Title: Usmle Step 1 MCQ's #
3
Subject: Behavioral
Science
Q NO 3: A
67-year-old man presents at his physician complaining of discomfort in his
lower abdomen and difficulty with urination. The man is 5 feet 11 inches tall
and weighs 220 pounds. Although he used to smoke cigarettes, he was able to
quit when he retired at age 65. Physical examination reveals an enlarged
prostate. Suspecting the possibility of cancer, the physician orders a PSA test
and tells the patient he will be contacted when the results are available. The
patient is visibly upset at hearing the word “cancer” and in spite of the
physician’s reassurances of the low probability of malignancy, is physically
shaking when he leaves the office. Several days latter the results of the test
are received. The patient has a PSA of 3.5, elevated, but below the commonly
used screening test cutoff. At this point the physician’s best course of action
would be to do which of the following?
A. Arrange an appointment to talk with the patient in the
next several days and review the results in person
B. Call the patient at once to deliver the news and offer
guidance
C. Call the patient to deliver the news and congratulate him
on his overall health.
D. Call the patient to deliver the news and schedule the
patient for a follow-up appointment to review what he can do to improve his
overall health.
E. Have the nurse employed by the practice call the patient
to deliver the news and take time to answer any questions he may have.
F. Schedule an appointment to talk to the patient about the
results and offer him a referral for counseling
G. Send the patient a letter detailing the test results and
suggesting the next course of action.
Explanation:
The correct answer is D. All communication with a patient is
best handled face to face. When this is not possible because of the need to
deliver news in a timely manner, as in the present case the phone conversation
should be followed up by a visit. The follow-up visit is also needed to discuss
some of the patient’s other health issues, including his weight. This patient’s
body mass index (weight/height) is too high.
The patient is likely to have high anxiety over the next
several days as he waits to hear the results (choice A). Alleviate the anxiety
by telling him as soon as possible.
The phone call gets the good news to the patient quickly,
but does nothing to either further the building of a good long-term
relationship with the physician or address the patient’s other health concerns
(choice B)
Choice C while getting the patient the news quickly, and in
a cheery manner, does not address the patient’s other health condition.
The physician himself should deliver the news not a nurse
(choice E) or other member of the office staff. The practice of having the
physician call with bad news and a staff member call with good news only
heightens patients anxiety anytime the physician calls. The physician is in the
best position to answer any questions that the patient has, and to talk about
the next steps to improve health.
The patient is likely to have anxiety waiting for days to
hear the test results. Also the physician himself should do counseling, and not
refer to patient to someone else (choice F).
A letter from the physician (choice G) takes time to get to
the patient, always creates anxiety and offers no one to discuss meaning of the
results.
