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Medical error disclosure — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeMedical error disclosureUSMLE Step 3

An 82-year-old cognitively intact woman presents with dehydration, pressure injuries, and bruises shaped like fingers. Her son, who controls her finances and medications, insists on answering questions and demands immediate discharge. She quietly says she is afraid to return home but denies immediate weapon access. Which action is most appropriate?

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Correct answer: C — Interview her privately, treat injuries, document findings, and contact adult protective services

The best answer is “Interview her privately, treat injuries, document findings, and contact adult protective services”. Her injuries, neglect, coercive control, and expressed fear raise substantial concern for elder abuse. Capacity does not require clinicians to ignore danger. The team should separate her from the suspected perpetrator, assess immediate safety and preferences, document objective findings, treat medical needs, and involve social work and adult protective services according to state law. Emergency services are used if imminent danger emerges.

Reference: AHRQ Effective Health Care: Elder Abuse: https://effectivehealthcare.ahrq.gov/health-topics/elder-abuse