WBR0744: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Ethics
|MainCategory=Ethics
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|MainCategory=Ethics
|MainCategory=Ethics
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|MainCategory=Ethics
|MainCategory=Ethics
|MainCategory=Ethics
|MainCategory=Ethics
|MainCategory=Ethics
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|MainCategory=Ethics
|MainCategory=Ethics
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 22 year old male patient, previously healthy, presents to the emergency department (ED) complaining of acute constant abdominal pain and tenderness. He reports that at first his pain was periumbilical, but it then shifted to the right lower abdominal quadrant. Following appropriate work-up, he is diagnosed with appendicitis and is a candidate for appendectomy. At the same time, another patient in the ED presents with abdominal pain; he is diagnosed with cholecystitis. The surgeon makes a mistake and accidentally performs a cholecystectomy for the patient with the appendicitis. When the patient wakes up, what is the best way the surgeon might approach his mistake?
|Prompt=A 22-year-old man presents to the emergency department complaining of acute abdominal pain and tenderness. Following initial work-up, he is diagnosed with appendicitis and is cleared for appendectomy. Rushed by the high patient load, the surgeon accidentally performs the appendectomy on a patient admitted for cholecystectomy. What is the best way to approach this mistake?
|Explanation=Regardless of high benign or unimportant the medical error is, disclosure of the error and informing the patient clearly that an error has been made is an ethical obligation.  The physician must tell the patient in details what the nature of the error is and how severe it is or it might become. In the case of an adult patient (above 18 years of age), the physician must share all his information with the patient himself; involvement of a third party regarding the patient's medical history is considered a breach to the patient's confidentiality. In some cases, the hospital offers reimbursement to the patient; the physician is not requested to offer personal money to the patient.  
|Explanation=Regardless of how benign or how serious a medical error is, disclosure of that error and a clear explanation of the circumstances that led to it is an ethical obligation.  The physician must also be clear about the severity of the error and what consequences may arise from it. In the case of an adult patient (above 18 years of age), the physician must only share the information with the patient himself; involvement of a third party is considered a breach to the patient's confidentiality. In some cases, the hospital may offer reimbursement to the patient; however, the physician is never to offer monetary compensation to the patient.  


Educational Objective: A physician must always inform the patient when a medical error is made.
Educational Objective: A physician must always inform the patient when a medical error is made.
|AnswerA=The surgeon should inform the patient that a mistake has been made.
|AnswerA=The surgeon should inform the patient that a mistake has been made.
|AnswerAExp=The surgeon is ethically obliged to tell the patient of the mistake.
|AnswerAExp=The surgeon is ethically bound to disclose the mistake to the patient.
|AnswerB=The surgeon should inform the patient's parents that a mistake has been made.
|AnswerB=The surgeon should inform the patient's parents that a mistake has been made.
|AnswerBExp=The patient is an adult;  the surgeon must maintain confidentiality with his patient and only the patient has the right to know of the surgeon's mistake.
|AnswerBExp=The patient is an adult;  the surgeon must maintain confidentiality with his patient and only the patient has the right to know of the surgeon's mistake.
|AnswerC=The surgeon is not required to inform the patient of the mistake only if appendectomy is later performed during the same surgical procedure.
|AnswerC=The surgeon is not required to inform the patient of the mistake if cholecystectomy is later performed during the same surgical procedure.
|AnswerCExp=The surgeon is ethically obliged to inform the patient, regardless of how benign or how reversible the mistake is.
|AnswerCExp=The surgeon is ethically obliged to inform the patient, regardless of how benign or how reversible the mistake is.
|AnswerD=The surgeon may elect not to inform the patient
|AnswerD=The surgeon may elect not to inform the patient
|AnswerDExp=The surgeon is ethically obliged to inform the patient.
|AnswerDExp=The surgeon is ethically obliged to inform the patient.
|AnswerE=The surgeon must inform the patient that a mistake has been made and offer personal monetary compensation right away.
|AnswerE=The surgeon must inform the patient that a mistake has been made and offer monetary compensation.
|AnswerEExp=The surgeon is supposed to inform the patient without directly offering any compensation for the mistake. However, in some cases, reimbursement by the hospital to the patient is required.
|AnswerEExp=The surgeon is supposed to inform the patient without directly offering any compensation for the mistake. However, in some cases, reimbursement by the hospital to the patient is required.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=ethical, mistake, make, made, appendicitis, appendectomy, cholecystectomy, surgeon, surgery, wrong, monetary, compensation, money, ethical, ethically, inform, disclosure, error, medical, right, confidentiality
|WBRKeyword=ethical, mistake, make, made, appendicitis, appendectomy, cholecystectomy, surgeon, surgery, wrong, monetary, compensation, money, ethical, ethically, inform, disclosure, error, medical, right, confidentiality
|Approved=No
|Approved=Yes
}}
}}

Revision as of 17:09, 13 January 2015
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Ethics
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 22-year-old man presents to the emergency department complaining of acute abdominal pain and tenderness. Following initial work-up, he is diagnosed with appendicitis and is cleared for appendectomy. Rushed by the high patient load, the surgeon accidentally performs the appendectomy on a patient admitted for cholecystectomy. What is the best way to approach this mistake?]]
Answer A AnswerA::The surgeon should inform the patient that a mistake has been made.
Answer A Explanation AnswerAExp::The surgeon is ethically bound to disclose the mistake to the patient.
Answer B AnswerB::The surgeon should inform the patient's parents that a mistake has been made.
Answer B Explanation AnswerBExp::The patient is an adult; the surgeon must maintain confidentiality with his patient and only the patient has the right to know of the surgeon's mistake.
Answer C AnswerC::The surgeon is not required to inform the patient of the mistake if cholecystectomy is later performed during the same surgical procedure.
Answer C Explanation AnswerCExp::The surgeon is ethically obliged to inform the patient, regardless of how benign or how reversible the mistake is.
Answer D AnswerD::The surgeon may elect not to inform the patient
Answer D Explanation AnswerDExp::The surgeon is ethically obliged to inform the patient.
Answer E AnswerE::The surgeon must inform the patient that a mistake has been made and offer monetary compensation.
Answer E Explanation AnswerEExp::The surgeon is supposed to inform the patient without directly offering any compensation for the mistake. However, in some cases, reimbursement by the hospital to the patient is required.
Right Answer RightAnswer::A
Explanation [[Explanation::Regardless of how benign or how serious a medical error is, disclosure of that error and a clear explanation of the circumstances that led to it is an ethical obligation. The physician must also be clear about the severity of the error and what consequences may arise from it. In the case of an adult patient (above 18 years of age), the physician must only share the information with the patient himself; involvement of a third party is considered a breach to the patient's confidentiality. In some cases, the hospital may offer reimbursement to the patient; however, the physician is never to offer monetary compensation to the patient.

Educational Objective: A physician must always inform the patient when a medical error is made.
Educational Objective:
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::ethical, WBRKeyword::mistake, WBRKeyword::make, WBRKeyword::made, WBRKeyword::appendicitis, WBRKeyword::appendectomy, WBRKeyword::cholecystectomy, WBRKeyword::surgeon, WBRKeyword::surgery, WBRKeyword::wrong, WBRKeyword::monetary, WBRKeyword::compensation, WBRKeyword::money, WBRKeyword::ethical, WBRKeyword::ethically, WBRKeyword::inform, WBRKeyword::disclosure, WBRKeyword::error, WBRKeyword::medical, WBRKeyword::right, WBRKeyword::confidentiality
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