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 concerns, particularly when dealing with infectious diseases like tuberculosis, must take precedence to prevent the spread of the disease within the community. While the patient’s need for a job is important, it should not compromise the safety and health of the public.
- Kevin O’Brien should share his concern about the possible contamination of the pizza with his roommate. This is important because it not only affects Kevin’s health but also his roommate’s health. Tuberculosis is an airborne disease, and if the delivery person is actively infected and contagious, there is a risk of transmission to others. By informing his roommate, Kevin can ensure that both of them take appropriate precautions and seek medical advice if necessary.
- Yes, Kevin should report the incident to his instructor and/or the clinic staff. Reporting is essential because it involves a breach of public health guidelines regarding the handling of food by individuals with active TB. Kevin is a part of the public health system, and it is his responsibility to ensure that public health measures are followed to prevent the spread of infectious diseases. Reporting the incident allows the appropriate authorities to investigate the situation, provide guidance, and take necessary actions to protect the public.
- Kevin should consider entering into a more direct and empathetic discussion with the patient/delivery man. While public health concerns are crucial, it’s also important to understand the patient’s perspective. The patient may genuinely be in a difficult situation with financial responsibilities and may not fully understand the risks involved. Kevin can use this opportunity to educate the patient about the potential consequences of working in food delivery while having active TB. It may be possible to find alternative employment opportunities for the patient that do not pose a risk to public health. However, Kevin should still report the incident to his superiors, as their expertise is needed to handle the situation appropriately.