Markkula Center of Applied Ethics

SHHHHHHHHH, DON'T TELL

Case prepared by Pat Wolfe, Paula Smith, Margaret McLean, and Thomas Shanks.

After suffering a back injury at work, Lowell Baxter has completed three weeks of physical therapy. While unable to work, Lowell has been going three times per week to see therapist Eve Nye who has been working for three months at a new clinic and is still learning the ropes.

After Mr. Baxter's ninth treatment, his physician, Dr. Felton Cranz, explained that he had made good progress. Lowell no longer needed PT but was unable to return to his physically demanding job. He continued the home exercise regimen that Ms. Nye had given him. Dr. Cranz, who was not adverse to ordering additional physical therapy if necessary, told Lowell to call him if he had any further problems.

One month later, Mr. Baxter called Dr. Cranz's office and told the nurse that there had been "a flare up" in his lower back. After talking with the doctor, the nurse called Lowell and told him that Dr. Cranz ordered another round of PT - 3 times per week for 3 weeks - that he should begin right away.

During his third session, while telling Eve about his recent activities, Lowell mentioned that he slipped and fell on a rainy night while coaching his daughter's soccer team. He said that this happened "a couple of days" before the "flare up". Eve asked if he told his doctor about this latest fall. Surprised at the question, Lowell replied, "Well, no. Why would I? Anyway, I was having some painful twinges in my back before I slipped. Besides I fell on the soft grass. I'm sure I didn't hurt myself when I slipped. Dr. Cranz is always so busy and I don't need to waste his time with this. He told me after I finished my sessions a month ago that I might need another round of PT anyway. I feel better after our therapy sessions ….So, how about those Sharks - the men in teal?"

When Ms. Nye saw Mr. Baxter on his fifth visit, he complained of increased pain with radiation down his left leg. During her evaluation, Eve concluded that his pain was different from the pain he experienced after the first fall and was almost certianly related to the second fall. She explained this to Lowell and suggested to him that he talk to his doctor to ensure that he recieved the appropriate treatment. Lowell insisted that he did want to bother his doctor with this.

Now, on his seventh visit, Mr. Baxter is visibly fatigued and short-tempered. He complains of weakness and numbness in the left leg. Eve strongly encourages him to talk with Dr. Cranz. He adamantly refuses.

"Well, perhaps I should talk with Dr. Cranz for you. I could tell him about your fall at the soccer game and this onset of numbness and weakness in your leg. You know, Dr. Cranz looks at the notes I write."

"No," blurts Mr. Baxter. "I don't want you to say anything. It's none of your business! This is my injury, and I don't want to bother him with this. You have to respect my wishes. Your job is to do therapy; not to interfere. Now, let's get on with it!"

What should Eve Nye do now? Why?
What might Eve Nye have done earlier?
How would you have dealt with Lowell Baxter?

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