Behavioral Science & Ethics USMLE Step 1 Practice Question
A 77-year-old man presents to clinic with his daughter for results of neuropsychological testing performed to evaluate progressive memory loss over the past 2 months. The testing reveals cognitive changes consistent with mild cognitive impairment. His medical history is significant for prostate cancer diagnosed 3 weeks ago, major depressive disorder treated 20 years ago (currently off medications), and recent depressed mood. Vital signs are stable. Before the patient enters the examination room, his daughter pulls the physician aside and says, "Doctor, my father gets upset easily. Please don't tell him the test results are abnormal—I'll explain things to him at home in my own way." The patient then enters the room appearing anxious. Which of the following is the most appropriate initial approach?
Answer choices
- AAgree to speak with the daughter alone first about the results, then provide a general summary to the patient without specific details about cognitive impairment
- BAcknowledge the patient's current emotional state and recent stressors, then discuss whether he would like to hear his test results before proceedingCorrect answer
- CImmediately refer the patient to psychiatry given his history of depression and current depressed mood, delaying the discussion of results
- DInform the daughter that you will respect her wishes and call her with results separately, then give the patient only reassuring information about normal aging
- EPresent the full test results directly to the patient without preamble, emphasizing the importance of informed consent
- FSuggest starting a memory-enhancing medication as a precaution before discussing any abnormal findings with either the patient or daughter
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