A 65-year-old heavy smoker with a lengthy history of chronic obstructive pulmonary disease comes to the office due to recent-onset hemoptysis. He reports 3-5 episodes of coughing up blood in the past month. He also reports a 9.1-kg (20-lb) weight loss in the past 2 months. Chest radiograph reveals a suspicious lesion, and a bronchoscopy followed by biopsy establishes the diagnosis of squamous cell carcinoma of the lung. When the patient is informed of his condition and the prognosis, he asks that no one in his family be told the news yet. He seems tearful but cognitively intact. His wife, who usually brings him to his visits and is also his health care proxy, calls the next day to inquire about the pathology report. She says she is deeply concerned because her husband is reluctant to discuss his condition. Which of the following is the most appropriate course of action?

Question

A 65-year-old heavy smoker with a lengthy history of chronic obstructive pulmonary disease comes to the office due to recent-onset hemoptysis.  He reports 3-5 episodes of coughing up blood in the past month.  He also reports a 9.1-kg (20-lb) weight loss in the past 2 months.  Chest radiograph reveals a suspicious lesion, and a bronchoscopy followed by biopsy establishes the diagnosis of squamous cell carcinoma of the lung.  When the patient is informed of his condition and the prognosis, he asks that no one in his family be told the news yet.  He seems tearful but cognitively intact.  His wife, who usually brings him to his visits and is also his health care proxy, calls the next day to inquire about the pathology report.  She says she is deeply concerned because her husband is reluctant to discuss his condition.  Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

Health information cannot be shared with anyone (including family members) without the patient's permission. This patient's wishes must be respected and his confidentiality strictly maintained. That said, he should be strongly encouraged to discuss his diagnosis with his spouse as she will be significantly impacted by it. Moreover, she may be able to provide moral support to her husband, thereby easing his burden. The physician should encourage an open dialogue between the patient and his wife but should in no way coerce the patient to share the information (Choice D). (Choices A and E) The health care proxy is in effect only if the patient is deemed to have insufficient capacity to make decisions regarding his medical treatment (eg, delirious, nonresponsive). In this case it is not in effect, as there is no indication that the patient lacks capacity. (Choices B and C) Without the patient's permission, it would be inappropriate to reveal any information to his wife about his condition or care over the phone or in person. Educational objective: Medical information should be shared with family members only with the patient's permission. References: Patient and provider relationships: consent, confidentiality, and managing mistakes in integrated primary care settings. (http://www.ncbi.nlm.nih.gov/pubmed/23566125)

A 65-Year-Old Heavy Smoker with a Lengthy History of Chronic