Read the Case-Based Curriculum for Neurology Residents.

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TRUTH TELLING AND DISCLOSURE n \./ I. Learning Objectives At the conclusion of this case, neurology residents will: l. be able ro define and explarn the following terms and concepts: rrurh relling, disclosure, therapeutic privilege, paternalism, confidentiality of medical records. 2. be able to discuss applicable state law and institutional rules regarding confrdenriality of medical information. 3. have increased ability to sensitively communicate information in a way that avoids euphemisms and half-truths. 4. be aware of hisAreresponsibility to communicare with patients wirh respect, honesty, and sensitiviry.
II. Case Ms. JA is a 24 year old woman, a law student in her final year, who developed blurred vision in her right eye. After several days, her vision deteriorated so much that she could not read her textbooks, and her eye became painful upon movement. Her family physician referred her to an ophthalmologist who, in rum, referred her to a neuro-ophtha.lmologist, Dr. JM, who made a diagnosis of acute retrobulbar neuriris. Without giving a specific medical diagnosis, Dr. JM told the parient that she had an inflammarion of rhe optic nerve and suggested a course of rntravenous methylprednisolone, which he explained should reduce the swelling ofthe nerve and restore her sight. Dr. JM happened to be a friend ofthe patient's parents. Later that aftemoon, when the patient's father called to inquire about his daughter, the docror told him that JA had optic neuritis and that this might be rhe firsr evidence of multiple sclerosis (MS), and consequently Dr. JM was going to obtain a neurological consultation. The father urged the doctor nor to tell his daughter, arguing that she was about to take her final exams. He feared that the news would uoset her_ causing her to fail the exams. Funhermore. she already had prospecrs of a job with a taw firm, and he feared thar they might not hire her ifthey thought she had the porential for subsequent illness. Ms. JA went to the library, and between the lnrernet and books, concluded that the inflammation ofthe optic nerve was optic neuritis, and discovered the possible relationship to MS. She recalled thar several years earlier she had experienced numbness of one leg, which naa lasted for several weeks, but for which she had not sought medical attention. She deiided nor ro tell the doctor because she was concerned that Dr. JM might be asked ro provide a medical rcpon and her job chances rnighr be jeopardized if he confirmed the diagnosis. over the subsequent weeks, Ms. JA's vision improved, and she was successfur in her examinations. when she began her new job, she completed information for a health insurance package. when asked about her past health, she did not repon her visual or neurological symptoms. Her vision returned to normal. Ms. JA had no further difiiculties over the subsequent year. When she became romantically involved with one of her colleagues in the law hrm, she debated whether or not she should tell him about her medical historv.
Page 1 and 2: AMERJC,{N ACADEMY OF NETJROLOGY ETI
Page 3 and 4: TABLE OF CONTENTS l. Introduction 2
Page 5 and 6: Followrng each case is a proposed o
Page 7 and 8: CODE OF PROFESSIONAL CONDUCT PREFAC
Page 9 and 10: arrange transfer ofthe patient's ca
Page 11 and 12: items as long as this practice prov
Page 13: 2 AmericanAssociationofNeurological
Page 17 and 18: III. Case Comments (bv Roben F. Nel
Page 19 and 20: 8. What ethical considerations are
Page 21 and 22: HUNTINGTON'S DISEASE - PRESYMPTOMAT
Page 23 and 24: PROPOSED OUTLINE FOR ETHICAL ANALYS
Page 25 and 26: 6. Are there institutional, legal,
Page 27 and 28: AMENCAN ACADEMYOF NEUROLOGY Page I
Page 29 and 30: CARE OFAN HIV.INFECTED PATIENT IN A
Page 31 and 32: The following format is advised for
Page 33 and 34: B. Idenrification ofthe Ethical Pro
Page 35 and 36: 9. t0. Are there analogous cases? W
Page 37 and 38: Ethical Role of Ncurologisrs io AID
Page 39 and 40: OPIOID TREATMENT OF CHRONIC NONMALI
Page 41 and 42: and mexilitene. Finally, Mr. Jones
Page 43 and 44: III. Case Commenb (by Glenn A. Mack
Page 45 and 46: Ponenoy has extensively reviewed ex
Page 47 and 48: defined "rescue" doses or hospitali
Page 49 and 50: 8. What ethical considerations are
Page 51 and 52: 16. Rodwin MA. Srrains in rhe fiduc
Page 53 and 54: II. Case A 25 year-old woman sustai
Page 55 and 56: III. Case Comments (by Michael P. M
Page 57 and 58: some guidance, if they are consiste
Page 59 and 60: On the basis of this analytic appro
Page 61 and 62: 80 years ago by Justice Benjamin Ca
Page 63 and 64: Although physicianshould always act
Page 65 and 66:
t(, ;-)- AMERICAN ACADEMY OF NEUROL
Page 67 and 68:
@ Persistent VeSetativeSlate Paticn
Page 69 and 70:
1r= ) AMERICAN ACADEMY OF NEUROLOCY
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PRSISTE\TT }TGETATTVE STAIE ard chi
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PRSISTE{T VEGETATryE STATE PAGE 5 T
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PNSISTEYT ITGETATTVE STATE PAGE 7 5
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PNSISTF{T VEGETATTVE STATE PAGE 9 O
Page 79 and 80:
II. Case Because of progressive dys
Page 81 and 82:
III. Case Comments (by James Bernat
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mother's wishes, some of her guilt
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Special Article n"r.oro*r*,ffi* Eth
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injur5r from improper application o
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,R,, '.=--' AMERICAN ACADEMY OF NEU
Page 91 and 92:
DIAGNOSIS AND EVALUAIION OF D&TBI"I
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DLTGNOSIS AND EVALUAIION OF DE\,I6|
Page 95 and 96:
II. Case The patient (Mrs. M) was a
Page 97 and 98:
III. Case Comments (by Alison Wichm
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usually be identified as her surrog
Page 101 and 102:
with the surrogate and other family
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RAIN DEATH IN ADULTS PAGE 2 3. with
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BRAIN DEATH IN ADIJLTS PAGE 4 E. So
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PHYSICIAN-ASSISTED DYING I. Learnin
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The neurologist writes the prescrip
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Continuation Version Two when the g
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Continuation Version Four The pills
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III. Case Comments (by David Goldbl
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might have benefitted from professi
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from engaging in any acr thar direc
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II. Case @ Neurologi consultation w
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III. Case Comments (by Russell D. S
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C. Dcci.sion Mnkinp and Intplernent
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UNCOOPERATIVE PARENTS @ I. Learning
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The following format is advised for
Page 131 and 132:
even though rhese needs appear to t
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CLINICAL TRIALS I. Learning Objecti
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III, Case Comments (by David Goldbl
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@ ro identify a her to enroll in th
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II. Case A 46-year-old white ntale
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III. Case Comments (by Russell Snyd
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4. The medical community needs to c
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GIFTS FROM INDUSTRY t. Learning Obj
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II. Case Dr. Daniel Barker was rece
Page 149 and 150:
@ B. Identifcation of the Ethical P
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@ specialty medical associations. U
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PROFESSIONAL MISCONDUCT OF A SEXUAL
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The following format is advised for
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one class of nonsexual touching is
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