xi88 Posted February 22, 2009 Report Share Posted February 22, 2009 How would you answer this question: You are the doctor at a fertility clinic. A couple having trouble concieving a child comes to see you. After some test results come back, you find that the man is infertile, and cannot have children. However, when you see the woman's results, she is already pregnant. What do you tell the couple? Link to comment Share on other sites More sharing options...
yj09 Posted February 22, 2009 Report Share Posted February 22, 2009 This could totally be an episode of Private Practice Anyway, I think revealing the paternity of the child should be up to the mother. I would tell her the results of the tests privately and encourage her to tell the husband herself. Even though this does not seem fair to the husband, I think it's better to be respectful of the situation and allow the patient to have control over her decisions.......unless there is a law that requires physicians to disclose all test results to their patients.... what does everyone else think? Link to comment Share on other sites More sharing options...
~me~ Posted February 22, 2009 Report Share Posted February 22, 2009 This could totally be an episode of Private Practice Anyway, I think revealing the paternity of the child should be up to the mother. I would tell her the results of the tests privately and encourage her to tell the husband herself. Even though this does not seem fair to the husband, I think it's better to be respectful of the situation and allow the patient to have control over her decisions.......unless there is a law that requires physicians to disclose all test results to their patients.... what does everyone else think? I agree with you While the husband and wife are both my 'patients', my duty to them lies in their medical well-being and not so much in their personal lives. As a physician, it is probably not my place to tell the husband behind his wife's back that she may have been unfaithful. I would, however, tell the couple that the husband is infertile and privately tell the wife that she is pregnant. I don't think it's fair to withhold information from the husband regarding his infertility to protect his wife's secret. What the wife does with the situation is up to her after that, although I would personally encourage her to tell her husband. I would also recommend any services that may be beneficial (social worker, etc.) that may help her in breaking the news to her husband. Would anyone handle the situation differently? Link to comment Share on other sites More sharing options...
RCP90 Posted February 22, 2009 Report Share Posted February 22, 2009 Immaculate conception. Link to comment Share on other sites More sharing options...
rmorelan Posted February 22, 2009 Report Share Posted February 22, 2009 This could totally be an episode of Private Practice Anyway, I think revealing the paternity of the child should be up to the mother. I would tell her the results of the tests privately and encourage her to tell the husband herself. Even though this does not seem fair to the husband, I think it's better to be respectful of the situation and allow the patient to have control over her decisions.......unless there is a law that requires physicians to disclose all test results to their patients.... what does everyone else think? You are required to report the findings I think. I am not sure you can even tell the wife the husband's findings unless you have prior consent to do so or at the very least they are present - and therefore implying consent. Spouses don't automatically have access to each others test results do they? Tests can also be incorrect as well, so you are still not completely sure the husband actually is sterile. You didn't actually run a paternity test after all. This actually happened to a friend of mine - told he was sterile, and now they have a child on the way! Link to comment Share on other sites More sharing options...
fandanstan Posted February 22, 2009 Report Share Posted February 22, 2009 Tell them both to their face: "Sir, you are infertile. Ma'am, you are pregnant." Then do the gangster walk out of there. Okay, seriously? I would talk to them both about the general info (he's infertile blah blah blah), then speak to the wife in private and tell her that she's pregnant, and it's up to her to tell her husband. Link to comment Share on other sites More sharing options...
Sanserie Posted February 22, 2009 Report Share Posted February 22, 2009 Immaculate conception. Hahahaha Link to comment Share on other sites More sharing options...
rmorelan Posted February 22, 2009 Report Share Posted February 22, 2009 Tell them both to their face: "Sir, you are infertile. Ma'am, you are pregnant." Then do the gangster walk out of there. Okay, seriously? I would talk to them both about the general info (he's infertile blah blah blah), then speak to the wife in private and tell her that she's pregnant, and it's up to her to tell her husband. Still not sure you have right to reveal full disclosure about the test results about one party (the husband) but not the other (the wife). Why can you do one and not the other? Doesn't seem like you are using the same standard of case for both parties. Link to comment Share on other sites More sharing options...
tjey Posted February 22, 2009 Report Share Posted February 22, 2009 Still not sure you have right to reveal full disclosure about the test results about one party (the husband) but not the other (the wife). Why can you do one and not the other? Doesn't seem like you are using the same standard of case for both parties. Good point - My initial instinct would be to do what was stated before: openly disclose the man's fertility result (the fact that both of them are present and are requesting the result justify this) but then tell the woman she is pregnant in a private setting...but now i'm doubting whether this is the right course of action. I think we need to clarify the nature of the "tests" and the protocol in general. Do physicians at a fertility clinic normally check whether or not a woman is pregnant when they are trying to determine why the couple cannot conceive? Link to comment Share on other sites More sharing options...
kenzle Posted February 22, 2009 Report Share Posted February 22, 2009 I think that they would do all the standard tests, ie. bloodwork and urinalysis for each patient simply to rule out/determine any other illness not specific to reproduction and in doing so they would find out the wife is pregnant. As for disclosing the info, I agree with ~me~: tell the couple that he is infertile (if you do not disclose this info to the husband he could later sue you) and then tell the wife privately that she is pregnant and then whether she tells her husband about it or not is up to her...unless the husband is in imminent danger from her secret pregnancy, you cannot invade her privacy by revealing her secrets to others (again, you could be sued for this). As for running a paternity test, you would have to do it with the consent of the husband, which means she would have to tell him about the pregnancy first. Link to comment Share on other sites More sharing options...
ploughboy Posted February 23, 2009 Report Share Posted February 23, 2009 Immaculate conception. And I'm going to be that nerd who points out that the Immaculate Conception (Mary was conceived without Original Sin) and the Virgin Birth (Jesus was conceived without aid of a human father, via the Holy Spirit) are two completely different concepts in the eyes of those people who lie awake at night worrying about such things. / Not Roman Catholic // Theology geek Link to comment Share on other sites More sharing options...
rmorelan Posted February 23, 2009 Report Share Posted February 23, 2009 I think that they would do all the standard tests, ie. bloodwork and urinalysis for each patient simply to rule out/determine any other illness not specific to reproduction and in doing so they would find out the wife is pregnant. As for disclosing the info, I agree with ~me~: tell the couple that he is infertile (if you do not disclose this info to the husband he could later sue you) and then tell the wife privately that she is pregnant and then whether she tells her husband about it or not is up to her...unless the husband is in imminent danger from her secret pregnancy, you cannot invade her privacy by revealing her secrets to others (again, you could be sued for this). As for running a paternity test, you would have to do it with the consent of the husband, which means she would have to tell him about the pregnancy first. I don't want to belabour the point but I am really trying to make sure I am not making some gross error in my medical ethics thought processes - bad on interviews of course I still don't understand how you can tell the wife about the husband's medical test res ults, and not the husbands about the wife's. That just seems entirely inconsistent to me. Both have equal rights to privacy, and there is risk to the relationship in either case: 1) Telling a couple that really wants children that one of them is completely infertile can and has broken up relationships. 2) Telling a couple that one member has likely cheated on the other can and has broken up relationships. Why not tell both of them in private their medical test results and leave both both of them to discuss the matter together if they choose. That removes the legal arguments some have made, and satisfies the requirement to report the findings. Otherwise what is the ethical grounds for making the distinction you are trying to make between how you choose to report the findings? Pretend I am one of those ruthless adcom people pushing you at an interview I like these questions by the way, it is good to force us all to be thinking right now about these issues. wow, this is my 500th post! Gah! Link to comment Share on other sites More sharing options...
NewfieMike Posted February 23, 2009 Report Share Posted February 23, 2009 I'm pretty sure if a couple were seeing a fertility doctor, they are there to know which one of them (or both) are the reason they can't become pregnant. Or there's definitely some sort of consent of information release to spouses in that kind of situation. So you tell them straight up: the man is infertile, the woman is not. (you have openly disclosed the results to both parties involved). They came to find out who was the infertile one, they now know - case closed. And then of course privately tell the woman she's preggo Link to comment Share on other sites More sharing options...
rmorelan Posted February 23, 2009 Report Share Posted February 23, 2009 I'm pretty sure if a couple were seeing a fertility doctor, they are there to know which one of them (or both) are the reason they can't become pregnant. Or there's definitely some sort of consent of information release to spouses in that kind of situation. So you tell them straight up: the man is infertile, the woman is not. (you have openly disclosed the results to both parties involved). They came to find out who was the infertile one, they now know - case closed. And then of course privately tell the woman she's preggo Good response! Lets make it interesting though. Lets say there isn't just a document - I doubt at the interview they will let you off as easily as stating their is some prior arrangement By the way checked with a friend of mine who actually having fertility problems - being trying for years unfortunately. They did NOT have to sign such a consent form at all. Actually the findings were specifically (in this case at least) released just to the wife and husband separately. Link to comment Share on other sites More sharing options...
NewfieMike Posted February 23, 2009 Report Share Posted February 23, 2009 whatever the 'best' answer is, i highly doubt just leaving it be and saying "congrats" is the best way to go. My high school biology teacher was giving a class to students about basic genetics and looked at a student with brown eyes and said "so in your scenario, at least one of your parents has to have brown eyes" and the girl said "...but both of my parents have blue eyes..." ....bad news. Link to comment Share on other sites More sharing options...
random Posted February 23, 2009 Report Share Posted February 23, 2009 If you tell the woman that she is pregnant and not tell her that the man is infertile, then you are bound to be misleading the couple. Because she thinks her husband is fertile and would think it is her husband's kid. (so the doc can expect his actions will mislead the couple - unethical act?) If you tell each one of them their diagnosis separately, and expect the situation to work itself out, then they will leave the office, the man all choked up, the woman all flying high in joy. They get in the car driving on the highway, the man is about to burst into tears when the woman turns to him and says:"ahh cheer up, I was gonna wait till we get home but I see you could use the good news, Im PREGNANT!!!" And then the man goes WAAA? and swirls into the incoming lane and .... (so the doc can expect his actions will lead to many deaths and traffic delays on the highway - unethical act?) Link to comment Share on other sites More sharing options...
rmorelan Posted February 23, 2009 Report Share Posted February 23, 2009 whatever the 'best' answer is, i highly doubt just leaving it be and saying "congrats" is the best way to go. My high school biology teacher was giving a class to students about basic genetics and looked at a student with brown eyes and said "so in your scenario, at least one of your parents has to have brown eyes" and the girl said "...but both of my parents have blue eyes..." ....bad news. and that would be a great time to start the genetics section on spontaneous random mutation and how it can cause usual genetic variability You got to be light on your feet if you are high school teacher! Link to comment Share on other sites More sharing options...
kenzle Posted February 23, 2009 Report Share Posted February 23, 2009 I'm not 100% sure, but I would assume that because you came into the office looking for fertility treatment AS A COUPLE...results and treatments would be discussed as a couple as well. Unless, one person or the other asks otherwise. However, you can always be super-careful and just ask if they would like to get their results together or separately. and these results would only include the fertility results, not the pregnancy result. Link to comment Share on other sites More sharing options...
SpanishFly Posted February 23, 2009 Report Share Posted February 23, 2009 I would tell each of them separately and then encourage them to discuss their results with each other (for obvious reasons) and encourage them to come see me again after they have. I think in a normal situation (where the wife didn't possibly cheat on her husband), I would probably give the results to both at once because I think its pretty obvious that if a couple for comes in for treatment together, then both are comfortable with knowing each others medical info (unless they specifically tell you otherwise). In this case however, I would have to use some tact. In the mean time, I would certainly double check the results of the test results to make sure they really are right. At the end of the day, my job is to ensure the patients' health is taken care of, the marriage is a whole other issue (and i'm not their psychiatrist). So while trying to be tactful is one thing, being their marriage councilor is another...at some point you have to draw the line, after all, a doctor can't be all things to all people all the time. Link to comment Share on other sites More sharing options...
HighContrast Posted February 23, 2009 Report Share Posted February 23, 2009 I would tell each person their diagnosis separately. If, for some reason, I was unable to do this, I would inform the man that the current test results states that he is infertile but it could be erroneous and it should be performed again to ensure the validity of its results. I would let the woman know she was pregnant when she was apart from the man. Informing both parties of their results at the same time would likely result in a highly charged situation, one where the basis is revovled around the woman's past actions. I feel that a physician should not get invovled in your patient's personal life to such a certian degree. As well, by releasing the results to the both of the them at the same time, you are undoubtly going to cause problems and emotional hardships for the both of them; you will indirectly be telling the man his wife is cheating on him. Again, I feel that a physician's role is not this. I know you may have to inflict trying times due to test results, but this is a special situation, an ethical one. Link to comment Share on other sites More sharing options...
medhopeful09 Posted March 2, 2009 Report Share Posted March 2, 2009 The fact that the couple came to a fertility clinic means they are here to find out which one of them, if any, cannot conceive. The question here is therefore: which one of us is infertile? Finding out the woman is pregnant is what I like to call a "side finding" which was not intended in the initial search for an answer to the above question. What I would do is sit down with the couple together and inform them that the wife is ok and the husband is infertile. I would thereby answer the question they came to me with. I would then take the wife on the side and inform her she's pregnant, encourage her to discuss it with her husband, and provide information about counselling if she may need it. I would be doing my duty as a physician by answering the original question, informing the different parties of their specific situations without however creating tension or interfering in their personal lives. I believe this would be my answer if I am asked such question during a medical interview. Link to comment Share on other sites More sharing options...
youngdad Posted March 2, 2009 Report Share Posted March 2, 2009 Infertile does not always mean spermless it usually means a low or very low sperm count....it only takes one. I don't think it is a breach of confidentiality to discuss with both of them the infertilility issue as it is a joint venture. The pregnancy must be handled very sensitively to respect both of their rights to confidentiality. This needs to be discussed with the woman and myself (the doc) alone first. It might be easy to assume that the woman was unfaithful, but this may not be true because, yes, it only takes one sperm. If she has not been with anyone else then they have the baby they have been trying for. Even if the female was unfaithful, there would still be doubt as to the paternity of the child. Redoing every test that yields unexpected results is a poor way to spend resources, but in this case rechecking this man's results, and possibly retesting him altogether, is probably a good idea. As a side issue (could see a follow up question on this), if the woman wants a paternity test than she needs to discuss her pregnancy with her partner. I cannot give him a fake reason for performing a procedure on him, nor can I disclose the real reason for doing one. He would have to come to me or another doctor on his own for a paternity test. Link to comment Share on other sites More sharing options...
Jochi1543 Posted March 3, 2009 Report Share Posted March 3, 2009 Just because 1 test shows someone's infertile/doesn't have some disease/has a disease doesn't mean it's a fact. Was talking to an HIV+ patient about his health recently....he said when he was diagnosed a decade ago, the first test was positive, the next negative, the 3rd positive (talk about a rollercoaster of emotions). And I've read/heard many stories regarding infertility specifically, where a person is diagnosed as infertile but end up suddenly conceiving. Link to comment Share on other sites More sharing options...
rmorelan Posted March 3, 2009 Report Share Posted March 3, 2009 Just because 1 test shows someone's infertile/doesn't have some disease/has a disease doesn't mean it's a fact. Was talking to an HIV+ patient about his health recently....he said when he was diagnosed a decade ago, the first test was positive, the next negative, the 3rd positive (talk about a rollercoaster of emotions). And I've read/heard many stories regarding infertility specifically, where a person is diagnosed as infertile but end up suddenly conceiving. Excellent point. Med tests are NOT completely reliable and I think it is always important to keep that in mind. It is completely possible in this scenario that he is not actually infertile. Link to comment Share on other sites More sharing options...
medhopeful09 Posted March 6, 2009 Report Share Posted March 6, 2009 I just realized something. What if this question (or a similar one) is asked during the interview and is set as roleplay? Do we ask the husband to leave the room so that we can talk privately to his wife? Link to comment Share on other sites More sharing options...
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