PCM Online Cases - Case Scenarios (PDF)

Applied case on informed consent – lecture (8)  Scott is 63 years old and has been severely cognitively impaired since birth. A few years ago, he was brought to hospital with an enlarged bladder, secondary to prostatic hypertrophy. He refused all investigations and the doctors tre...

Applied case on informed consent – lecture (8)  Scott is 63 years old and has been severely cognitively impaired since birth. A few years ago, he was brought to hospital with an enlarged bladder, secondary to prostatic hypertrophy. He refused all investigations and the doctors treating him at the time did not feel his condition was serious enough to warrant investigation under restraint. He has now come to hospital again with acute urinary retention. He needs a catheter to relieve the retention and is likely to need a transurethral resection of the prostate under general anaesthesia. Without treatment recurrent retention and renal failure seem inevitable. However, Scott is uncomfortable and terrified of needles. It will be difficult to carry out treatment without his co-operation. He lives in a home and has a good relationship with his carers. His sister visits him frequently. ❶ Is the patient’s consent in this case valid or not? No, as the patient has been severely Cognitively impaired since birth. ❷ Who makes the decision about Scott’s best interests? His Sister- ❸ What information should be told to the carers (or sister)? They need to know that he needs a catheter to relieve the retention and is likely to need a transurethral resection of the prostate under general anesthesia. Without treatment recurrent retention and renal failure seem inevitable which will lead to his death. ❹ What if the Scott’s relatives disagree about treatment that is recommended by physician? The doctor must obligate to their refusal and not to do any treatment they refused. 16  Applied case on informed consent – lecture (8)  An Egyptian 29-year-old woman presents to accident and emergency with shock after a car accident. She was responsive to painful stimuli.  The doctor evaluated her and found that there is limb ischemia due to arterial injury and an immediate intervention should be done as rapid as possible or there is a risk of limb amputation.  The doctor searched for patient’s relatives but no relatives were present with the patient. ❶ Is this patient competent to make the decision for the surgery or not? No, as patient had an acute limb ischemia, and responsive only to painful Stimuli ❷ Does the physician need to wait for a written informed consent? No. It's an emergency Case ❸ Can the doctor operate the patient immediately or they should wait till the relatives appear or the patient regain his consciousness and give consent? Yes, They can perform operation 3 with no Consent as It's a medical Emergency- 17  Applied case on Professional secrecy – lecture (9)  Mohammed is working as a teacher at a school. He was going to his work regularly till yesterday.  Mohammed presented to his general practitioner with fever, cough and night sweats. After full investigations, he was diagnosed with tuberculosis.  The doctor asked Mohammed to take rest and not to go to school as tuberculosis is an airborne disease but he refuses and asked the doctor to keep it secret.  The general practitioner is concerned about the risk of transmission of a serious infectious disease. ❶ What should the general practitioner do in this situation? He must Inform the school about the teacher's Case to prevent Possibility of transmission of TB. ❷ What would happen if the general practitioner kept it secret? He will be assistent to the teacher in transmission of TB as TB is an airborne disease which may lead to an epidemic. ❸ In this case, is it professional not to keep it secret? Why? Yes, as the doctor duty here is to divulge the patient's secret (disclosure of patient secrecy for the Sake of public). 18 ❹ What are similar conditions in which the doctor should not to keep it secret? 1. in Cases of Infectious diseases. 2- If The Patient is mentally ill. 3. If the disease is contraindicating Certain Jobs examples uncontrolled hypertension în drivers. gonorrhea among swimmers 19  Applied case on Professional secrecy – lecture (9)  A female patient working in an important organization, is suffering from schizophrenia for the last 15 y. She is under treatment by a psychiatrist who is famous for high scientific and professional standards. She usually goes to the doctor for treatment accompanied with her husband. In one of these visits, the husband went alone and asked the doctor for a medical certificate stating his wife’s condition to be presented to the National Health Service.  Instead, he used the certificate to get a court order to control his wife money due to her incompetency. The patient’s lawyer accused the psychiatrist of professional misconduct. ❶ Is the husband authorized to know his wife’s disease? No ❷ Do you think that psychiatrist divulged patient’s information without her agreement? Yes ❸ How can the doctor explain his act? Is he guilty? Yes he is guilty. His act is not excusable or justified. 20  Applied case on Conflict management– lecture (13)  A child was recently diagnosed with a malignant tumour and was scheduled for its resection.  On the day of the operation, the anesthesiologist approached the child and started his pre-operative examination but he was interrupted by the child’s family that has only this child.  The family requested the presence of the surgeon as they need to speak to him.  This situation could result in an angry of anesthesiologist towards the child’s family, worsening the situation and not benefit the patient. ❶ What was the likely reason of this family behaviour? The reason is that the family has only this child and they Cannot lose him. Also absence of the Surgeon. ❷ What would be consequence if this situation not resolved? The operation will not be done as the family will refuse so the child will not do his surgery. ❸ What is the best action the anesthesiologist can do? To reassure the family, Call the surgeon to Come. 21 What is the name of the best conflict management strategy to be used in this situation? Collaboration Strategy. What if the anesthesiologist used the dominating strategy? The operation will not be done, and the child will be the only loser. 22