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 68-year-old man is being evaluated in your radiation oncology clinic for treatment of a solid tumor. Your hospital has just purchased a new proton beam purported to deliver targeted radiation with fewer side effects than traditional radiation therapy. The patient expresses strong interest in receiving proton beam therapy, and you feel that he may have a better outcome with this new treatment modality. Later that day, an executive from the patient's insurance company calls to tell you that proton beam therapy will cost the company (but not the patient) a much larger amount of money than traditional therapy. They are willing to pay for proton beam therapy, but request that you convince the patient to undergo traditional therapy instead. You have a longstanding relationship with this insurance company as well as this particular executive. How should you proceed?
ATell the patient that proton beam therapy will not be covered by his insurance company, so you will need to proceed with traditional radiation therapy
BDiscuss the issue of cost to the insurer with your patient, relaying the company's request to him without making further commentary or recommendation
CCall your hospital's ethics committee for a formal consultation
DProceed with proton beam therapy as discussed at your patient's appointment
EDiscuss the issue of cost to the insurer with your patient, pointing out that keeping his insurance company happy may make them more likely to cover additional treatments in the future
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?
AExplain the procedure's benefits, alternatives, and potential complications
BRefer the patient to a psychotherapist to discuss his reluctance to have children
CDiscourage the patient from undergoing the procedure because his wife wants children
DInsist that the patient returns with his wife to discuss the risks and benefits of the procedure together
ECall the patient's wife to obtain her consent for the procedure
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