Q: Jacob is a 37 year old man who is brought to the emergency room by police after being arrested for suspected driving under influence of alcohol. Police requests you to give him sample of his gastric aspirates to prove alcohol consumption and test for other substances. The patient refuses to consent for insertion of a gastric tube. What should you do?
A: Follow the patient's requests. A physician cannot take orders from police. Patient has full right to refuse any medical treatment. A blood alcohol level can be performed. Rules vary from state to state with regards to refusal of breath or blood testing. Some states mandate either of the two while in some states the patient can refuse but will lose their driving license for a variable period of time. For the sake of USMLE I would advice that doing breath alcohol testing or blood alcohol levels should be chosen as the answer.
Showing posts with label Ethics. Show all posts
Showing posts with label Ethics. Show all posts
USMLE Ethics Question 7
Q: 72 year Ms. Smith has chronic renal failure from diabetes and decides to stop getting dialysis. She understands that not getting dialysis will kill her. As her physician if you do not intervene she is certainly going to die. His 45 year old son urges you to save her life. What do you do?
A: Patients have the absolute right to refuse medical intervention. They can refuse cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition or IV fluids, dialysis etc. even if it results in his or her death. Such a decision to withdraw or withhold life-sustaining treatment is not considered suicide and physician participation is not considered physician-assisted suicide. Physicians do not have any legal liability.
A: Patients have the absolute right to refuse medical intervention. They can refuse cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition or IV fluids, dialysis etc. even if it results in his or her death. Such a decision to withdraw or withhold life-sustaining treatment is not considered suicide and physician participation is not considered physician-assisted suicide. Physicians do not have any legal liability.
USMLE Ethics Question 6
Q: Dr. Austin is a 42 year old obstetrician who is recently diagnosed with HIV infection. Is she required to tell her patients or fellow doctors about her HIV status?
A: No. She is not obliged to tell anyone. She should take appropriate universal precautions (which all doctors should, irrespective of their HIV status). She does need to authorize the hospital authority but this information cannot be used to terminate her job.
A: No. She is not obliged to tell anyone. She should take appropriate universal precautions (which all doctors should, irrespective of their HIV status). She does need to authorize the hospital authority but this information cannot be used to terminate her job.
USMLE Ethics Question 5
Q: John is a 2nd year pediatric resident and is asked to order a particular medicine for his patient by his attending physician. He thinks that the treatment is not appropriate and could be potentially harmful. What should he do?
A: He should ask the attending to explain the rationale. In most cases the attending will be able to convince the resident why the medicine is important. If he still doesn't agree with the attending he should not order the medicine and seek advice/consultation from senior resident, senior attending or division chief.
A: He should ask the attending to explain the rationale. In most cases the attending will be able to convince the resident why the medicine is important. If he still doesn't agree with the attending he should not order the medicine and seek advice/consultation from senior resident, senior attending or division chief.
USMLE Ethics Question 4
Q: Mr. Jameson is a 56-year old patient of yours who you have recently diagnosed with pancreatic carcinoma. You have referred him to an oncologist who plans to treat him aggressively with chemotherapy, radiation and surgery. The patient urges you not to tell his wife who is also a patient of yours about his diagnosis. His wife asks you about his diagnosis. What should you do?
A: Do not discuss Mr. Jameson's medical condition without his permission. However, you should encourage him to reveal his diagnosis to his wife.
A: Do not discuss Mr. Jameson's medical condition without his permission. However, you should encourage him to reveal his diagnosis to his wife.
USMLE Ethics Question 3
Q: John is a 55 year old man who works as a bus driver for the city of Washington DC. He had a stroke 6 months ago from which recovered well except that he has had 2 seizures in last 4 months and has focal damage on an MRI from the stroke. As his physician you believe that he is at risk of having more seizures and you have started him on antiepileptics. He requests his doctor not to mention his seizures to his employer as this may result in loss of his job and he is the sole earner in his family. What should you do?
A: Try to convince him to tell his employer. If he refuses you have to inform the appropriate the authorities because you have a duty towards him as well as the society.
USMLE Ethics Question 2
Q: Sam Smith is a 4th year medical student currently doing his AI (acting intern) rotation in a big teaching, university hospital. He carries his own patients on the general medicine team. How should he introduce himself? Can a patient refuse treatment from him?
A: He should introduce himself as a student. He cannot say 'I am Dr. Smith'. A patient can refuse a medical student from performing any procedure. However, students are allowed to perform a procedure under appropriate supervision if the patient agrees to that.
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A: He should introduce himself as a student. He cannot say 'I am Dr. Smith'. A patient can refuse a medical student from performing any procedure. However, students are allowed to perform a procedure under appropriate supervision if the patient agrees to that.
Click on Ethics label in the label cloud to see more posts on ethics in USMLE
USMLE Ethics Question 1
Q: A 17 year old male was diagnosed with metastatic osteogenic sarcoma of the left leg. After thorough investigation and discussion with the family the oncology team decided that the only way to cure him was to perform above knee amputation. The patient refuses amputation after understanding all the risks including that the cancer will certainly kill him if his leg is not amputated. What should the medical team do?
A: Correct answer is almost always respecting the individual's wishes. If this was not an adolescent patient (say a 5 year old) then the parents wishes should be respected but if the boy would die without it then doctors can bring in a court ruling against parent's wishes to perform amputation. There is no sharp demarcation as to above what age a patient can make true informed decisions but for the purpose of USMLE I would say 16 years or older patient who is mentally sound should be his or her own decision maker.
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A: Correct answer is almost always respecting the individual's wishes. If this was not an adolescent patient (say a 5 year old) then the parents wishes should be respected but if the boy would die without it then doctors can bring in a court ruling against parent's wishes to perform amputation. There is no sharp demarcation as to above what age a patient can make true informed decisions but for the purpose of USMLE I would say 16 years or older patient who is mentally sound should be his or her own decision maker.
Click Ethics on the label clould on the side to view more posts on ethics in the USMLE.
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