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 54-year-old man suffered an anterior wall myocardial infarction that was managed in the cath lab with emergent coronary stenting and revascularization. The patient states that his wife, adult children, and cousins may be disclosed information regarding his care and health information. The patient has been progressing well without any further complications since his initial catheterization. On hospital day #3, a woman stops you in the hall outside of the patient's room whom you recognize as the patient's cousin. She asks you about the patient's prognosis and how the patient is progressing after his heart attack. Which of the following is the most appropriate next step?
ADecline to comment per HIPAA patient confidentiality regulations
BDirect the woman to discuss these issues with the patient himself
CAsk the patient if it is acceptable to share information with this individual
DDiscuss the patient's hospital course and expected prognosis with the woman
EAsk for identification confirming that the woman is truly the patient's cousin
A 68-year-old woman was recently diagnosed with pancreatic cancer. At what point should her physician initiate a discussion with her regarding advance directive planning?
AOnce she enters hospice
BNow that she is ill, speaking about advance directives is no longer an option
COnly if her curative surgical and medical treatment fails
DOnly if she initiates the conversation
EAt this visit
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