USMLE PRACTICE QUESTION #55
TOPIC: Principles of Medical Law & Ethics
Today’s question will test your understanding of the principles of medical law & ethics.
I’m Paul Ciurysek, MD, and this is The USMLE Times: An independent, subscriber-supported newsletter designed to help you survive medical school, pass your USMLE exams, and match into your dream residency program.
A 40-year-old female presents to your clinic with a suspicious breast lump. After conducting a physical examination and ordering diagnostic tests, you confirm that the lump is malignant. The patient's family members privately approach you and request that you withhold the cancer diagnosis from the patient, as they believe it will cause her extreme distress and worsen her condition. Which of the following is the most appropriate response to the family’s request?
A) Respect the family's wishes and withhold the diagnosis from the patient
B) Inform the patient about the cancer diagnosis without mentioning the family's request
C) Refer the patient to another healthcare provider without discussing the diagnosis
D) Inform the patient's primary care physician about the diagnosis and let them disclose the information
E) Share the diagnosis with the patient but downplay its severity to minimize distress
F) Seek advice from the hospital's ethics committee before making a decision
G) Discuss the family's concerns and explain the ethical obligation to disclose the diagnosis to the patient
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The mental model used to answer this question comes from our detailed test-taking skills masterclass. Here’s how to think through this question:
Step 1. Read the last line to determine what the question is asking: Which response is most appropriate?
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order: Recognize the dilemma, then find the best solution.
Step 3. Read the vignette to gather information.
Step 4. Consider what’s being asked and consider the most appropriate way to address the family’s concerns.
Step 5. Look at the answer choices and select the option most closely resembling your thoughts from “Step 4” above.
GENERAL ANALYSIS
This question involves a 40-year-old female patient diagnosed with breast cancer. Her family requests that the diagnosis be withheld from her, fearing it will cause her distress. The task is determining the most appropriate response to the family's request, considering ethical and legal obligations.
ANSWER CHOICES:
ANSWER CHOICE A: Respect the family's wishes and withhold the diagnosis from the patient
Explanation: Withholding the diagnosis violates the principles of informed consent and patient autonomy, which are fundamental ethical obligations in healthcare.
ANSWER CHOICE B: Inform the patient about the cancer diagnosis without mentioning the family's request
Explanation: This involves directly communicating the diagnosis to the patient without discussing the family's concerns. While informing the patient is correct, addressing the family's concerns may be beneficial to maintain trust and transparency.
ANSWER CHOICE C: Refer the patient to another healthcare provider without discussing the diagnosis
Explanation: This involves transferring care to another provider without disclosing the diagnosis. This avoids addressing the issue and does not fulfill the obligation to inform the patient.
ANSWER CHOICE D: Inform the patient's primary care physician about the diagnosis and let them disclose the information
Explanation: This involves delegating the responsibility of disclosure to another physician. The physician who made the diagnosis is responsible for disclosing the diagnosis, and it is important to ensure the patient is informed directly and accurately.
ANSWER CHOICE E: Share the diagnosis with the patient but downplay its severity to minimize distress
Explanation: This involves informing the patient but minimizing the seriousness of the diagnosis. Downplaying the diagnosis can lead to misinformation and does not respect the patient's right to understand their health condition fully.
ANSWER CHOICE F: Seek advice from the hospital's ethics committee before making a decision
Explanation: This involves consulting with an ethics committee to guide decision-making. While seeking advice is often necessary, it does not address the immediate need to inform the patient.
ANSWER CHOICE G: Discuss the family's concerns and explain the ethical obligation to disclose the diagnosis to the patient
Explanation: This involves conversing with the family to acknowledge their concerns and explaining the ethical duty to inform the patient. This approach respects the family's concerns while upholding the ethical obligation to disclose the diagnosis to the patient. It maintains transparency and trust, ensuring the patient receives the necessary information to make informed decisions about their care
FINAL VERDICT…
Informed consent and patient autonomy are fundamental principles in healthcare, requiring that patients be fully informed about their diagnoses and treatment options. While the family's concerns about causing distress are understandable, withholding a cancer diagnosis from the patient violates these ethical obligations. The most appropriate response is to discuss the family's concerns, explain the importance of truth-telling, and proceed with disclosing the diagnosis to the patient. This approach respects the family's perspective and the patient's right to be informed, allowing the patient to participate actively in their healthcare decisions.
CORRECT ANSWER: G) Discuss the family's concerns and explain the ethical obligation to disclose the diagnosis to the patient
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