Question

You are a resident managing a private patient with cellulitis. The patient has a history of congestive heart failure and a normal EKG. The patient is on digoxin, an ACE inhibitor and a diuretic, but not a bera-blocker. You cannot find a contraindication to the use of beta-blockers either in the chart or in discussion with the patient. You ask the private attending why there is no beta-blocker and he looks at you as if you had anoxic encephalopathy. He says, "I have been in practice for 40 years. Don't you think I know what I am doing? Beta-blockers are dangerous in congestive failure." The patient looks proudly at the attending and says, "I have the smartest doctor in the world." What should you do about this disagreement? a. Wait for the attending to leave and give the patient a prescription for carvedilol. b. Suggest to the patient that he should find another doctor. c. Report the physician to the state licensing board. d. Do nothing; he is the attending of record. e. Bring the disagreement to the chief of service. f. Help the patient find a good lawyer and volunteer to testify.

    You are a resident managing a private patient with cellulitis. The patient has a history of congestive heart failure and a normal EKG. The patient is on digoxin, an ACE inhibitor and a diuretic, but not a bera-blocker. You cannot find a contraindication to the use of beta-blockers either in the chart or in discussion with the patient. You ask the private attending why there is no beta-blocker and he looks at you as if you had anoxic encephalopathy. He says, "I have been in practice for 40 years. Don't you think I know what I am doing? Beta-blockers are dangerous in congestive failure." The patient looks proudly at the attending and says, "I have the smartest doctor in the world."
What should you do about this disagreement?
a. Wait for the attending to leave and give the patient a prescription for carvedilol.
b. Suggest to the patient that he should find another doctor.
c. Report the physician to the state licensing board.
d. Do nothing; he is the attending of record.
e. Bring the disagreement to the chief of service.
f. Help the patient find a good lawyer and volunteer to testify.
Show more…
Medical Ethics for the Boards
Medical Ethics for the Boards
Conrad Fischer 3rd Edition
Chapter 1, Problem 55 ↓

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Step 1

Recognize that the attending physician has significant experience and may have valid reasons for their treatment decisions, but also consider the current guidelines and evidence regarding the use of beta-blockers in patients with congestive heart failure.  Show more…

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You are a resident managing a private patient with cellulitis. The patient has a history of congestive heart failure and a normal EKG. The patient is on digoxin, an ACE inhibitor and a diuretic, but not a bera-blocker. You cannot find a contraindication to the use of beta-blockers either in the chart or in discussion with the patient. You ask the private attending why there is no beta-blocker and he looks at you as if you had anoxic encephalopathy. He says, "I have been in practice for 40 years. Don't you think I know what I am doing? Beta-blockers are dangerous in congestive failure." The patient looks proudly at the attending and says, "I have the smartest doctor in the world." What should you do about this disagreement? a. Wait for the attending to leave and give the patient a prescription for carvedilol. b. Suggest to the patient that he should find another doctor. c. Report the physician to the state licensing board. d. Do nothing; he is the attending of record. e. Bring the disagreement to the chief of service. f. Help the patient find a good lawyer and volunteer to testify.
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