to, you gotta take chances and trust the pt... that's the basis of western medicine.
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| doctor_tanya23
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the answer is yes.
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| peacekeeper1
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the answer is YES..
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| SMALLFIDGET
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First - the "adult" patient has the right to know everything even if the family is against.
Secondly, in BRS (Fadem 3rd ed. p219) it is clearly mentioned -- "doctor does not have to relay findings immediately if doctor believes such knowledge will adversely affect the patient's health. The doctor can delay telling the patient the diagnosis until the patient indicates that he or she is ready to receive the news. The opinions of family members as to whether to tell the patient the diagnosis and prognosis ARE NOT RELEVANT."
So, now you see why the answer is NO to "Should you respect the family's concerns?"
One should ask the patient if she is ready for her diagnosis, NOT the family members.
P.S: Let me share a joke!
Rule1: Patient is BOSS!!
Rule2: When in doubt, refer to Rule1.
Hope that helped :P
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VR.
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| miky
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Since TB is a highly infectious disease, I presume that some of his family members might be infected as well but they do not present the symptoms yet. So, would it be righteous to apply the same principle to them?
Besides, TB is usually fully curable with proper tx although it might be quite a problem in this patient (old & from an area with a high incidence of multidrug resistant TB !!!!!!!!!!)
I think we should inform the patient about his condition and therapeutical protocols used, then wait for his decision. However, even he declines therpay, we should insist that he follow the full regimen and even appeal to justice in case he proves non compliant.
I think nobody likes to have around a person with a MDR TB and become infected.
I myself had some patients with MDR - TB and believe me, it's not so pleasant to know that you might also become infected and there are few and expensive drugs to cure that.
:cry:
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