Please don't tell me if it is cancer - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Medicolegal and Ethics Please don't tell me if it is cancer

You are caring for 65-year-old African American man in the inpatient wards of a hospital. He was admitted for shortness of breath and initially diagnosed with a COPD exacerbation. A routine chest-X-ray revealed a large hilar mass and CT scan confirmed the presence of four centimeter mass in the right hilum. While consenting the patient for a bronchoscoopy and biopsy, the patient tells you ,"Doc, please don't tell me what they find because if it's cancer, I don't want to know." Which of the following is the most appropriate reply to this patient's request?

A. "I will need to get a psychiatric evaluation first to decide if you are competent to make decesions"

B. "Do you have any family members who you would like to make further decesions about your health"

C. "you are competent to make all health care decisions,so i am ethically and legally obligated to share your health informations with you"

D. "if you do not want to know the results ,then i will unable to do the procedure because there is no point in it"

E. "tell me more about your depression"

Help pls, its a UW question and i couldn't understand it

Thanks
Reply With Quote Quick reply to this message
The above post was thanked by:
sukar (02-03-2012)



  #2  
Old 02-03-2012
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 177
Threads: 33
Thanked 86 Times in 16 Posts
Default

I guess c shud be correct.
Reply With Quote Quick reply to this message
  #3  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 761 Times in 256 Posts
Reputation: 772
Default

in such cases...... the answer choices will have one of the following options
you shud pick them in this order



1st look for answer that says------ tell me more about why you dont want to know?

(open ended question.. will allay the patients fear.... best choice answer)



if not then
2nd---- has the patient specified... EVEN NOT INFORM TO FAMILY??
if yes then say --- OK I WILL NOT INFORM YOU OR FAMILY

(cos patient has the right to refuse treatment or any medical advice)
*specially if it is something like cancer.. which the patient knows he has... or high suspicion... or metastasis/recurrence*


if he has said only DONT INFORM ME

then ask him who can make decisions on his behalf for his treatment
Reply With Quote Quick reply to this message
The above post was thanked by:
Amenah (02-03-2012), docusmle9 (02-03-2012), misha_america (01-24-2014), step_enhancer (02-03-2012), sukar (02-03-2012)
 
  #4  
Old 02-03-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 876 Times in 507 Posts
Reputation: 889
Default

B is correct.
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
  #5  
Old 02-03-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

I think its E ....... you need to know why he doesnot want to know abt it , why is he depressed ??????? it might not be cancer .... so the right ans is usually to encourage discussion ....
Reply With Quote Quick reply to this message
  #6  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 644 Times in 408 Posts
Reputation: 654
Default

its either B or D
i think B.
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message
  #7  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 761 Times in 256 Posts
Reputation: 772
Default

Quote:
Originally Posted by Hitman View Post
I think its E ....... you need to know why he doesnot want to know abt it , why is he depressed ??????? it might not be cancer .... so the right ans is usually to encourage discussion ....

yup
but with E.. u are jumping to a conclusion that the pt has depression?

how can u prove that to a pt.. on the contrary pt might stop answering you.. become hostile if u confront him like that
Reply With Quote Quick reply to this message
The above post was thanked by:
step_enhancer (02-03-2012)
  #8  
Old 02-03-2012
doxorubicin's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 391
Threads: 98
Thanked 161 Times in 98 Posts
Reputation: 171
Default

i would go with B. for the same reason mbbs2010 has given.

though i have come cross such a q in nbme but there was a option that ok i will not inform you of result.
__________________
if ur ready to learn......world is ready to teach...take d leap!!
Reply With Quote Quick reply to this message
  #9  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

The correct answer is B

uw explained this Question poorly

@mbbs2010 why "then ask him who can make decisions on his behalf for his treatment" ,the patient has refuse to be informed of Dx ,then why he is asked about further decisions.

he will probably die of cancer ,then still somebody will make decisions for him.i find it strange . . . .
Reply With Quote Quick reply to this message
The above post was thanked by:
sukar (02-03-2012)
  #10  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 761 Times in 256 Posts
Reputation: 772
Default

Quote:
Originally Posted by step_enhancer View Post
The correct answer is B

uw explained this Question poorly

@mbbs2010 why "then ask him who can make decisions on his behalf for his treatment" ,the patient has refuse to be informed of Dx ,then why he is asked about further decisions.

he will probably die of cancer ,then still somebody will make decisions for him.i find it strange . . . .
Cos the patient has said DON'T INFORM ME...
He hasn't said I DON'T WANNA BE TREATED ... Irrespective of the diagnosis.
Reply With Quote Quick reply to this message
The above post was thanked by:
misha_america (01-24-2014), step_enhancer (02-03-2012), sukar (02-03-2012)
  #11  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Quote:
Originally Posted by mbbs2010 View Post
Cos the patient has said DON'T INFORM ME...
He hasn't said I DON'T WANNA BE TREATED ... Irrespective of the diagnosis.
okay so he doesn't want to know the Dx ,but he will/may receive treatment.....okay .yah u r right .thanks a lot .this question is weird ,i have not come across such a rule.
anyways thanks
Reply With Quote Quick reply to this message
  #12  
Old 02-03-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Quote:
Originally Posted by mbbs2010 View Post
yup
but with E.. u are jumping to a conclusion that the pt has depression?

how can u prove that to a pt.. on the contrary pt might stop answering you.. become hostile if u confront him like that
well he is not a positive guy who would face the problem and deal with it , instead he is sad and negetive from before that its cancer ....

in this case if there i would have selected the option of not informing the patient , but since its not there .. you cannot ask the competent patient for his relatives who would take decision on his behalf ... infact he will become more hostile and tell you that he like to take his own decisions ...

its not about what patient thinks or will say ... its about playing with medical rules we should follow ... so the first rule is to respect his decision and privacy ..... you cannot go ahead and share his information with his relatives if doesnot want to hear them ....

the best way is to initiate a discussion , may be he might say No doctor i am not depressed or he might express his fears to you ..... that is what usmle wants i guess , rest BS is strange .....
Reply With Quote Quick reply to this message
  #13  
Old 02-03-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 761 Times in 256 Posts
Reputation: 772
Default

Well I checked ... N the answer is B.
It's a uworld question.


And thats the reasoning they hv given too.
Reply With Quote Quick reply to this message
  #14  
Old 02-03-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

oops ....... another BS Qs wrong .......

nice call Mbbs 2010 .......
Reply With Quote Quick reply to this message
  #15  
Old 02-03-2012
USMLE Forums Master
 
Steps History: Not yet
Posts: 590
Threads: 8
Thanked 239 Times in 192 Posts
Reputation: 249
Default

Quote:
Originally Posted by Hitman View Post
well he is not a positive guy who would face the problem and deal with it , instead he is sad and negetive from before that its cancer ....

in this case if there i would have selected the option of not informing the patient , but since its not there .. you cannot ask the competent patient for his relatives who would take decision on his behalf ... infact he will become more hostile and tell you that he like to take his own decisions ...

its not about what patient thinks or will say ... its about playing with medical rules we should follow ... so the first rule is to respect his decision and privacy ..... you cannot go ahead and share his information with his relatives if doesnot want to hear them ....

the best way is to initiate a discussion , may be he might say No doctor i am not depressed or he might express his fears to you ..... that is what usmle wants i guess , rest BS is strange .....
I agree!
Also, some patients just dont want to know the results immediately and might want others to listen to it and then later want to listen to what the case is when they are calm. Infact that happens to us even for little things like finding our score. Sometimes we make our friends check it when we are scared and later tell them "just tell me now". So its one of those cases...
Reply With Quote Quick reply to this message
The above post was thanked by:
Hitman (02-04-2012)



  #16  
Old 02-04-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 761 Times in 256 Posts
Reputation: 772
Default

Quote:
Originally Posted by Hitman View Post
oops ....... another BS Qs wrong .......

nice call Mbbs 2010 .......
i got this question wrong both times it came up on uworld! lol
was so annoyed...
thats how i remember it

anyways.. better wrong on uworld or here than on the exam
Reply With Quote Quick reply to this message
The above post was thanked by:
Hitman (02-04-2012)
  #17  
Old 02-04-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Quote:
Originally Posted by mbbs2010 View Post
i got this question wrong both times it came up on uworld! lol
was so annoyed...
thats how i remember it

anyways.. better wrong on uworld or here than on the exam
hahaha same thing happened to me
Reply With Quote Quick reply to this message



Reply

Tags
MedicoLegal-Ethics, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
cancer jaik USMLE Step 1 Forum 0 08-22-2011 08:57 AM
Man with breast cancer bebix USMLE Step 1 Forum 17 07-06-2011 11:18 AM
Testicular Cancer aksyonez USMLE Step 2 CK Forum 3 06-21-2011 02:34 PM
esophageal cancer Seetal USMLE Step 2 CK Forum 1 04-22-2011 11:28 PM
Cause of cancer cachexia alindawater USMLE Step 1 Forum 1 07-28-2009 08:17 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)