Communicating with Patients about Harmful Behaviors

Commentary by Carol R. Schermer, MD, MPH

“Come on in, Travis,” said Dr. Kennedy. “Looks as though that could be a nasty scrape.”

“Yeah, well thanks for working me in,” said Travis, holding a bloody bandana to his head. “We’re laying sewer pipe for the city and the crane operator can’t see us too well. A pipe grazed me going down,” he said. “I guess my timing’s off today. It kind of rang my bell.”

“Let me take a look.” Dr. Kennedy, examined his temple and the skin around the orbital area and eye. “I can patch this up for you, and then we’ll send you for some X-rays.”

While he was at work on Travis’s temple, Dr. Kennedy asked for more information about the accident. “Why is your timing off? Are you getting enough sleep? Were you hung over?”

“Maybe.”

“How many drinks do you have in a week?” Dr. Kennedy asked calmly.

“I don’t know. I don’t count ’em. Three or four a day maybe. Not on the job, though.” Travis replied.

“Well I smell whiskey on your breath now and I’m worried. You could have gotten a concussion down there today—or worse.”

“Easy on the sermons, OK? The other guys bought me one for the pain today. I can handle the drink,” Travis said.

“OK, Travis,” said Dr Kennedy, exasperated. “But we need to see what problems you’re having that could be related to your drinking. You might need to cut back, and some people need to do that under supervision.”

This case study scenario appears in the American Medical Association Journal of Ethics.

January 2008, Volume 10, Number 1: 13-16.

Case Study 1: Questions To Answer

What are the ethical issues are presented in the case study scenario above? (5 points)
The interviewing that takes place between Dr. Kennedy and Travis represents a brief intervention, and it is a motivational intervention.

a. Using the 4 steps of intervention design and delivery, consider a broader intervention design that could be employed by those in Dr. Kennedy’s practice. (Speak on the design, delivery and evaluation. Support your answer with information from the ASP text). (20 points)

How might Dr. Kennedy slow down the intervention? He jumps quickly to suggesting professional help. Why is he doing that? (5 points)

4. List all the stakeholders) (5 points)

5. Finally, does Dr. Kennedy have a duty to disclose his findings to Travis’s employer? Why or why not? (answer here from your opinion, you do not need to look up legal issues of doctors, employers, HIPAA laws etc.) (5 points)

Answer all your questions with the question number to which you are responding. Must be at least 3 pages (double spaced, 12 point font, 1 inch margins). Make sure to proofread your work. Spelling and grammar count. (10 points).

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