D.P. is a seventy-four-year-old man who presents to an orthopaedic surgeon
for an evaluation of thigh pain. He is accompanied by his wife and daughter.
The physical examination demonstrates a well-developed patient with midthigh
tenderness. When the orthopaedic surgeon leaves the examination room to
request radiographs, he is followed by the patient's wife and daughter. They
instruct the surgeon that, if the radiographs show cancer, the patient must
not be told the diagnosis. The radiographs demonstrate a lytic lesion in the
midpart of the femur consistent with metastatic disease. Before reentering the
examination room, the physician is stopped and again instructed not to tell
D.P. the diagnosis. The family members argue that the patient is old and frail
and has a "heart condition."