A 68-year-old man comes to the physician for a follow-up examination, accompanied by his daughter. Two years ago, he was diagnosed with localized prostate cancer, for which he underwent radiation therapy. He moved to the area 1 month ago to be closer to his daughter but continues to live independently. He was recently diagnosed with osteoblastic metastases to the spine and is scheduled to initiate therapy next week. In private, the patient’s daughter says that he has been losing weight and wetting the bed, and she tearfully asks the physician if his prostate cancer has returned. She says that her father has not spoken with her about his health recently. The patient has previously expressed to the physician that he does not want his family members to know about his condition because they “would worry too much.” Which of the following initial statements by the physician is most appropriate?
A“As your father's physician, I think that it's important that you know that his prostate cancer has returned. However, we are confident that he will respond well to treatment.”
B“I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your father.”
C“It concerns me that he's not speaking openly with you. I recommend that you seek medical power of attorney for your father. Then, we can legally discuss his diagnosis and treatment options together.”
D“It’s difficult to deal with parents aging, but I have experience helping families cope. We should sit down with your father and discuss this situation together.”
E“Your father is very ill and may not want you to know the details. I can imagine it's frustrating for you, but you have to respect his discretion.”
A 22-year-old man is brought to the emergency department by his friends 30 minutes after falling down a flight of stairs. His friends report that they were at a college party, where he drank large amounts of alcohol. He is aggressive and restless. Examination shows tenderness to palpation and swelling of his right lower leg. An x-ray of the right leg shows a lower tibial shaft fracture. The physician recommends overnight observation and surgery the following morning. The patient refuses the suggested treatment and requests immediate discharge. Otherwise, he says, he will call his lawyer and sue the entire medical staff involved in his care. Which of the following is the most appropriate response by the physician?
AYou can leave the hospital after signing a self-discharge against medical advice form.
BIf you don't consent to treatment, I'll be forced to obtain consent from your parents.
CI understand that you want to go home, but I'll have to keep you here as long as you are intoxicated.
DHave you ever felt you should cut down on your drinking?
EI can't force you to stay here, but I'll have to inform your dean of this incident.
After the administration of an erroneous dose of intravenous phenytoin for recurrent seizures, a 9-year-old girl develops bradycardia and asystole. Cardiopulmonary resuscitation was initiated immediately. After 15 minutes, the blood pressure is 120/75 mm Hg, the pulse is 105/min, and the respirations are 14/min and spontaneous. She is taken to the critical care unit for monitoring and mechanical ventilation. She follows commands but requires sedation due to severe anxiety. Which of the following terms most accurately describes the unexpected occurrence in this patient?
AActive error
BSentinel event
CNear miss
DLatent error
EAdverse event
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