Case Study: Public Health Versus Individual Focus of Care
Kevin O’Brien is studying for his Master of Science Degree in Public Health (MSPH). As part of his clinical practicum he works with patients in the tuberculosis (TB) clinic. Patients with active TB are instructed not to work handling food (among other restrictions), to prevent contagion, until they have completed a full course of treatment and are medically cleared. One evening, Kevin and his roommate order a pizza to be delivered. Much to his surprise, the pizza is delivered by one of the patients who Kevin knows from the TB clinic. The patient recognizes him as well. Kevin says, “You know, you’re not supposed to work with food.” The patient says, “I know, but I don’t handle the food directly. I just deliver it. Hey man, don’t say anything to the clinic, okay? I really need this job, I have a family to feed.” Kevin says nothing in response, pays for the pizza, and tips the “patient/delivery man.” Kevin wonders whether he should even eat the pizza, and whether he should communicate his concern to his roommate. He is also conflicted about whether to report the incident to his instructor or preceptor at the clinic, or both. Kevin also was unsure whether “handling food” includes delivery, or what is involved in the patient’s job.
Discussion Questions
- Which should be the main consideration in this case, the potential for the public’s exposure to a contagious disease or the patient’s need for a job? Explain your decision.
- Should Kevin O’Brien share his concern about the possible contamination of the pizza with his roommate? Why or why not?
- Should Kevin report the incident to his instructor and/or the clinic staff? Why or why not?
- Should Kevin enter into a more direct discussion with the patient/delivery man?
- The main consideration in this case should be the potential for the public’s exposure to a contagious disease. Public health, especially in the context of infectious diseases like tuberculosis (TB), places a significant emphasis on preventing the spread of disease to protect the health and safety of the wider community. While it is understandable that the patient needs a job to support their family, the risk of transmitting TB to others through food delivery, even if indirect, is a serious concern. Public health measures and guidelines are put in place to prevent such situations, and they prioritize the health of the population. Therefore, in this case, public health considerations should take precedence over the patient’s need for a job.
- Kevin O’Brien should share his concern about the possible contamination of the pizza with his roommate. This is important because it directly affects his roommate’s health and safety. While the risk of TB transmission through food delivery may be low, it is still a potential risk that should not be ignored. Kevin can explain the situation to his roommate and advise him on taking appropriate precautions, such as reheating the pizza to kill any potential bacteria, to minimize the risk.
- Kevin should report the incident to his instructor and/or the clinic staff. Reporting the incident is essential because it is in the interest of public health. The clinic needs to be aware of any potential breaches in their patients’ adherence to treatment and restrictions, as it can have serious consequences for TB control. The clinic staff can assess the situation, provide support and guidance to the patient, and take necessary actions to ensure that public health measures are upheld. Reporting is a responsible action to prevent the possible spread of TB.
- Kevin should consider entering into a more direct discussion with the patient/delivery man, but this should be done cautiously and with empathy. Kevin can express his concerns about the potential risk of TB transmission and the importance of following the clinic’s instructions for the safety of the public. At the same time, he can acknowledge the patient’s need for a job and explore whether there are alternative job opportunities that do not pose a risk to public health. It’s important to approach this conversation with sensitivity and a willingness to help the patient find a solution that balances their employment needs with public health considerations. However, Kevin should not make any promises or agreements that compromise public health guidelines. Ultimately, the patient’s adherence to the clinic’s instructions is crucial to prevent the spread of TB.