Abstract

In a large Colombian teaching hospital, a fifty-five-year-old woman complaining of stomach pain is examined by a foreign-exchange medical student from the United States. Speaking in Spanish, the student elicits a medical history that suggests a possible recurrence of gallstones, but nothing further. Upon discussing the patient's case in private with the attending physician, the student is shocked to learn that the patient is suffering from terminal, metastatic gastric cancer but is unaware of her diagnosis. The attending physician explains that the patient's husband instructed the health care providers not to tell the patient what her diagnosis is. The medical student feels uncomfortable withholding the diagnosis from the patient. The thought of disclosure feels equally uncomfortable, however, as it would mean contradicting the instructions of the attending physician at the host hospital as well as violating what the student suspects, but is not sure, may be acceptable medical practice in Colombia. How should the medical student proceed?