You have a patient who has recently been diagnosed with myeloma and he is discussing treatment options with you. You are the full-time employee of an outpatient facility run by a managed-care plan and you have recently received written instructions not to bring up subjects such as bone marrow transplantation in myeloma with patients. The reasoning was that they are outrageously expensive and do not cure the disease, although it may extend survival. The data that they extend survival are not entirely conclusive. In addition, in a private meeting with the medical director, you have been told that the expenditures per patient load of care of each of the physicians would be examined yearly to determine which physician would be promoted.
What do you do?
a. Fully inform the patient about the risks and benefits of bone marrow transplantation.
b. Refer your patient to an oncologist to have this discussion.
c. Transfer the patient to another primary-care provider.
d. Advise the patient to file suit against the managed care plan.
e. Give the patient treatment with melphalan or thalidomide.
f. Inform the patient about bone marrow transplantation if he asks you about it.