Book contents
- Frontmatter
- Contents
- Contributors
- Acknowledgments
- Introduction
- PART ONE DEFINING MEDICAL PROFESSIONALISM
- PART TWO CASES INVOLVING MEDICAL STUDENTS
- PART THREE CASES INVOLVING PHYSICIANS
- 3 Principle of Primacy of Patient Welfare
- 4 Principle of Patient Autonomy
- 5 Principle of Social Justice
- 6 Commitment to Honesty with Patients
- 7 Commitment to Patient Confidentiality
- 8 Commitment to Improving Quality of Care
- 9 Commitment to Maintaining Trust by Managing Conflicts of Interest
- 10 Commitment to Professional Responsibilities
- APPENDIX: Cases by Specialty
- Index
- References
4 - Principle of Patient Autonomy
Published online by Cambridge University Press: 25 February 2010
- Frontmatter
- Contents
- Contributors
- Acknowledgments
- Introduction
- PART ONE DEFINING MEDICAL PROFESSIONALISM
- PART TWO CASES INVOLVING MEDICAL STUDENTS
- PART THREE CASES INVOLVING PHYSICIANS
- 3 Principle of Primacy of Patient Welfare
- 4 Principle of Patient Autonomy
- 5 Principle of Social Justice
- 6 Commitment to Honesty with Patients
- 7 Commitment to Patient Confidentiality
- 8 Commitment to Improving Quality of Care
- 9 Commitment to Maintaining Trust by Managing Conflicts of Interest
- 10 Commitment to Professional Responsibilities
- APPENDIX: Cases by Specialty
- Index
- References
Summary
PATIENT AUTONOMY – PRIMARY CARE
An eighty-seven-year-old man wants prostate cancer screening despite his family physician's recommendation that such screening is not warranted. He has not had any change in urinary symptoms over the past five years. His past medical history is significant for chronic atrial fibrillation, hypertension, and advanced osteoarthritis. His medications include warfarin, diltiazem and acetaminophen. He has no family history of prostate cancer.
A Perspective from a General Internist
Clinical Background
Screening for prostate cancer is done through palpation during a digital rectal examination (DRE) and measurement of the level of prostate specific antigen (PSA) in blood serum. Digital rectal examination allows for palpation of only a portion of the prostate gland. PSA measurement is used to augment the digital rectal examination in screening. PSA levels are known to rise as the prostate volume increases, even in the absence of cancer. The recommendations for initiation and frequency of prostate cancer screening are controversial. The presence of new urinary or sexual symptoms should prompt an evaluation to exclude the presence of prostate cancer.
Further testing for prostate cancer takes place if the DRE is abnormal with marked asymmetry, presence of a nodule or nodules, or a hard consistency. PSA levels that are within the normal range but rise more rapidly than expected are also an indication for further testing.
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- Professionalism in MedicineA Case-Based Guide for Medical Students, pp. 154 - 188Publisher: Cambridge University PressPrint publication year: 2009