A 44-year-old man is brought to the emergency department of a large academic medical center by ambulance after being shot in the thigh during an altercation at a local bar. Blood pressure 113/66 mm Hg, pulse is 102/min, and respirations are 22/min. On examination, the patient appears intoxicated and in moderate distress. The left lower extremity has a gunshot entry wound on the anterolateral upper left thigh and an exit wound on the medial thigh. The patient repeatedly uses offensive and racially charged language toward the treating physician. Which best describes the physician's ethical duty to provide treatment for this patient?

Question

A 44-year-old man is brought to the emergency department of a large academic medical center by ambulance after being shot in the thigh during an altercation at a local bar.  Blood pressure 113/66 mm Hg, pulse is 102/min, and respirations are 22/min.  On examination, the patient appears intoxicated and in moderate distress.  The left lower extremity has a gunshot entry wound on the anterolateral upper left thigh and an exit wound on the medial thigh.  The patient repeatedly uses offensive and racially charged language toward the treating physician.  Which best describes the physician's ethical duty to provide treatment for this patient?

Quizplus · Accepted Answer

Explanation: The physician's duty to treat comprises ethical and legal components. Physicians are ethically obligated to place patients' interests above their own and care for patients with potentially life-threatening conditions. In the emergency department setting, the legal duty to treat is further specified by the Emergency Medical Treatment and Active Labor Act (EMTALA). The emergency medicine provider (eg, physicians) must: Provide a screening examination Appropriately treat and stabilize the patient Transfer the patient (with limited exceptions) only after the patient is stabilized This patient comes to the emergency department with an acute, serious condition (eg, gunshot wound). His use of racially charged language presents a difficult situation to the physician and supporting staff and likely violates hospital policies. However, considering his medical emergency, withholding treatment from this patient would be unethical and considered abandonment (a form of medical malpractice). Therefore, the physician is legally and ethically obligated to treat this patient (Choice E). In some situations, disruptive behaviors may threaten the immediate safety of the physician and staff. Safety in the emergency department requires the presence of adequate security personnel and protocols for managing agitated patients to ensure adequate protections for staff and other patients. (Choices A and B) In nonemergency clinical settings, physicians may in some circumstances ethically and legally refuse to treat patients without life-threatening conditions when doing so conflicts with personal beliefs (eg, performing abortion). In an outpatient setting, the physician may terminate a patient-physician relationship if adequate notice has been provided and the patient is given a reasonable opportunity to find another physician. Neither condition applies to this patient's situation. (Choice D) Although transferring the care of a stable patient to another emergency medicine provider (eg, due to disruptive behavior) is sometimes considered, physicians have an ethical duty to put aside personal views or responses to disruptive behavior and treat patients with life-threatening conditions without delay. Educational objective: Physicians have an ethical and legal duty to treat patients with life-threatening conditions, regardless of the patients' behavior. The Emergency Medical Treatment and Active Labor Act requires providers (eg, physicians) to appropriately screen, treat, and stabilize patients arriving to the emergency department. References: The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. (http://www.ncbi.nlm.nih.gov/pubmed/16369643)

A 44-Year-Old Man Is Brought to the Emergency Department of a Large