USMLE Forum Archives - USMLE Step 2 CK - Psychaitry & Ethics 2
Psychaitry & Ethics 2
TheOne - 12-06-06 11:39
A previously healthy 50-year-old woman has lump in her right breast. She comes to her primary care physician at the clinic for evaluation and undergoes a fine needle aspiration, which shows malignant cells. She is sent for a core biopsy, which shows invasive carcinoma of the breast. She is referred to a surgeon but refuses to go because her religious beliefs prevent her from undergoing surgery, radiation, or chemotherapy or from taking hormonal therapy. Her primary care physician discusses all of the potential outcomes of her disease, including death, and the risks and benefits of her decision. She says that she fully understands her condition and the consequences of her choice. A psychiatrist finds that she is competent. She is married and has a 14-year-old daughter. A meeting with the whole family proves that they all agree that surgery, radiation, chemotherapy, and hormonal therapy are not acceptable treatments. The physician believes that the patient is making a huge mistake. Which of the following is the most appropriate next step in management on the part of the physician?
A. Call the clinic's attorney to obtain a court order for surgery.
B. Contact the chairman of the surgery department to have her override the patient's refusal for surgery,
radiation, or chemotherapy.
C. No further steps are necessary.
D. Send the patient to another primary care physician because each party's views on this matter differ so
dramatically.
E. Send the patient to another psychiatrist to confirm that she is indeed competent to make decisions.
F. Tell the patient that her decision is crazy because she has a young daughter who will possibly lose her mother.
TheOne - 12-06-06 11:39
A previously healthy 50-year-old woman has lump in her right breast. She comes to her primary care physician at the clinic for evaluation and undergoes a fine needle aspiration, which shows malignant cells. She is sent for a core biopsy, which shows invasive carcinoma of the breast. She is referred to a surgeon but refuses to go because her religious beliefs prevent her from undergoing surgery, radiation, or chemotherapy or from taking hormonal therapy. Her primary care physician discusses all of the potential outcomes of her disease, including death, and the risks and benefits of her decision. She says that she fully understands her condition and the consequences of her choice. A psychiatrist finds that she is competent. She is married and has a 14-year-old daughter. A meeting with the whole family proves that they all agree that surgery, radiation, chemotherapy, and hormonal therapy are not acceptable treatments. The physician believes that the patient is making a huge mistake. Which of the following is the most appropriate next step in management on the part of the physician?
A. Call the clinic's attorney to obtain a court order for surgery.
B. Contact the chairman of the surgery department to have her override the patient's refusal for surgery,
radiation, or chemotherapy.
C. No further steps are necessary.
D. Send the patient to another primary care physician because each party's views on this matter differ so
dramatically.
E. Send the patient to another psychiatrist to confirm that she is indeed competent to make decisions.
F. Tell the patient that her decision is crazy because she has a young daughter who will possibly lose her mother.
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#3
Re: Psychaitry & Ethics 2
TheOne - 12-11-06 11:32 The correct answer is C. No further steps are necessary because the patient makes the medical decisions, not the physician. Competent, informed patients can refuse recommended interventions. In such cases, it is important for the physician to document in the patients' charts that they were informed of the potential risks of refusing treatment.
A court order (choice A) and the surgery chairman's decisions (choice B) are not indicated because this is a competent and informed patient who can refuse treatment.
Sending the patient to another primary care physician because of opposing views (choice D) is inappropriate because the patient should never be abandoned. If the physician provides the appropriate information and the competent patient makes an informed decision, there is no reason to try to send her to another physician because of differing beliefs.
One psychiatrist concluded that this patient is competent; there is no reason to doubt the evaluation and send her to another (choice E).
#5
Re: Psychaitry & Ethics 2 babbu5508 - 07-08-10 01:11 C. No further steps are necessary...because She says that she fully understands her condition and the consequences of her choice. A psychiatrist finds that she is competent.
#6
Re: Psychaitry & Ethics 2 bingousmle - 07-09-10 01:33 No further steps are necessary as she is competent and has the right to make her own decision regarding her health as the physician has to respect the autonomy
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