A 60-year-old man with a history of chronic obstructive pulmonary disease comes to the office due to hemoptysis. For the past several days, he has had increasing cough with greenish-yellow sputum. He also had 2 episodes of blood-streaked sputum, which prompted the clinic visit. The patient has mild dyspnea but no fever or chest pain. His other medical problems are peripheral vascular disease and osteoarthritis. His current medications include aspirin, inhaled fluticasone and salmeterol, and ipratropium. He continues to smoke 1/2 pack of cigarettes daily and drinks alcohol occasionally. The patient had a screening CT scan 2 years ago that was negative for lung mass. His father died of lung cancer. Blood pressure is 140/95 mm Hg and heart rate is 100/min. The patient's pulse oximetry shows 95% on room air. Lung auscultation reveals bilateral expiratory wheezing. Soon after the patient leaves the office, his wife calls and requests information about her husband's condition. She is also the treating physician's patient. Which of the following is the most appropriate response to her request?

Question

A 60-year-old man with a history of chronic obstructive pulmonary disease comes to the office due to hemoptysis.  For the past several days, he has had increasing cough with greenish-yellow sputum.  He also had 2 episodes of blood-streaked sputum, which prompted the clinic visit.  The patient has mild dyspnea but no fever or chest pain.  His other medical problems are peripheral vascular disease and osteoarthritis.  His current medications include aspirin, inhaled fluticasone and salmeterol, and ipratropium.  He continues to smoke 1/2 pack of cigarettes daily and drinks alcohol occasionally.  The patient had a screening CT scan 2 years ago that was negative for lung mass.  His father died of lung cancer.  Blood pressure is 140/95 mm Hg and heart rate is 100/min.  The patient's pulse oximetry shows 95% on room air.  Lung auscultation reveals bilateral expiratory wheezing. Soon after the patient leaves the office, his wife calls and requests information about her husband's condition.  She is also the treating physician's patient.  Which of the following is the most appropriate response to her request?

Quizplus · Accepted Answer

Explanation: Confidentiality is one of the basic tenets of medical ethics. It underscores patient privacy and autonomy. Information about a patient's condition, including that obtained by history taking and chart review, should not be discussed with family and friends unless the patient authorizes the physician to do so. The best response in this case is to inform the patient's wife that the information about the patient's condition cannot be shared without his consent because it is considered confidential. (Choices A, C, and D) In some situations, the risk of withholding information outweighs the principles of confidentiality. Examples are general public health issues (eg, public officials and people at risk should be informed about cases of reportable infectious diseases) or cases in which a third party could be harmed (eg, suicidal/homicidal patient or impaired driver). This patient's case is not an exception to confidentiality principles. (Choice E) This statement may sound offensive and does not explain why the physician is unable to share patient information. Educational objective: Information about a patient's condition, including that obtained by history taking and chart review, should not be discussed with family and friends unless authorized by the patient.

A 60-Year-Old Man with a History of Chronic Obstructive Pulmonary