What would YOU do? Is it professional?

You are a hardworking doctor in a clinic. Due to your busy schedule, you have always missed your daughter’s school events. On Sunday evening, she looks at you with pleading eyes, and says, “Tomorrow, at 7pm, I will be representing my school in an elocution contest in USM and I have been practicing very hard for it. All my friends’ parents will be there. Can you come just this once to cheer for me? It means a lot to me.” You promise that you will be there, and makes a mental note to leave your clinic latest by 6.15pm because you knows you need at least 40 minutes to arrive with rush hour traffic in Jalan Masjid Negeri.

 

Time flew by the next day, and all too soon, it was already 6.05pm. You still had one patient left – your 75 year old hypertensive, diabetic patient who traveled from Sg Bakap to see you. You prayed that he was well, so that you can just prescribe him his usual medication and send him on his way, but alas… he tells you, “Doctor, I have this nagging cough that hasn’t gone away for the past 2 months”. You look at him, and thought he didn’t look really sick (apart from being slightly thinner than usual). Taking a full history and performing a thorough examination will definitely mean you’d miss your daughter’s performance.

 

Since the vital signs taken by the nurse (including his respiratory rate and temperature) were normal, would you just prescribe him with some cough mixtures on top of his usual diabetic and hypertensive medication, but stress to him the importance of coming back the following week if the cough persisted?

Ahmad is an engineer and the sole breadwinner of a family with 4 young children. He was recently diagnosed with a cancer that would be fatal if untreated. However, he has been responding very well to Drug A, and there is Level 1 evidence that Drug A can cure him of his condition. Today, you realise that Drug A has some porcine elements in it. You know that Ahmad is very religious and would most likely stop his medication if he knows of this.

 

Would you tell Ahmad what you that the drug has porcine elements in it?

You have 2 patients with end stage liver disease: Jane, 35 years old, who is an ex- alcoholic, on the waiting list for 18 months. She has abstained from alcohol for the last 18 months because this is a criteria for them to receive a transplant Sally, 8 years old, who has biliary atresia, failed Kasai operation, on the waiting list for 6 months.

 

Today, you are told a suitable donor that matched both patients is available, and since Jane has been on the waiting list longer, she was given priority. That night, as were going home from the hospital, you are dismayed to find Jane outside the pub, smelling of alcohol, vomiting and obviously drunk.

 

As you help Jane get treatment at the hospital, you contemplate if you should report this to the liver transplant committee. If you did, would this be a breach of patient confidentiality, hence unprofessional? If you doesn’t, would this mean that you are denying a more suitable patient the chance of getting the transplant?

Mary, an 88 year old lady who was otherwise active despite her age comes with her family to see you for a lump in her breast. You decide to do a biopsy. Her children later see you in private, and asks you not to tell her the truth should the biopsy turn out malignant. They are worried that their mother would not be able to handle it, and give up on life because she has just lost her husband. Today, the results are out, and confirms malignancy.

 

Would you tell Mary the truth?