Page 58 - Ethical Situations Flashcards
Patient is not adherent.
Attempt to identify the patient’s reason for nonadherence and determine his/her willingness to change; do not attempt to coerce the patient into adhering or refer the patient to another physician.
Patient desires an unnecessary procedure.
Attempt to understand why the patient wants the procedure and address underlying concerns. Do not refuse to see the patient or refer him/her to another physician. Avoid performing unnecessary procedures.
Patient has difficulty taking medications.
Provide written instructions; attempt to simplify treatment regimens; use teach-back method (ask patient to repeat medication regimen back to physician) to ensure patient comprehension.
Family members ask for information about patient’s prognosis.
Avoid discussing issues with relatives without the permission of the patient.
A child wishes to know more about his/her illness.
Ask what the parents have told the child about his/her illness. Parents of a child decide what information can be relayed about the illness.
A 17-year-old girl is pregnant and requests an abortion.
Many states require parental notification or consent for minors for an abortion. Unless she is at medical risk, do not advise a patient to have an abortion regardless of her age or the condition of the fetus.
A 15-year-old girl is pregnant and wants to keep the child. Her parents want you to tell her to give the child up for adoption.
The patient retains the right to make decisions regarding her child, even if her parents disagree. Provide information to the teenager about the practical issues of caring for a baby. Discuss the options, if requested. Encourage discussion between the teenager and her parents to reach the best decision.
A terminally ill patient requests physician assistance in ending own life.
In the overwhelming majority of states, refuse involvement in any form of physician assisted suicide. Physicians may, however, prescribe medically appropriate analgesics that coincidentally shorten the patient’s life.
Patient is suicidal.
Assess the seriousness of the threat; if it is serious, suggest that the patient remain in the hospital voluntarily; patient can be hospitalized involuntarily if he/she refuses.
Patient states that he/she finds you attractive.
Ask direct, closed-ended questions and use a chaperone if necessary. Romantic relationships with patients are never appropriate. Never say, “There can be no relationship while you are a patient,” because this implies that a relationship may be possible if the individual is no longer a patient.
A woman who had a mastectomy says she feels “ugly” when she undresses.
Find out why the patient feels this way. Do not offer falsely reassuring statements (e.g., “You still look good.”).
Patient is angry about the amount
of time he/she spent in the waiting room.
Acknowledge the patient’s anger, but do not take a patient’s anger personally. Apologize for any inconvenience. Stay away from efforts to explain the delay.
Patient is upset with the way he/she was treated by another doctor.
Suggest that the patient speak directly to that physician regarding the patient’s concerns. If the problem is with a member of the office staff, tell the patient you will speak to that individual.
A drug company offers a “referral fee” for every patient a physician enrolls in a study.
Eligible patients who may benefit from the study may be enrolled, but it is never acceptable for a physician to receive compensation from a drug company. Patients must be told about the existence of a referral fee.
A physician orders an invasive test for the wrong patient.
No matter how serious or trivial a medical error, a physician is ethically obligated to inform a patient that a mistake has been made.
