Case Scenario: REALITY CHECK: Paternalism and Breach of Confidentiality Paternalism is not only a concern when caring for patients. It also occurs frequently in the workplace. Vicky traveled with her husband, Dan, to a consulting assignment in Michigan. While visiting with her brother in Michigan, she believed that her potassium was low because of the physical symptoms that she was experiencing. Dan suggested to Vicky that she get her blood tested. Vicky's brother suggested that she have her blood tested at a small blood-drawing station at a local athletic club. It turned out that the station was owned and operated by the organization that Dan was assigned to consult with. Vicky went to breakfast with Dan the following day.

A physician consultant joined Dan and Vicky at breakfast. During breakfast, Vicky related her ongoing battle with her autoimmune disease. Joan, a nurse consultant, arrived a bit later for breakfast. She offered her opinion that Dan should leave work and be with Vicky. Dan said, "We have been fighting this battle together for many years. We know when to push the panic button." Vicky spoke up and said, "Our family lives here. They are familiar with my health needs and will take of care me while Dan is working." Later that morning, while at work, Dan learned that some of the results of Vicky's lab tests revealed that her potassium was low, which was a common ongoing medical problem that Vicky and Dan were used to and had previously addressed on numerous occasions. Dan's physician colleague inquired as to how she was doing. Dan described her condition. The physician and the nurse suggested that Dan leave the job to be with Vicky. Dan said, "This has been our life, and we have things under control." Later that morning, Joan, without Dan's knowledge, decided to call the corporate office and discuss her concerns with Bill, who was Dan's supervisor. Bill had overslept and had not yet arrived at work. Joan then decided to speak to a supervisor on call. After that conversation, Joan, being led by three staff members from the organization, tracked Dan down on several occasions that morning. On the first occasion, at approximately 10:15 AM, Dan was consulting with the organization's staff in a family practice center when Joan arrived. She abruptly called Dan aside, excusing the organization's staff from a room in which Dan was consulting. Joan said, with surprise, "Dan, you are working?" Dan, even more surprised at the question, said, "Yes, I have been working."

Joan replied, "Well, anyway, the corporate office wants to speak to you." Dan asked, "Did you call and report Vicky's health needs?" Joan said that she had. Dan replied, "Couldn't this have waited until lunch? I will call at lunch." Joan again tracked Dan down with an entourage of the organization's staff at 11:30 AM. She located him while he was in the organization's transfusion center. She intruded into a conference room where Dan was discussing the care being rendered to a cancer patient and asked the staff with whom Dan was consulting, "Could everyone please leave? I need to talk to Dan." After the organization's staff left, the nurse said, "I called the corporate office, and they want you to call them." Dan inquired, "Are they pulling me off this assignment?" The nurse replied, "Yes, they are. I spoke to Bill, and he has decided that out of concern for Vicky that you should be removed from this particular assignment. He wants you to call him." Dan again said, "Couldn't this have waited until lunch? I don't understand why you did this, calling my boss and continuously interrupting my work and sharing with others confidential information. I will wrap up with the staff regarding this patient and call Bill." As Joan left the conference room, disgruntled, Dan said, "I trusted that the information my wife and I shared with you would remain confidential." Dan called Bill during his lunch break. During that call Bill said, "I am going to remove you from your assignment because I think your wife's health needs should be addressed, and this could be disruptive to the survey." Dan replied, "The only disruption has been the nurse consultant tracking me down with staff from the organization and not conducting her work activities." Bill said, "My decision stands. You can opt to take vacation time for the remainder of the week."

Discussion: 1. Discuss what examples of paternalism you have gleaned from this case. Do you think Dan was treated fairly? Discuss your answer.

2. Discuss the issues of trust, confidentiality, and fairness as they relate to this case.