Informed refusal US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Informed refusal. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Informed refusal US Medical PG Question 1: A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and intubated for airway protection. During his second day in the ICU, his blood pressure is measured as 91/54 mmHg and pulse is 120/min. He is given fluids and antibiotics, but he progresses to renal failure and his mental status deteriorates. The physicians in the ICU ask the patient’s family what his wishes are for end-of-life care. His wife tells the team that she is durable power of attorney for the patient and provides appropriate documentation. She mentions that he did not have a living will, but she believes that he would want care withdrawn in this situation, and therefore asks the team to withdraw care at this point. The patient’s daughter vehemently disagrees and believes it is in the best interest of her father, the patient, to continue all care. Based on this information, what is the best course of action for the physician team?
- A. Call other family members and consult them for their opinions
- B. Listen to the patient’s daughter’s wishes and continue all care
- C. Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated
- D. Listen to the patient’s wife’s wishes and withdraw care (Correct Answer)
- E. Consult the hospital ethics committee and continue all care until a decision is reached
Informed refusal Explanation: ***Listen to the patient’s wife’s wishes and withdraw care***
- The **durable power of attorney for healthcare** legally designates the wife as the patient's surrogate decision-maker when the patient lacks capacity, overriding other family opinions.
- In the absence of a living will, the **surrogate's interpretation of the patient's best interests** and previously expressed wishes is legally and ethically binding.
*Call other family members and consult them for their opinions*
- While involving family is good practice in general, the presence of a **legally appointed durable power of attorney** means that other family members' opinions do not supersede the designated surrogate's decisions.
- Consulting other family members could **create more conflict and delay** crucial decisions, as the wife holds the legal authority.
*Listen to the patient’s daughter’s wishes and continue all care*
- The daughter's wishes, while understandable, **do not hold legal authority** over the decisions of the legally appointed durable power of attorney.
- Disregarding the wife's authority would be a **breach of ethical and legal obligations** in patient care.
*Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated*
- A compromise that goes against the legal surrogate's explicitly stated decision (to withdraw all care) is **ethically problematic and legally unsound**.
- Healthcare decisions should be based on the patient's best interest as interpreted by the **authorized surrogate**, not on attempting to please all family members.
*Consult the hospital ethics committee and continue all care until a decision is reached*
- While an ethics committee consult is appropriate if there's **disagreement over the interpretation of the patient's wishes** *among legally designated surrogates* or concerns about the surrogate's decision-making capacity, it's not the first step when a clear legal surrogate with documentation is present and makes a decision.
- Continuing all care against the wishes of the **legal proxy** would be contrary to patient autonomy and the principles of substituted judgment.
Informed refusal US Medical PG Question 2: A 32-year-old man visits his primary care physician for a routine health maintenance examination. During the examination, he expresses concerns about not wanting to become a father. He has been sexually active and monogamous with his wife for the past 5 years, and they inconsistently use condoms for contraception. He tells the physician that he would like to undergo vasectomy. His wife is also a patient under the care of the physician and during her last appointment, she expressed concerns over being prescribed any drugs that could affect her fertility because she would like to conceive soon. Which of the following is the most appropriate action by the physician regarding this patient's wish to undergo vasectomy?
- A. Explain the procedure's benefits, alternatives, and potential complications (Correct Answer)
- B. Refer the patient to a psychotherapist to discuss his reluctance to have children
- C. Discourage the patient from undergoing the procedure because his wife wants children
- D. Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together
- E. Call the patient's wife to obtain her consent for the procedure
Informed refusal Explanation: ***Explain the procedure's benefits, alternatives, and potential complications***
- The physician's primary ethical obligation is to the individual patient, ensuring informed consent for any medical procedure. Providing comprehensive information about **vasectomy benefits, alternatives, and risks** allows the patient to make an autonomous decision.
- While patient-physician confidentiality generally prohibits disclosing specific details of one spouse's medical history to the other, the general knowledge that his wife desires children creates an important backdrop for the discussion. It is the patient's responsibility to consider this and convey this information to his wife.
*Refer the patient to a psychotherapist to discuss his reluctance to have children*
- It is **not appropriate** to assume the patient has a psychological issue solely based on his desire for a vasectomy, even with his wife's conflicting wishes. This action could be seen as judgmental and dismissive of the patient's autonomy.
- A patient's preference for sterilization, even if contrary to a partner's desires, does not inherently indicate a need for psychiatric evaluation unless there are other concerning psychological symptoms.
*Discourage the patient from undergoing the procedure because his wife wants children*
- **Discouraging** the patient based on his wife's wishes infringes upon the patient's **autonomy and reproductive rights**. The physician's role is to provide information and support the patient's informed decisions, not to act as a relationship counselor or impose personal values.
- Medical decisions, especially concerning fertility, are deeply personal, and a physician should not pressure a patient into a decision they do not want based on a partner's separate, yet relevant, wishes.
*Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together*
- While open communication between spouses about reproductive decisions is beneficial, **insisting** on the wife's presence for the consultation undermines the patient's **confidentiality and individual autonomy**. The patient has the right to make medical decisions independently.
- The physician should encourage the patient to discuss this with his wife, but it is ultimately the patient's decision whether to involve her in the consultation for his procedure.
*Call the patient's wife to obtain her consent for the procedure*
- This action would be a **breach of patient confidentiality**. The physician cannot disclose information about the patient's decision or medical discussions with a third party, even a spouse, without the patient's explicit consent.
- A spouse's consent is **not legally or ethically required** for an individual to undergo a vasectomy in most jurisdictions, as it is a decision pertaining to the individual's body and reproductive rights.
Informed refusal US Medical PG Question 3: A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?
- A. Duty, breach, causation, and damages (Correct Answer)
- B. Only duty and breach
- C. Only breach and causation
- D. Duty, breach, and damages
Informed refusal Explanation: ***Duty, breach, causation, and damages***
- In a medical malpractice lawsuit, all four elements—**duty, breach, causation, and damages**—must be proven for a successful claim.
- The healthcare provider had a **duty** to provide competent care, they **breached** that duty by administering the wrong blood type, this breach **caused** the patient's death and renal failure, and these injuries constitute **damages**.
*Only duty and breach*
- While **duty** and **breach** are necessary components, proving only these two is insufficient for a malpractice claim.
- It must also be demonstrated that the breach directly led to the patient's harm and resulted in legally recognized damages.
*Only breach and causation*
- This option omits the crucial elements of professional **duty** owed to the patient and the resulting **damages**.
- A claim cannot succeed without establishing that a duty existed and that quantifiable harm occurred.
*Duty, breach, and damages*
- This option misses the critical element of **causation**, which links the provider's breach of duty to the patient's injuries.
- Without proving that the breach *caused* the damages, even if a duty was owed and breached, and damages occurred, the claim would fail.
Informed refusal US Medical PG Question 4: A 13-year-old boy is brought to the emergency department after being involved in a motor vehicle accident in which he was a restrained passenger. He is confused and appears anxious. His pulse is 131/min, respirations are 29/min, and blood pressure is 95/49 mm Hg. Physical examination shows ecchymosis over the upper abdomen, with tenderness to palpation over the left upper quadrant. There is no guarding or rigidity. Abdominal ultrasound shows free intraperitoneal fluid and a splenic rupture. Intravenous fluids and vasopressors are administered. A blood transfusion and exploratory laparotomy are scheduled. The patient's mother arrives and insists that her son should not receive a blood transfusion because he is a Jehovah's Witness. The physician proceeds with the blood transfusion regardless of the mother's wishes. The physician's behavior is an example of which of the following principles of medical ethics?
- A. Autonomy
- B. Nonmaleficence
- C. Informed consent
- D. Justice
- E. Beneficence (Correct Answer)
Informed refusal Explanation: ***Beneficence***
- The physician prioritized the patient's immediate survival and well-being, which is the core principle of **beneficence** (acting in the best interest of the patient).
- In cases of life-threatening emergencies, especially with minors, the duty to preserve life often outweighs other considerations like parental wishes, particularly when the patient lacks the capacity for **informed refusal**.
*Autonomy*
- The physician’s action directly overrides the mother's wishes, which would be an infringement of surrogate autonomy for a minor.
- While patient autonomy is a fundamental principle, it was superseded by the immediate need to save the patient's life.
*Nonmaleficence*
- **Nonmaleficence** means "do no harm." While transfusions have risks, refusing one in this critical situation would cause more harm (death) than performing it.
- The physician acted to prevent immediate harm (death from hemorrhage), even if it meant overriding a family's wishes regarding the specific treatment method.
*Informed consent*
- **Informed consent** requires obtaining permission from a capacitated patient (or legal guardian for a minor) after explaining the risks and benefits of a treatment.
- In this emergency scenario, the patient is a minor and incapacitated, and the urgent need for a life-saving intervention (blood transfusion for a splenic rupture) did not allow for full informed consent or negotiation with the mother, who was refusing a life-saving measure.
*Justice*
- **Justice** refers to the fair and equitable distribution of healthcare resources and equal treatment, which is not the primary ethical concern in this personal patient-physician interaction.
- The scenario focuses on the individual patient's treatment decision, not broader societal resource allocation or fairness in access to care.
Informed refusal US Medical PG Question 5: A 57-year-old man presents to his oncologist to discuss management of small cell lung cancer. The patient is a lifelong smoker and was diagnosed with cancer 1 week ago. The patient states that the cancer was his fault for smoking and that there is "no hope now." He seems disinterested in discussing the treatment options and making a plan for treatment and followup. The patient says "he does not want any treatment" for his condition. Which of the following is the most appropriate response from the physician?
- A. "You seem upset at the news of this diagnosis. I want you to go home and discuss this with your loved ones and come back when you feel ready to make a plan together for your care."
- B. "It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."
- C. "It must be very challenging having received this diagnosis. I want to work with you to create a plan." (Correct Answer)
- D. "We are going to need to treat your lung cancer. I am here to help you throughout the process."
- E. "I respect your decision and we will not administer any treatment. Let me know if I can help in any way."
Informed refusal Explanation: ***"It must be very challenging having received this diagnosis. I want to work with you to create a plan."***
- This response **acknowledges the patient's emotional distress** and feelings of guilt and hopelessness, which is crucial for building rapport and trust.
- It also gently **re-engages the patient** by offering a collaborative approach to treatment, demonstrating the physician's commitment to supporting him through the process.
*"You seem upset at the news of this diagnosis. I want you to go home and discuss this with your loved ones and come back when you feel ready to make a plan together for your care."*
- While acknowledging distress, sending the patient home without further engagement **delays urgent care** for small cell lung cancer, which is aggressive.
- This response might be perceived as dismissive of his immediate feelings and can **exacerbate his sense of hopelessness** and isolation.
*"It must be tough having received this diagnosis; however, new cancer therapies show increased efficacy and excellent outcomes."*
- This statement moves too quickly to treatment efficacy without adequately addressing the patient's current **emotional state and fatalism**.
- While factual, it **lacks empathy** for his personal feelings of blame and hopelessness, potentially making him feel unheard.
*"We are going to need to treat your lung cancer. I am here to help you throughout the process."*
- This response is **too directive and authoritarian**, which can alienate a patient who is already feeling guilty and resistant to treatment.
- It fails to acknowledge his stated feelings of "no hope now" or his disinterest in treatment, which are critical to address before discussing the necessity of treatment.
*"I respect your decision and we will not administer any treatment. Let me know if I can help in any way."*
- While respecting patient autonomy is vital, immediately accepting a patient's decision to refuse treatment without exploring the underlying reasons (e.g., guilt, hopelessness, lack of information) is **premature and potentially harmful**.
- The physician has a responsibility to ensure the patient is making an informed decision, especially for a rapidly progressing condition like small cell lung cancer.
Informed refusal US Medical PG Question 6: A 72-year-old woman is brought to the emergency department by ambulance after an unexpected fall at home 1 hour ago. She was resuscitated at the scene by paramedics before being transferred to the hospital. She has a history of ischemic heart disease and type 2 diabetes mellitus. She has not taken any sedative medications. Her GCS is 6. She is connected to a mechanical ventilator. Her medical records show that she signed a living will 5 years ago, which indicates her refusal to receive any type of cardiopulmonary resuscitation, intubation, or maintenance of life support on mechanical ventilation. Her son, who has a durable power-of-attorney for her healthcare decisions, objects to the discontinuation of mechanical ventilation and wishes that his mother be kept alive without suffering in the chance that she might recover. Which of the following is the most appropriate response to her son regarding his wishes for his mother?
- A. “We will take every measure necessary to prolong her life.”
- B. “She may be eligible for hospice care.”
- C. “The opinion of her primary care physician must be obtained regarding further steps in management.”
- D. “Based on her wishes, mechanical ventilation must be discontinued.” (Correct Answer)
- E. “Further management decisions will be referred to the hospital’s ethics committee.”
Informed refusal Explanation: ***Based on her wishes, mechanical ventilation must be discontinued.***
- A **living will** is a legally binding document that outlines a patient's wishes regarding medical treatment, including **refusal of life support**.
- In this scenario, the patient’s clear and documented wishes in her living will take precedence over the son's objections, even though he holds **durable power of attorney for healthcare** (DPA).
*“We will take every measure necessary to prolong her life.”*
- This statement directly contradicts the patient's **documented wishes** in her living will to refuse intubation and maintenance on mechanical ventilation.
- Ignoring a patient's advance directive can lead to ethical and legal issues, as it undermines the principle of **patient autonomy**.
*“She may be eligible for hospice care.”*
- While hospice care is a relevant consideration for patients with terminal illnesses, suggesting it prematurely without addressing the immediate issue of the **living will** can be dismissive of the patient's explicit directives.
- The primary concern is upholding the patient's autonomy, which includes addressing her advance directive regarding **withdrawal of life support**.
*“The opinion of her primary care physician must be obtained regarding further steps in management.”*
- While the **primary care physician's** input is valuable for understanding the patient's overall health and discussing goals of care, the existence of a clear and legally binding **living will** simplifies the decision-making process concerning life support.
- The patient's advance directive is paramount and generally does not require further medical negotiation unless there's ambiguity or new information suggesting a change in her wishes.
*“Further management decisions will be referred to the hospital’s ethics committee.”*
- An **ethics committee** consultation may be appropriate in cases of ambiguity surrounding an advance directive, conflict among surrogates, or uncertainty about the patient's capacity at the time of signing the directive.
- However, in this case, the **living will** explicitly states her wishes regarding mechanical ventilation, making the patient's intent clear and generally overriding the need for an ethics committee in the initial response.
Informed refusal US Medical PG Question 7: A 32-year-old male asks his physician for information regarding a vasectomy. On further questioning, you learn that he and his wife have just had their second child and he asserts that they no longer wish to have additional pregnancies. You ask him if he has discussed a vasectomy with his wife to which he replies, "Well, not yet, but I'm sure she'll agree." What is the next appropriate step prior to scheduling the patient's vasectomy?
- A. Insist that the patient first discuss this procedure with his wife
- B. Telephone the patient's wife to inform her of the plan
- C. Refuse to perform the vasectomy
- D. Explain the risks and benefits of the procedure and request signed consent from the patient and his wife
- E. Explain the risks and benefits of the procedure and request signed consent from the patient (Correct Answer)
Informed refusal Explanation: ***Explain the risks and benefits of the procedure and request signed consent from the patient***
- A patient has the **right to make autonomous decisions** about their own medical care, including reproductive choices, regardless of their marital status or spousal approval.
- The physician's role is to ensure the patient is fully informed and provides **voluntary, uncoerced consent** after understanding the risks, benefits, and alternatives of the procedure.
*Insist that the patient first discuss this procedure with his wife*
- This option would be a **violation of patient autonomy** and confidentiality, as a married person has the right to make independent medical decisions.
- Requiring spousal consent for a procedure performed solely on one individual is not ethically or legally mandated and could be considered discriminatory.
*Telephone the patient's wife to inform her of the plan*
- This action would be a **breach of patient confidentiality**, as the patient's medical information, including his intent to have a vasectomy, cannot be shared with a third party, even a spouse, without explicit permission.
- Informing the wife without the husband's consent also undermines the patient's autonomy and right to privacy regarding his healthcare decisions.
*Refuse to perform the vasectomy*
- Refusing to perform the procedure simply because the patient has not discussed it with his wife would be **unethical and inconsistent with medical professionalism**, assuming the patient is competent and fully informed.
- A physician should not deny medically appropriate care based on a patient's marital dynamics or the presumed wishes of a spouse, as long as the patient's consent is valid.
*Explain the risks and benefits of the procedure and request signed consent from the patient and his wife*
- While it is advisable for a patient to discuss major life decisions with their spouse, requiring **spousal consent for a patient's own medical procedure** is not legally or ethically mandated for competent adults.
- Obtaining consent from both individuals is typically reserved for procedures affecting both parties directly or for those involving a surrogate decision-maker, not for an autonomous adult's personal medical choice.
Informed refusal US Medical PG Question 8: A 28-year-old woman is brought to the emergency department after being resuscitated in the field. Her husband is with her and recalls seeing pills beside her when he was in the bathroom. He reveals she has a past medical history of depression and was recently given a prescription for smoking cessation. On physical exam, you notice a right-sided scalp hematoma and a deep laceration to her tongue. She has a poor EEG waveform indicating limited to no cerebral blood flow and failed both her apnea test and reflexes. She is found to be in a persistent vegetative state, and the health care team starts to initiate the end of life discussion. The husband states that the patient had no advance directives other than to have told her husband she did not want to be kept alive with machines. The parents want all heroic measures to be taken. Which of the following is the most accurate statement with regards to this situation?
- A. The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.
- B. The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.
- C. The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf. (Correct Answer)
- D. An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.
- E. A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.
Informed refusal Explanation: ***The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.***
- The **hierarchy for healthcare surrogates** typically prioritizes the spouse over parents when there is no advance directive. The husband's recollection of the patient's wishes, although not a formal advance directive, is also relevant.
- State laws generally designate the **spouse as the primary default decision-maker** for incapacitated patients, followed by adult children, parents, and then adult siblings.
*The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.*
- A physician's role is to provide medical care and guidance, not to act as a **healthcare surrogate** due to potential conflicts of interest.
- Appointing the treating physician as a surrogate undermines the principles of **patient autonomy** and impartial decision-making.
*The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.*
- While parents are part of the surrogate hierarchy, they are generally ranked below the **spouse** in most jurisdictions.
- The parents' desire for "heroic measures" directly conflicts with the patient's stated wish to her husband, potentially leading to decisions not in the patient's best interest or previously expressed values.
*An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.*
- An ethics committee's role is to provide **guidance and recommendations** in complex cases, mediate disputes, and ensure ethical principles are upheld, not to act as the primary healthcare surrogate.
- A functional healthcare surrogate takes precedence over an ethics committee in making direct treatment decisions.
*A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.*
- A court-appointed guardian is typically sought only if there is **no clear or willing surrogate** from the established hierarchy, or if there is a dispute among family members that cannot be resolved.
- In this scenario, the husband is the legally recognized next of kin and surrogate by default, making court intervention unnecessary at this stage.
Informed refusal US Medical PG Question 9: A 32-year-old woman is brought to the emergency department by her husband because of an episode of hematemesis 2 hours ago. She has had dyspepsia for 2 years. Her medications include occasional ibuprofen for headaches. After initial stabilization, the risks and benefits of upper endoscopy and alternative treatments, including no therapy, are explained thoroughly. She shows a good understanding of her condition and an appreciation of endoscopic treatment and its complications. She decides that she wants to have an endoscopy to find the source of bleeding and appropriately manage the ulcer. Her medical records show advance directives that she signed 3 years ago; her sister, who is a nurse, has a durable power of attorney. Regarding obtaining informed consent, which of the following is the most accurate conclusion for providing endoscopic treatment for this patient?
- A. There are reasons to believe that she may not have decision-making capacity
- B. Endoscopic treatment may be performed without further action
- C. Her sister must sign the consent form
- D. Documentation of her decision prior to treatment is required (Correct Answer)
- E. Her decision to have an endoscopy is not voluntary
Informed refusal Explanation: **Documentation of her decision prior to treatment is required**
- The patient has been fully informed, understands her condition, and has expressed a clear desire for the procedure, demonstrating **decision-making capacity**.
- To ensure ethical and legal compliance, her **informed consent** must be accurately documented in her medical record before any invasive treatment, including endoscopy, is performed.
*There are reasons to believe that she may not have decision-making capacity*
- The patient has clearly demonstrated **understanding of her condition, treatment options, and potential complications**, which indicates preserved decision-making capacity.
- Despite the acute medical situation, her ability to articulate her preference after a thorough discussion confirms her competence for informed consent.
*Endoscopic treatment may be performed without further action*
- While the patient has consented verbally, this does not negate the need for proper **documentation of informed consent** before initiating the procedure.
- Legally and ethically, a verbal agreement alone is insufficient; a signed consent form or detailed chart note confirming her understanding and decision is essential.
*Her sister must sign the consent form*
- Her sister, holding a **durable power of attorney**, would only be authorized to make medical decisions if the patient were deemed to lack **decision-making capacity**.
- Since the patient clearly demonstrates the ability to make her own medical decisions, her sister's consent is not required and would override the patient's autonomy.
*Her decision to have an endoscopy is not voluntary*
- The scenario explicitly states that the risks and benefits were **thoroughly explained**, and she shows a "good understanding" and "appreciation of endoscopic treatment."
- Her decision to "want to have an endoscopy" despite knowing the alternatives suggests a **voluntary and informed choice**, not coercion.
Informed refusal US Medical PG Question 10: You are the attending physician on duty on an inpatient hospitalist team. A 48-year-old patient with a history of COPD and atrial fibrillation on warfarin is admitted to your service for management of a COPD exacerbation. Four days into her admission, routine daily lab testing shows that patient has an INR of 5. She is complaining of blood in her stool. The bleeding self-resolves and the patient does not require a transfusion. Review of the medical chart shows that the patient's nurse accidentally gave the patient three times the dose of warfarin that was ordered. What is the correct next step?
- A. Do not tell the patient about the mistake as no harm was done
- B. Do not tell the patient about the mistake because she is likely to sue for malpractice
- C. Do not tell the patient about the mistake because you did not make the mistake
- D. Tell the patient that a mistake was made and explain why it happened (Correct Answer)
- E. Tell the patient that the blood in her stool was likely a side effect of the warfarin
Informed refusal Explanation: ***Tell the patient that a mistake was made and explain why it happened***
- **Transparency** and **honesty** are fundamental ethical principles in medicine, even when an error occurs. Patients have a right to know about medical errors that affect them.
- Explaining the error fosters **trust**, allows the patient to make informed decisions about their care, and is essential for implementing **system-based improvements** to prevent future occurrences.
*Do not tell the patient about the mistake as no harm was done*
- This is ethically unsound; the patient experienced **blood in her stool**, indicating harm, even if not severe enough to require transfusion.
- Withholding information about a medical error undermines the **patient-physician relationship** and violates principles of informed consent and patient autonomy.
*Do not tell the patient about the mistake because she is likely to sue for malpractice*
- While malpractice concerns exist, fear of litigation should not override the ethical obligation to disclose medical errors. **Open communication** can often reduce the likelihood of lawsuits by building trust and demonstrating accountability.
- Focusing solely on medico-legal risk disregards the **patient's right to information** and reinforces a defensive medical culture.
*Do not tell the patient about the mistake because you did not make the mistake*
- As the **attending physician**, you are ultimately responsible for the patient's care and for overseeing the team. Even if you personally did not administer the wrong dose, you are accountable for managing complications and communicating with the patient.
- Ethically, the **healthcare team** is responsible for addressing errors collectively, irrespective of who precisely made the mistake, and the lead physician should facilitate this communication.
*Tell the patient that the blood in her stool was likely a side effect of the warfarin*
- This response is **deceptive** and does not provide an accurate explanation for the event. While bleeding is a side effect of warfarin, attributing it solely to a "side effect" without disclosing the overdose is misleading.
- It avoids accountability and prevents the patient from understanding the true cause of her symptoms, which is crucial for her health decisions and for ensuring **system quality improvement**.
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