A 33-year-old woman comes to the office due to dyspareunia. The pain started about a year ago after the birth of her second child. When the patient saw her obstetrician for follow-up 4 months ago, he reassured her that everything was normal and her pain would improve shortly. She has no other medical issues and her vital signs are within normal limits. Pelvic examination reveals an abnormal episiotomy scar with contracture around the perineum secondary to scarring. This is the fifth patient in the past 12 months the physician has seen with the same examination findings; all 5 are patients of the same obstetrician. Previously, after seeing the second of those patients, the physician had contacted the obstetrician to discuss his rationale for the procedure, and the obstetrician had responded, "It is an acceptable and safe procedure that generally has excellent results. Both of those patients' symptoms should get better soon. I appreciate your concern, but I am a specialist and I know what I am doing." Which of the following is the most appropriate course of action?

Question

A 33-year-old woman comes to the office due to dyspareunia.  The pain started about a year ago after the birth of her second child.  When the patient saw her obstetrician for follow-up 4 months ago, he reassured her that everything was normal and her pain would improve shortly.  She has no other medical issues and her vital signs are within normal limits.  Pelvic examination reveals an abnormal episiotomy scar with contracture around the perineum secondary to scarring.  This is the fifth patient in the past 12 months the physician has seen with the same examination findings; all 5 are patients of the same obstetrician.  Previously, after seeing the second of those patients, the physician had contacted the obstetrician to discuss his rationale for the procedure, and the obstetrician had responded, "It is an acceptable and safe procedure that generally has excellent results.  Both of those patients' symptoms should get better soon.  I appreciate your concern, but I am a specialist and I know what I am doing."  Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

Explanation: Physicians have an ethical responsibility to report impaired, incompetent, or unethical colleagues to appropriate authorities. Unusual practices that deviate from the standard of care and threaten patient welfare should be reported to the appropriate state regulatory body, typically a division of the state's medical board, for further investigation. Physicians have a duty to report if patients inform them about misconduct or if they directly observe the act of misconduct itself. In this case, the physician should notify the state medical board as there is reason to be concerned that this obstetrician's practices threaten patient health and welfare. If the medical board's investigation confirms misconduct, disciplinary actions may include monitoring requirements, reprimands, probation, restrictions on practice, and license suspension. (Choice A) The physician's previous attempt to discuss his concerns about the procedure was met with denial. Further discussion is unlikely to be effective and is an insufficient response when there is reason to believe that patient welfare is at risk. (Choices C and E) Explaining to the patient that she had an avoidable complication or referring her to another gynecologist is insufficient. The physician is ethically obligated to report this obstetrician as there is reasonable evidence to suspect misconduct (ie, similar physical findings in multiple patients). (Choice D) It is inappropriate to burden the patient with the responsibility of preventing this obstetrician from performing a potentially harmful procedure. Educational objective: Physicians are ethically obligated to report colleagues who subject patients to potentially harmful treatments. State medical boards are authorized to conduct investigations of possible misconduct and institute disciplinary actions if indicated.

A 33-Year-Old Woman Comes to the Office Due to Dyspareunia