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However, under some circumstances a doctor is obligated to breach confidentiality, as required by law, or because of a higher competing interest. Examples of legally required disclosures are public health hazards such as sexually transmissible diseases, which include HIV infections. The law not only permits such reporting, the law mandates it. Even if there is no regulation on point, a doctor may need to disclose sensitive information to named third parties if actual harm can be prevented through disclosure. Under the facts above, disclosure to the wife is necessary because repeated advice to the patient has gone unheeded and harm is imminent. The fact that the wife is also a patient simply adds to this ethical and legal duty to disclose. Of course the patient may sue the doctor for any breach of confidentiality but the doctor will likely win. There is a much greater risk for a lawsuit from the wife if the doctor fails to disclose and as a result, harm comes to the spouse. In such a lawsuit, the physician would likely lose. ANSWER TO QUESTION 17: A, B, C Choice A is correct because prescribing a drug without the proper indication amounts to breaching the standard of care, unless it is for an `offlabel' use, and there is scientific support for using the drug in that manner. The informed consent doctrine requires that physicians discuss all material risks, including rare but serious risks. Patients are assumed to have little or no knowledge of medications and they have no duty to inquire about side effects. The doctor, on the other hand, has an affirmative duty to warn of these side effects. In a malpractice case alleging lack of informed consent, the defense cannot plead contributory negligence. D is therefore incorrect. The "Learned Intermediary" Doctrine stipulates that the doctor, not the pharmaceutical company, is liable for medication-related injuries as he she is a learned professional who directly communicates with the patient and who does the actual prescribing. This puts the doctor in the hot seat for a drug reaction, although the drug company is frequently dragged into the lawsuit because it has the deep pocket. In some instances there is a separate duty of the pharmaceutical company to directly warn the consumer, e.g., immunization hazards. ANSWER TO QUESTION 18: C, E Strictly speaking, the doctor's negligence was a `but-for' factual cause of the injuries. That is, without the doctor's negligent prescription in the first place.

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. Health care expenditures for osteoporotic fractures exceed $14 billion annually fractures caused by osteoporosis can lead to a reduction in quality of life because of the pain, disability, and fear of subsequent fractures experienced by many with the disease and mesterolone. My doctor says as long as the lasix is working, we shouldn't be worrying.
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