An 83-year-old man presents to the gastroenterologist to follow-up on results from a biopsy of a pancreatic head mass, which the clinician was concerned could be pancreatic cancer. After welcoming the patient and his wife to the clinic, the physician begins to discuss the testing and leads into delivering the results, which showed metastatic pancreatic adenocarcinoma. Before she is able to disclose these findings, the patient stops her and exclaims, "Whatever it is, I don't want to know. Please just make me comfortable in my last months alive. I have made up my mind about this." Which of the following is the most appropriate response on the part of the physician?
A"If that is your definite wish, then I must honor it"
B"The cancer has spread to your liver"
C"As a physician, I am obligated to disclose these results to you"
D"If you don't know what condition you have, I will be unable to be your physician going forward"
E"Please, sir, I strongly urge you to reconsider your decision"
A 52-year-old man with stage IV melanoma comes to the physician with his wife for a routine follow-up examination. He was recently diagnosed with new bone and brain metastases despite receiving aggressive chemotherapy but has not disclosed this to his wife. He has given verbal consent to discuss his prognosis with his wife and asks the doctor to inform her of his condition because he does not wish to do so himself. She is tearful and has many questions about his condition. Which of the following would be the most appropriate statement by the physician to begin the interview with the patient's wife?
AHave you discussed a living will or goals of care together?
BWe should talk about how we can manage his symptoms with additional chemotherapy.
CWhy do you think your husband has not discussed his medical condition with you?
DWhat is your understanding of your husband's current condition?
EYour husband has end-stage cancer, and his prognosis is poor.
A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?
ADisallow the mother to be present in the examination room throughout the entirety of the visit
BGive the patient a social history questionnaire to fill out in the exam room
CAsk the mother to step outside into the hall for a portion of the visit
DAsk the patient the questions directly, with her mother still in the exam room
ESpeak softly to the patient so that the mother does not hear and the patient is not embarrassed
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