A 28-year-old woman comes to the office for a regularly scheduled prenatal appointment. Her pregnancy has been going well and the patient says that she is thrilled to be having a baby after trying to become pregnant for several years. She and her husband experienced considerable strain in their marriage as they went through multiple unsuccessful fertility treatments. During the visit, the physician orders some blood work and performs a 1-hour glucose challenge test. The patient becomes apprehensive when this is mentioned and begins to ask questions about the purpose of the testing. When asked about her concern, she confides that the fetus is not her husband's child. Her husband is also the physician's patient, and she asks the physician not to tell him about this because "it will ruin everything." Which of the following is the most appropriate response by the physician?

Question

A 28-year-old woman comes to the office for a regularly scheduled prenatal appointment.  Her pregnancy has been going well and the patient says that she is thrilled to be having a baby after trying to become pregnant for several years.  She and her husband experienced considerable strain in their marriage as they went through multiple unsuccessful fertility treatments.  During the visit, the physician orders some blood work and performs a 1-hour glucose challenge test.  The patient becomes apprehensive when this is mentioned and begins to ask questions about the purpose of the testing.  When asked about her concern, she confides that the fetus is not her husband's child.  Her husband is also the physician's patient, and she asks the physician not to tell him about this because "it will ruin everything."  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

Physicians are ethically obligated to respect patient autonomy and protect patient confidentiality, keeping all personal health information private unless the patient gives specific consent to release the information. Maintaining patient confidentiality is essential to developing a trusting physician-patient relationship as patients would otherwise be less likely to share sensitive information, which could negatively impact their care. This is particularly critical for issues that might be stigmatizing, such as reproductive, sexual, substance use, and mental health concerns. Confidentiality assures that private information not be disclosed to family or employers without the patient's explicit consent. This patient's request not to inform her husband should be respected. Exceptions to confidentiality include the following: (Choice A) The physician's primary duty is to protect the patient's confidentiality regardless of whether her husband is a patient or not. Imposing one's personal belief that it would be in the husband's best interest to know is inappropriate. (Choices B and D) These statements could be considered directive and/or judgmental by the patient. The physician should be neutral with regard to the patient's decision and not force her into actions or a conversation with which she may be uncomfortable. It would be appropriate to inquire about the patient's concerns, specifically if there are any safety concerns. (Choice C) The physician has no legal or ethical obligation to inform the biological father. Under current law, a father has no legal right to know that a child is his unless he is ordered to make child support payments. Educational objective: Patient confidentiality is strongly protected because patients must feel free to disclose details of all aspects of their lives so that physicians can provide optimal care. Exceptions to patient confidentiality include suspected child, disabled person, or elder abuse; knife or gunshot wounds; diagnosis of a reportable communicable disease; and patients at risk of physically harming themselves or others. __________ References: From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine--part I: conceptual, moral, and legal foundations. (http://www.ncbi.nlm.nih.gov/pubmed/15635311)

A 28-Year-Old Woman Comes to the Office for a Regularly