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  #1  
Old 08-16-2011
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Medicolegal and Ethics Patient threatens to sue if you tell his ex-wife!

Your paticnt has just recently been diagnosed with familial adenomatous polyposis (IAP). This disorder is chronic, progressive, and fatal. There is a genetic test that can tell whether children of parents with the disease will develop it. The test is very accurate. The patient has become divorced and refuses to give you his consent to inform his ex-wife who now has custody of their three children. He threatens to sue you if you reveal elements of his medical care to his ex-wife. What should you do?

A) Respect the patient's right to confidentiality.
B) Transfer the patient's care to another physician as long as the patient agrees.
C) Ask the health departnent to inform the patient's ex-wife about the disease risk.
D) Seek a court order to inform the patient's ex-wife.
E) Inform the patient's ex-wife of the risk to the children.
F) Inform the ex-wife's doctor.
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Old 08-16-2011
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my guess is A, as there is no acute risk for anyone
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Old 08-16-2011
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I think it shud be E) Inform the patient's ex-wife of the risk to the children.

you're trying to stop harm to others. by getting the children to take genetic testing you can find out if they carry the mutation or not.
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Old 08-16-2011
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I would go with choice A,

Doctor-Patient Confidential can only be broken when his disease falls in the Reportable Disease Category (SSSMMART Chick is Gone, 2010FA pg 58)or he is a psyc patient that is planning out a crime on some one (notify police and the person whom the crime was planned be on).

In this case, since its FAP, you cannot violate the doctor-patient confidentiality.

If there was an option for COUNSELING THE PATIENT TO TELL THE EX-WIFE HIMSELF, then that would be a better choice.
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Old 08-16-2011
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Quote:
Originally Posted by docspeed786 View Post
I would go with choice A,

Doctor-Patient Confidential can only be broken when his disease falls in the Reportable Disease Category (SSSMMART Chick is Gone, 2010FA pg 58)or he is a psyc patient that is planning out a crime on some one (notify police and the person whom the crime was planned be on).

In this case, since its FAP, you cannot violate the doctor-patient confidentiality.

If there was an option for COUNSELING THE PATIENT TO TELL THE EX-WIFE HIMSELF, then that would be a better choice.
hmm ok but if you find out that a patient of urs has a possibly fatal disease and by genetic testing others can increase their prognosis or u can start the family members on prophylaxis, wouldn't that be a better choice ethically?
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Old 08-16-2011
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A) Respect the patient's right to confidentiality.
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Old 08-16-2011
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the answer is a i think but if it was me i would go with d to avoid all d hassles lol
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A) Respect the patient's right to confidentiality.
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Old 08-16-2011
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i think is E. I should warm them..and i think i should be protected from any sue.
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I think the answer might be A)

Because increased detection doesn't mean increased survival. Even if the children happen to have that genetic abnormality, there's nothing they can do regardless.
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i think it's E. if the ex-wife has the custody of children she has to be informed. but D is a good option too
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Old 08-17-2011
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Correct Answer correct answer E

The patient's right to confidentiality ends where it comes into conflict with the safety of other people. The right to confidentiality is extremrely strong, but it is not universal and absolute. In this case, the children of the patient have a right to know whether their lives will be cut short by the disease if familial adenomatous polyposis (FAp) and colon cancer The most important element is that screening for polyps should begin at the age of 12 with screening sigmoidoscopy every year. Colectomy needs to
be done if polyps are found. Hence, in FAP there is a very specific intervention that can prevent colon cancer and a very specific screening that can be done. ln addition,
the mother has a right to know whether her children will become ill and how to plan for that. If a child falls and breaks his leg, ole parent cannot claim confidentiality as a reason to withhold this critical health information from the other parent. As a part of divorce, the stipulation that each parent must inform the other parent of health care issues for the children as they arise is a standard part of the agreement. Although, in this case, the health care issue involves the private health of one parent, the issue is still pertinent to the other parent as the caregiver of the children.
The right to one person's to privacy is not as important as the right of another person to safety. This is established standard and does not require a court order. you will have more liability from the mother of the children if she is NOT infomed than from violating the confidentiality of the patient to inform. She can successfully pursue a legal action stating you, the physician, did not inform her that her children were at risk of the "injury" of the genetic disease
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  #13  
Old 08-17-2011
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Quote:
Originally Posted by drnirajmavani View Post
The patient's right to confidentiality ends where it comes into conflict with the safety of other people. The right to confidentiality is extremrely strong, but it is not universal and absolute. In this case, the children of the patient have a right to know whether their lives will be cut short by the disease if familial adenomatous polyposis (FAp) and colon cancer The most important element is that screening for polyps should begin at the age of 12 with screening sigmoidoscopy every year. Colectomy needs to
be done if polyps are found. Hence, in FAP there is a very specific intervention that can prevent colon cancer and a very specific screening that can be done. ln addition,
the mother has a right to know whether her children will become ill and how to plan for that. If a child falls and breaks his leg, ole parent cannot claim confidentiality as a reason to withhold this critical health information from the other parent. As a part of divorce, the stipulation that each parent must inform the other parent of health care issues for the children as they arise is a standard part of the agreement. Although, in this case, the health care issue involves the private health of one parent, the issue is still pertinent to the other parent as the caregiver of the children.
The right to one person's to privacy is not as important as the right of another person to safety. This is established standard and does not require a court order. you will have more liability from the mother of the children if she is NOT infomed than from violating the confidentiality of the patient to inform. She can successfully pursue a legal action stating you, the physician, did not inform her that her children were at risk of the "injury" of the genetic disease
Is this given in any book, I mean the way you have described Dr Niraj?

Also what are the recommended reading material for Ethics ?
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  #14  
Old 08-21-2011
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Quote:
Originally Posted by indigo View Post
Is this given in any book, I mean the way you have described Dr Niraj?

Also what are the recommended reading material for Ethics ?
this is from medical ethics by conrad fischer...
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