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Old 03-31-2012
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Medicolegal and Ethics Patient does not understand the risks and benefits of treatment

A 63-year-old man is evaluated for slowly progressive mental status changes that have occurred over the past few weeks. The patient has a glioblastoma multiforme, with evidence of tumor enlargement and surrounding edema confirmed by head CT scan. Although he is conversant, the patient does not seem to understand the risks and benefits associated with the suggested therapeutic regimen of radiation and corticosteroid therapy and cannot provide consent for such treatment; however, he and his wife are agreeable to the physician's recommendation that this therapy be administered. The patient has not completed a formal advance directive, but his wife has accompanied him to every office visit and participated in previous discussions of diagnostic and therapeutic options.

Which of the following is the most appropriate next step in management?
A Initiate radiation and corticosteroid therapy immediately
B Withhold treatment pending results of psychiatric evaluation
C Initiate guardianship proceedings
D Seek consent from his wife before proceeding with treatment
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Old 03-31-2012
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ans: D
Best interest and Subsituted consent.
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Old 03-31-2012
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The ans is D
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Old 03-31-2012
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D is what i thought..

B might be true as well... psychiatric evaluation.. to know his baseline mental state n follow up while on treatment whether Rx improves or deteriorate his psychological state..
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Old 03-31-2012
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Default I agree

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Originally Posted by Rookie View Post
D is what i thought..

B might be true as well... psychiatric evaluation.. to know his baseline mental state n follow up while on treatment whether Rx improves or deteriorate his psychological state..
I agree that D is the answer.. In practice, I think it is wise to get a psychiatric consult, but as a general rule which has some exceptions in all USMLE tests, a consult is not what they are looking for.

I think for the sake of the consent, it is judged already in the question that the patient can't give the consent. But his wife is the best predictor of what his wishes would be.
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Old 04-01-2012
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Default Answer

D Seek consent from his wife before proceeding with treatment
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