another ethics question

[Guest docofmedicine]

Scenario: You are a neurologist and have just had a patient referred to you. You find that he is suffering from ataxia & chorea among other symptoms. You need an MRI scan to make a conclusive diagnosis, but the wait is 3 months. What explanation would you give the patient & what steps would you take?

 

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my take on this is to determine if I should treat this case as an emergency - which would allow me to get an MRI scan right away. The prob is knowing whether it is a slow neurodegenerative disease like huntington, or one that is imminent and rapidly progressing - such as a brain tumor.

 

but I'm not sure. what do all you ethics buffs think?8o

[Guest ttryit]

Quite an interesting question...but definitely one with too much prerequisite medical knowledge for interview's sake.

 

I would agree with you that the first step is to determine how emergent the case is. I would suggest that subsequent steps may involve looking at alternative diagnostic testing and your colleagues' opinions. Also, are there pre-existing medical conditions (esp. history of cancer)? How old is the patient? (If s/he is 110 and you did an emergency MRI and found out s/he had a malignant brain tumour, whould s/he want aggressive treatment?).

 

/tt

[Guest peachy]

I think it's a reasonable question ... but that the medical answers you gave, ttryit and docofmedicine, aren't relevant to the ethical question. If an interviewer asks that, I don't think they are looking for "well, if it was this medical condition I'd make this medical decision" they are asking for your consideration of the ethical issues.

 

That is, would you tell a patient that they possibly had a devastating disease if you weren't sure yet and wouldn't be sure until a crucial diagnostic test came back? You don't need to have a medical background to discuss the ethical implications of that.

[Guest DancingDoc]

One thing I think you need to consider is that you can't send everyone to get an emergency scan in case they have a devastating disease that progresses quickly. So how do you know where to draw the line.... what's makes this person an emergency over another?

[Guest TimmyMax]

Hey,

 

Get a CT head- it's much faster than an MRI and will give you a good idea as to whether or not the patient has a brain tumour!

 

Best of luck!

Timmy

[Guest Steve MD09]

"Get a CT head- it's much faster than an MRI and will give you a good idea as to whether or not the patient has a brain tumour!"

 

A CT is also less than a tenth of the cost of an MRI.

[Guest docofmedicine]

you all raise good points for such a technical question. I also spoke to a med student & his stance was to closely observe the patient. If any additional symptoms arose, the patient would have to contact the physician right away. In cases like this, ataxia (ie. tremors) could be attributed to anything, from brain tumor growth to alcoholism (yeah, i know!).

 

BTW, I just had my interview & no questions even remotely similar to this came up, but it is one worth contemplating.

 

thanks for the feedback though.

 

-docmed