Scenarios Flashcards
Patient May have viral illness; demanding antibiotics; agitated
-remain calm; acknowledge their concerns
“I know you’re not feeling well right now and I understand that you want to receive a medication to feel better”
-explain antibiotics don’t kill viruses
-side effects of antibiotics
-compromise: call his pharmacy in day or two if he’s not feeling better
Senior doctor removes the intubation tube from patient during surgery and demands that you replace it
- inform him or her or them that you are not able to complete the procedure with acceptable proficiency
- dangers to the patient
- danger of spreading message to other healthcare professionals in the room that this kind of behaviour is acceptable
- danger of this doctor repeating similar actions
- have a conversation with university administration
You are new in medical training; see woman with what looks to be nasty lesion on her back while you’re on the bus. What do you do!
- conflict: respecting her privacy vs. Principle of preventing harm
- approach her, notify her of your inexperience, ask if you can offer her a concern about her health
- if she says yes, then tell her
- skin cancer, if caught early, can be removed before it metastasizes
Ethical scenario: what to consider?
Various perspectives
Established legal precedent
Elderly man with multiple co-morbidities; hypochondriac; do you warn him of potential cross contamination with unsterilized equipment, risk that he contracted Creutzfeldt-Jakob disease?
Pros of warning him:
- honesty (maintaining trustworthiness)
- due diligence
- can do tests; earlier treatment may be more effective
Cons:
-may cause him worry and distress; he has history of depression
BUT, as his doctor, it’s your duty to tell him, and to guide him compassionately
Your patient revealed her husband abuses her (she says this in acceptable in her culture); now she is at hospital and doesn’t want you to tell attending physician; she will get mri to see why she is fainting
Pros of telling physician:
- she will not have unnecessary medical tests
- save healthcare resources
- beneficence: safety of the patient
Cons of telling physician:
- violate patient’s privacy and trust in you
- it would be harder for her to ask you for help in the future
- go against confidentiality; she has expressed that you not tell (autonomy)
- she is not in any imminent danger
Result: tell her you will respect her wishes
- talk to her about telling the healthcare team so she doesn’t have unnecessary tests, reassure her that all involved in her care must respect her privacy
- refer to a culturally sensitive services, shelters
Person comes to you with STI
- assess, treat
- post-exposure prophylaxis
- offer counselling
- offer testing for HIV; risk for HIV is increased for those with STIs, may be less responsive to treatment
- notify public health (if required), confidential partner notification (by patient or by HCP/public health)
- follow up on treatment effectiveness
- treat underlying issues: addiction (may be from needle sharing), mental health —> prevent recurrent exposure, infection
- educate: proper use of protection
Family wants to place elderly person in LTC home for their safety, but person does not want to go
Safety vs autonomy -weigh the potential risk of staying home: is it serious (ie smokes in bed, leaves stove on, wanders out in the cold) Potential alternatives: -resources to support them at home -resources to make environment safer
Elderly man is Living alone has no social support and you were told by a neighbour that she found him barely able to stand in frail in his kitchen and that he is of refusing medical help you are a doctor from across the street what do you do
Decision: to help man Or leave him alone
More information needed:
- What is his mental state like? Is he capable of refusing care?
- What is the risk of him living alone?
- Does he have any existing medical conditions? Is he taking medication? Is he able to remember when to take the medication and when to refill his prescriptions?
If you leave him alone:
- It may seem like you were respecting his autonomous wishes do not receive medical care
- The doctor will not enter into a patient position relationship
If you help him:
- Can assess his mental state and whether he has the capacity to refuse medical care
- Can assess his health and refer him to services or resources if necessary
- Moral duty to help him Dr. has knowledge and ability to help may be preventing serious injury or even fatality
Older adult requesting to keep receiving sleeping pill, despite your attempts to wean them off
Ethical dilemma: autonomy vs nonmaleficence
- talk about risks, possible alternatives
- prescribe limited quantities each time
- talk about risks on regular basis (document these conversations)
- carefully monitor for adverse effects
Patient is brought into emergency room unconscious, what do you do if they need an operation?
Consent is presumed; you have a duty to treat; it’s presumed a person would want everything done to prevent death or loss of limb or vital organ
If you do not need to act immediately, you should first:
Check for substitute decision maker
Respect any previously expressed wishes (advance directive, SDM)
Patient wants to stop treatment during procedure; what do you do?
HALT unless doing so would seriously harm the patient
Informed consent; can accept or refuse treatment AND WITHDRAW CONSENT AT ANY TIME, even during medical procedure
Breaking Bad News
- if not a medical setting, ask what you’d like to talk about and ask if this is a good time to talk about it
1. Setting: private place, comfortably seated
2. Ask if they’d like anyone else to be part of the discussion
3. If cultural or ethnic barriers to truthtelling, ask: would you like to know everything or would you prefer for us to speak to someone else?
4. Preparatory phrase: “things have not turned out as well as we’d hoped” or “I have some hard information to share with you”
5. Be honest and be simple.
6. Observe non-verbal cues, acknowledge emotions
7. Schedule follow up sessions as needed
