Confidentiality question - 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 06-06-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Medicolegal and Ethics Confidentiality question

Your patient has just recently been diagnosed with familial adenomatous polyposis (FAP). 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 a 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 department 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

Reply With Quote Quick reply to this message



  #2  
Old 06-06-2012
numbndumb's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 529
Threads: 57
Thanked 283 Times in 151 Posts
Reputation: 293
Default

i think its E.
__________________
I've become so numb
Reply With Quote Quick reply to this message
  #3  
Old 06-06-2012
sachinkumar's Avatar
USMLE Forums Addict
 
Steps History: 1 + CK
Posts: 180
Threads: 41
Thanked 110 Times in 36 Posts
Reputation: 120
Send a message via Skype™ to sachinkumar
Default

i think it a)...whats the answer??
Reply With Quote Quick reply to this message
 
  #4  
Old 06-06-2012
sachinkumar's Avatar
USMLE Forums Addict
 
Steps History: 1 + CK
Posts: 180
Threads: 41
Thanked 110 Times in 36 Posts
Reputation: 120
Send a message via Skype™ to sachinkumar
Default

i just went through conrad's ethics book's confidentiality chapter....but still m confused. i still think the answer should be a)
Reply With Quote Quick reply to this message
  #5  
Old 06-06-2012
USMLE Forums Scout
 
Steps History: 1 + CS
Posts: 90
Threads: 23
Thanked 14 Times in 9 Posts
Reputation: 24
Default

Guess its A..... "Patient confidentiality"...... In regards of the children you cant withhold life saving interventions, BUT since this is a screening test then its doesnt fall n this criterion... Hope i recalled that correctly
Reply With Quote Quick reply to this message
  #6  
Old 06-06-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 673 Times in 317 Posts
Reputation: 691
Default

my answer would be A....
Reply With Quote Quick reply to this message
  #7  
Old 06-06-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default Hey

I would go with 'd'
Reply With Quote Quick reply to this message
  #8  
Old 06-06-2012
imgchuchu's Avatar
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 218
Threads: 4
Thanked 74 Times in 55 Posts
Reputation: 84
Default

in as much as you avoid getting court order in practise,i think its inevitable in this scenario.
option Ddd
Reply With Quote Quick reply to this message
  #9  
Old 06-06-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default correct answer :)

The correct answer is e) inform the patient's ex-wife of the risk to the children

Explanation:

The patient's right to confidentiality ends where it comes into conflict with the safety of other people. The right to confidentiality is extremely strong but it is not universal and absolute. In this case the children of the patient have the right to know whether their lives will be cut short by the disease of 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 polips 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. In 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 one 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 informed 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.
Reply With Quote Quick reply to this message
The above post was thanked by:
Joanna (06-07-2012)
  #10  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default Why Not 'd'??

Quote:
Originally Posted by Casandra View Post
The correct answer is e) inform the patient's ex-wife of the risk to the children

Explanation:
---------
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 informed 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.
Why not 'D'?? The mother gets to know about the condition and the physician avoids getting sued by the patient.
Reply With Quote Quick reply to this message
  #11  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default :)

Quote:
Originally Posted by claustrophobic View Post
Why not 'D'?? The mother gets to know about the condition and the physician avoids getting sued by the patient.
The answer is in the paragraph you quoted plus they urge us both in Kaplan and Fish's book not to choose "court" option in the exam.
Reply With Quote Quick reply to this message
  #12  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default .

Quote:
Originally Posted by claustrophobic View Post
Why not 'D'?? The mother gets to know about the condition and the physician avoids getting sued by the patient.
Additionally thing that kind of helped me to understand that question and not to pick D) option was:
if a patient has a syphilis/threatens to kill someone which basically means the patient is a threat for someone else's health/life, what do you do? You inform this 'someone else' or you alert health department to inform this person. You don't go to court for that.
Reply With Quote Quick reply to this message
The above post was thanked by:
dockhi (06-07-2012)
  #13  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default Dr.Daughtery

Quote:
Originally Posted by Casandra View Post
The answer is in the paragraph you quoted plus they urge us both in Kaplan and Fish's book not to choose "court" option in the exam.
The paragraph I quoted says liability would be less if he breaches confidentiality compared to if he doesn't tell the mother. If he goes through the court, there would be 'NO' liability and 'NO' liability is better than less liability.
Dr.Daughtery said the same thing about courts but he also explained the exceptions. One was Anorexia Nervosa patient who is 18+ and refuses to eat and second was when a life is in danger but the threat is not immediate like in this case.
Reply With Quote Quick reply to this message
  #14  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default Immediate threats

In the other two cases that you have mentioned the threat to someone's life/health is immediate. Intervention is needed on behalf of the physician in those scenarios as failure to do so may result in someone dying/getting syphilis.
Reply With Quote Quick reply to this message
  #15  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default .

Quote:
Originally Posted by claustrophobic View Post
The paragraph I quoted says liability would be less if he breaches confidentiality compared to if he doesn't tell the mother. If he goes through the court, there would be 'NO' liability and 'NO' liability is better than less liability.
yeah, that is true that "no" liability is better than just "less" of it. Maybe time is the factor here? W/o court you simply contact the wife and inform her right away. With court a bit of time could be wasted...?


Quote:
Originally Posted by claustrophobic View Post
Dr.Daughtery said the same thing about courts but he also explained the exceptions. One was Anorexia Nervosa patient who is 18+ and refuses to eat and second was when a life is in danger but the threat is not immediate like in this case.
But wasn't he referring to competency rather than confidentiality???
In the case you mentioned you go to court to eg. enable parenteral feeding not to enable letting other people know that the patient is anorexic.
Reply With Quote Quick reply to this message



  #16  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default

Quote:
Originally Posted by Casandra View Post
But wasn't he referring to competency rather than confidentiality???
In the case you mentioned you go to court to eg. enable parenteral feeding not to enable letting other people know that the patient is anorexic.
The reference was when does one go to court. The anorexia patient is a competence issue and the other one is a confidentiality issue.
Reply With Quote Quick reply to this message
  #17  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default .

Quote:
Originally Posted by claustrophobic View Post
The reference was when does one go to court. The anorexia patient is a competence issue and the other one is a confidentiality issue.
ok. so is gonorrhea an immediate or a not immediate threat?
Reply With Quote Quick reply to this message
  #18  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default .

Quote:
Originally Posted by claustrophobic View Post
The paragraph I quoted says liability would be less if he breaches confidentiality compared to if he doesn't tell the mother. If he goes through the court, there would be 'NO' liability and 'NO' liability is better than less liability.
Dr.Daughtery said the same thing about courts but he also explained the exceptions. One was Anorexia Nervosa patient who is 18+ and refuses to eat and second was when a life is in danger but the threat is not immediate like in this case.
I would say that if the children are at risk of developing chronic, fatal disease it is an immediate threat. I don't think of an immediate threat time-wise (if I don't call the wife, the children will die tomorrow) but more end-point-wise (if I don't call the wife the children may die because the proper screening test will not be performed).
Reply With Quote Quick reply to this message
  #19  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default Immediate

Gonorrhea is an infectious disease. A single exposure can result in a healthy person getting the disease. So it is an immediate threat.
On the other hand FAP is not an immediate threat to the life of the children.
Reply With Quote Quick reply to this message
  #20  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default OK

Quote:
Originally Posted by Casandra View Post
I would say that if the children are at risk of developing chronic, fatal disease it is an immediate threat. I don't think of an immediate threat time-wise (if I don't call the wife, the children will die tomorrow) but more end-point-wise (if I don't call the wife the children may die because the proper screening test will not be performed).
OK. Our opinions differ and that is fine.
Reply With Quote Quick reply to this message
  #21  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default .

Quote:
Originally Posted by claustrophobic View Post
Gonorrhea is an infectious disease. A single exposure can result in a healthy person getting the disease. So it is an immediate threat.
I agree with you on that

Quote:
Originally Posted by claustrophobic View Post
On the other hand FAP is not an immediate threat to the life of the children.
Well, I can't agree with that... I posted above why.

Thanks for an interesting debate
Reply With Quote Quick reply to this message
  #22  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default Hmmm

When there is threat to someone's life or risk of getting a disease, the intervention on physician's behalf prevents something, it may prevent someone from dying or getting a disease. These are examples of immediate threats. In these cases, if the physician decides to go to court, it may be too late. So he has to intervene.
FAP is a genetic disease. The children either have it or they don't. The physician can't intervene in any way to prevent the children from getting the disease. Besides the polyps in FAP become malignant by the 4th or 5th decade. Since the subjects are only children, at the most the screening colonoscopies would get delayed by a few months if the physician decides to go to court. The threat is not immediate.
Reply With Quote Quick reply to this message
  #23  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default

Quote:
Originally Posted by claustrophobic View Post
FAP is a genetic disease. The children either have it or they don't. The physician can't intervene in any way to prevent the children from getting the disease.
Nor can he prevent patient from getting gonorrhea That's not the point

Quote:
Originally Posted by claustrophobic View Post
Besides the polyps in FAP become malignant by the 4th or 5th decade. Since the subjects are only children, at the most the screening colonoscopies would get delayed by a few months if the physician decides to go to court. The threat is not immediate.
as you said before: our opinions differ

the explanation to this part is as I posted it before:
"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 polips 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."

source: Fish's 100 cases

These qs are a bit confusing to me sometimes but thanks again for this discussion
Reply With Quote Quick reply to this message
  #24  
Old 06-07-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 24
Threads: 2
Thanked 6 Times in 6 Posts
Reputation: 16
Default He can

Quote:
Originally Posted by Casandra View Post
Nor can he prevent patient from getting gonorrhea That's not the point
Yes he can. And that's the whole point. His duty is to make sure that the patient doesn't have unprotected sex with someone else.

Do remember that Fish is primarily a physician. Daughtery is a professor of Behavioral Sciences. Anyways lets just leave it at difference of opinion.
Reply With Quote Quick reply to this message
  #25  
Old 06-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 561 Times in 319 Posts
Reputation: 571
Default .

Quote:
Originally Posted by claustrophobic View Post
Yes he can. And that's the whole point. His duty is to make sure that the patient doesn't have unprotected sex with someone else.
Oh, I understood that you meant that the physician can prevent this third party (sexual partner) from getting STD

Quote:
Originally Posted by claustrophobic View Post
Do remember that Fish is primarily a physician. Daughtery is a professor of Behavioral Sciences. Anyways lets just leave it at difference of opinion.
sure thing
Reply With Quote Quick reply to this message



  #26  
Old 06-07-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 135
Threads: 3
Thanked 73 Times in 48 Posts
Reputation: 83
Default

There was a case posted earlier. Where the patient tested positive for HIV and asked his doctor not to inform his wife at this time. I thought the answer would be to inform the wife even if it meant breaking confidentiality. The answer turned out to be inform the health authorities, and the logic was that they'll inform the wife and the doctor is protected.

I think D is the best choice, in this case the fact that the father has specifically stated that he doesn't want u to inform the wife and the fact that it's not an urgent/immediate threat to the life of the children. The best option is to get a court order.
__________________

To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
You can't confuse the confused!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
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
question help: diabetic foot related question dezirablize USMLE Step 2 CK Forum 5 01-15-2015 02:42 PM
confidentiality sonu.agarwall USMLE Step 2 CK Forum 1 08-01-2012 07:51 AM
SP Domestic Abuse and Confidentiality? chienpolska USMLE Step 2 CS SP Challenges 2 04-22-2012 09:43 AM
Patient Confidentiality Issues avash.nrs USMLE Step 1 Forum 7 02-06-2012 09:50 AM
a question concerning step1 question length sfsheran USMLE Step 1 Forum 2 01-30-2012 08:29 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)