12-28-2008, 03:30 AM
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