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  #1

You are on call for the medical services and a nurse pages you to ask you to come speak with the family of one of the patient's. The patient is not your own, but one that you are cross covering for the evening. You know that the patient carries a new diagnosis of widely metastatic pancreatic cancer. On arrival to the floor, three members of the patient's family greet you. They are somewhat confrontational and are very insistent that their father not be told of his diagnosis. When you attempt to discuss with the family the reasons for this, they continue to demand that you agree and threaten to sue you and the hospital if you or any other members of the team inform their father, the patient, of his diagnosis. The most appropriate course of action at this time is to
A. defer any discussion on the point until you talk with other members of the team
B. tell the family that the patient will be told his diagnosis and they need to be more supportive of their father
C. tell the family that the physician caring for the patient will talk with them in the morning
D. tell the family that you will agree to their demands
E. tell the family that your obligation is to the patient, not to them




  #2

answer-e

a--the team-part of being an MD is sometimes giving "bad news"and making big decisions.
b-not supportive and is being possibly even confrontational to the family.
c-this is called in slang "turfing" or "passing the buck" and LARGE part of the job is being able to effectively communicate.
d-is plain incorrect, showing weakness, the 1st obligation is the patient!


  #3

agree w/ E. Your obligation is to your patient. You have to assess the patient if he wants to know about his diagnosis & go from there.





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