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+--- Thread: NBME form2Q, "bad news." - nida (/showthread.php?tid=153954)
NBME form2Q, "bad news." - nida - ArchivalUser - 01-18-2007
A 72-year-old man is brought to the physician by his daughter because of painless jaundice for 1 month. His wife died 10 years ago, and his daughter is his only child. Before examining the patient, the daughter asks to speak privately with the physician and asks that she be given the results of any tests. She specifically requests that he not be given any "bad news." The patient is alert. His vital signs are within normal limits. Examination shows scleral icterus and jaundice. There is mild abdominal tenderness on palpation. He is oriented to person, place, and time. A CT scan of the abdomen shows a pancreatic mass with bile duct obstruction and probable metastatic lesions in the liver. Which of the following is the most appropriate next step?
A) Abide by the daughter's wishes
B) Ask the patient if he wishes to discuss his test results, preferably with his daughter present
C) Tell the daughter it is a legal requirement to tell the patient any and all results of medical testing
D) Consult with the hospital attorney
E) Ask another physician to take over the patient's care
0 - ArchivalUser - 01-18-2007
B) or C) ??
0 - ArchivalUser - 01-18-2007
its c
0 - ArchivalUser - 01-18-2007
ans: B
0 - ArchivalUser - 01-18-2007
c.
0 - ArchivalUser - 01-18-2007
I'd like to think ethics is my strong suit (he...). The answer is B.
It is not a requirement ro tell the patient all of medical results. If the pt says he does not want to know about his CT findings, he is afforded his right of ignorance.
0 - ArchivalUser - 01-19-2007
hey guys ,
just hav a look at this sequencce.
1) to tell the good/bad news , ptn an doc both should be in a calm serene surroundind, preferably, ward room
2) first ask the ptn wthat he feels/ thinks about his desease
3) then ask how much he wants to know about his conditn
4) warn him, if its bad news.`saying , the results have not com as good u had expectd'
5) based on how much ptn wants to know, u got top tell him. if he wants , his kith n kin to be thr, u can aloow them to be thr. If the ptn can comprehend the informatn, he shoukld be told first.
0 - ArchivalUser - 01-19-2007
C