Culture Awareness
A physician’s humility should extend to recognize diversity, cultural values, orientation and their significance in a patient’s decision-making process. The physician should also identify some basic familiarity with today’s diverse cultures.

A physician should not assume that a patient exercises all beliefs of an ethnic or racial community.

Asking appropriate questions will help to identify the patient’s beliefs and values.

Child Abuse
All physicians have a duty to report child abuse with no discretion. There is no discretion on whether to report abuse. Even suspected child abuse must be reported, and reporting to child protective services should be prompt, to prevent further abuse. If a report is being sincerely and honestly made, there is no associated liability.

Elder Abuse
The circumstances with elder abuse are less clear than child abuse, because an elderly person is often an adult who may object to the report of abuse, as they fear repercussions at home, or even loss of the home. Nevertheless, you must report the abuse to adult protective services.

Q28 An 86-year-old female presents to the office for follow-up care. Patient has several abrasions and ecchymoses and has been losing weight. She is widowed and lives with her granddaughter and her husband. Through further questioning, she does admit that her granddaughters’ husband occasionally physically abuses her when he is drunk. What should be done?
A-meet with you patient and granddaughters’ husband.
B – engage home healthcare agency to evaluate home situation.
C- have the patient removed from the house placed in an adult home environment.
D- Reported grandson in law to adult protective services.
E – Report the abuse only with patients’consent.

Duty to Warn
A physician must have reasonable grounds to warn possible victim if a patient may be in danger of harming others. Duty to warn is one of the few exceptions to the patient’s right to confidentiality. In cases of homicidal or suicidal ideation, the practitioner has a moral and legal obligation to inform potential victims and the proper authorities.

Q29 You are the primary care to a patient with a history of schizophrenia. During a follow up visit, he informs you of his frustrations with his boss. He asks if everything during the office visit is confidential, and you state that it is, in response. He then states “Sometimes, I really think that I will kill my boss if I get a chance.”
What should be your next step?
A-Inform the patient’s boss of the threat
B-inform law enforcement of the threat to the patient’s boss
C-continue to discourage patient of his plan and maintain confidentiality
D-inform both the patient’s boss and law enforcement of the threat
E-Commit patient to the psychiatric ward.