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?

Explain the procedure's benefits, alternatives, and potential complications

Refer the patient to a psychotherapist to discuss his reluctance to have children

Discourage the patient from undergoing the procedure because his wife wants children

Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together

Call the patient's wife to obtain her consent for the procedure

A 79-year-old man with a history of prostate cancer is brought to the emergency department because of lower abdominal pain for 1 hour. He has not urinated for 24 hours. Abdominal examination shows a palpable bladder that is tender to palpation. A pelvic ultrasound performed by the emergency department resident confirms the diagnosis of acute urinary retention. An attempt to perform transurethral catheterization is unsuccessful. A urology consultation is ordered and the urologist plans to attempt suprapubic catheterization. As the urologist is called to see a different emergency patient, she asks the emergency department resident to obtain informed consent for the procedure. The resident recalls a lecture about the different modes of catheterization, but he has never seen or performed a suprapubic catheterization himself. Which of the following statements by the emergency department resident is the most appropriate?

“I would prefer that you obtain informed consent when you become available again.”

“Suprapubic catheterization is not the treatment of choice for this patient.”

“I would be happy to obtain informed consent on your behalf, but I'm not legally allowed to do so during my residency.”

“I will make sure the patient reads and signs the informed consent form.”

“I will ask the patient to waive informed consent because this is an urgent procedure.”

You are a resident on a pediatric service entering orders late at night. Upon arrival the next morning, you note that you had mistakenly ordered that low molecular weight heparin be administered to a 17-year-old patient who does not need anti-coagulation. When you talk to her, she complains about the "shot" she had to get this morning but is otherwise well. How should you handle the situation?

Tell the patient and her parents about the error

Since there was no lasting harm to the patient, it is not necessary to disclose the error

You cannot disclose the error as a resident due to hospital policy

Tell the patient, but ask her not to tell her parents

Speak to risk management before deciding whether or not to disclose the error

A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?

Warn the ex-girlfriend and notify law enforcement

Only notify the patient's family

Maintain patient confidentiality

A 26-year-old man comes to the emergency department because of a 1-week history of fever, throat pain, and difficulty swallowing. Head and neck examination shows an erythematous pharynx with purulent exudates overlying the palatine tonsils. Microscopic examination of a throat culture shows pink, spherical bacteria arranged in chains. Treatment with amoxicillin is initiated. A day later, a physician colleague from another department approaches the physician in the lobby of the hospital and asks about this patient, saying, "Did you see him? What does he have? He's someone I play football with and he hasn't come to play for the past 5 days. I'm worried about him." Which of the following is the most appropriate action by the physician?

Inform the colleague that they cannot divulge any information about the patient

Inform the colleague that they should ask the patient's attending physician

Tell the colleague the patient's case file number so they can look it up themselves

Tell the colleague that they cannot tell them the diagnosis but that their friend was treated with antibiotics

Ask the colleague to meet in the office so they can discuss the patient in private

A 72-year-old woman is brought to the emergency department with dyspnea for 2 days. She is on regular hemodialysis at 3 sessions a week but missed her last session due to an unexpected trip. She has a history of congestive heart failure. After urgent hemodialysis, the patient’s dyspnea does not improve as expected. The cardiologist is consulted. After evaluation of the patient, he notes in the patient’s electronic record: “the patient does not have a chronic heart condition and a cardiac cause of dyspnea is unlikely.” The following morning, the nurse finds the cardiologist’s notes about the patient not having congestive heart failure odd. The patient had a clear history of congestive heart failure with an ejection fraction of 35%. After further investigation, the nurse realizes that the cardiologist evaluated the patient’s roommate. She is an elderly woman with a similar first name. She is also on chronic hemodialysis. To prevent similar future errors, the most appropriate strategy is to use which of the following?

Two patient identifiers at every patient encounter by any healthcare provider

Two patient identifiers at every nurse-patient encounter

A patient’s medical identification number at every encounter by any healthcare provider

Two patient identifiers at every physician-patient encounter

A patient’s medical identification number at every physician-patient encounter

A 40-year-old woman presents to her physician's home with a headache. She describes it as severe and states that her symptoms have not been improving despite her appointment yesterday at the office. Thus, she came to her physician's house on the weekend for help. The patient has been diagnosed with migraine headaches that have persisted for the past 6 months and states that her current symptoms feel like her previous headaches with a severity of 3/10. She has been prescribed multiple medications but is generally non-compliant with therapy. She is requesting an exam and urgent treatment for her symptoms. Which of the following is the best response from the physician?

Unfortunately, I cannot examine and treat you at this time. Please set up an appointment to see me in my office.

It sounds to me like you are in a lot of pain. Let me see how I can help you.

Do not come to my house when you have medical problems. You should make an appointment.

Your symptoms seem severe. Let me perform a quick exam to see if everything is alright.

You should go to the emergency department for your symptoms rather than coming here.

Truth-telling and disclosure | Medical Ethics

Core Principles - The Honest Truth

Physicians have an ethical & legal obligation to provide truthful information to patients.
Honesty is the foundation of the physician-patient relationship, upholding autonomy and enabling informed consent.
This duty includes the full disclosure of medical errors, regardless of the level of harm.

⭐ When disclosing a medical error, include the facts of the event, the health consequences for the patient, an expression of regret, and a commitment to prevent future errors. Many states have "apology laws" protecting such statements from being used as an admission of guilt.

Therapeutic privilege, withholding information believing it will cause severe harm, is ethically controversial and rarely justifiable.

Withholding Information - A Fine Line

Therapeutic Privilege: A narrow exception to full disclosure, used only when information itself would cause severe, direct, and demonstrable harm (e.g., acute psychological trauma leading to treatment refusal).
Invalid Reasons for Withholding:
- General patient anxiety or emotional state.
- Family's request if the patient is competent and desires information.
- The physician's own discomfort with the conversation.
Patient's Prerogative:
- A competent patient has the right to waive disclosure.
- 💡 Best practice: Always ask, "How much detail would you like to know about your results?"

⭐ If family requests non-disclosure for a competent patient, the physician's first step is to explore the patient's own wishes regarding their health information. The primary duty is to the patient, not the family.

Disclosing Medical Errors - Owning Up

Ethical and professional duty to inform patients about significant medical errors. This upholds patient autonomy, fosters trust, and is a core component of medical professionalism. Withholding information erodes the physician-patient relationship.
Key Components of Disclosure:
- Acknowledge: State clearly and promptly that an error occurred.
- Explain: Describe the event, the reasons for it (if known), and the potential short and long-term consequences.
- Apologize: Express sincere regret and empathy. This is a critical step.
- Plan: Outline the plan for managing the consequences and steps being taken to prevent a similar error in the future.

⭐ Many states have "apology laws" where expressions of sympathy are inadmissible in malpractice suits, encouraging physicians to apologize without fear of legal reprisal.

Do not: Blame other staff, use excessive medical jargon, or speculate on outcomes. Document the disclosure discussion in the medical record.

Breaking Bad News - SPIKES the Landing

📌 SPIKES is a six-step protocol for delivering difficult news, ensuring empathy and shared understanding.

Setting: Private, comfortable space. Sit down, make eye contact.
Perception: "What have you been told so far?" Assess understanding.
Invitation: "How would you like me to give the information?" Ask permission.
Knowledge: Warn the patient, then give information in small, clear chunks. Avoid jargon.
Emotions: Respond to emotions with empathy. "I can see this is upsetting."
Strategy & Summary: Check understanding and discuss next steps.

⭐ Never provide premature reassurance. Always address the patient's emotions first before discussing a treatment plan or prognosis. It validates their feelings and builds trust.

Doctor comforting patient: Empathy in medical ethics

Truth-telling is a core ethical duty, respecting patient autonomy and fostering trust.

Full disclosure of medical errors is mandatory, even if no harm occurred. Never conceal an error.

Disclosure must include the facts of the event, the consequences, and a sincere apology.

Therapeutic privilege-withholding information to prevent direct, substantial harm-is rarely justifiable.

Patients have the right to waive their right to information.