Commentaries on Truth, Trust, and Team Play

Abstract

Katie is a 47-year-old female who describes herself as very healthy. Katie’s only surgery was an elective breast augmentation performed when she was 38 years old. Her job as a breast cancer awareness specialist for her company has caused her to seek a baseline mammogram. Katie knows she has several risk factors for breast cancer. She started her menstrual cycle before the age of 12 and had her two children after she was 30. While 5% to 10% of breast cancer cases are thought to be hereditary, Katie does not know her biological history because she was adopted. Katie’s breast implants make it more difficult to see breast tissue on standard mammograms, but additional x-ray views, called implant displacement views, can be used to examine her breast tissue more completely. Katie’s insurance company will not pay for these additional views. Her gynecologist informs Katie that the most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 and BRCA2 genes. If Katie has inherited either gene her risk may be as high as 80% for developing breast cancer during her lifetime. After some deliberation, Katie’s gynecologist tells her insurance company that Katie has a family genetic history of breast cancer so that they will pay for the extended mammogram and expensive genetic testing that he believes Katie needs. However, the public health professional on Katie’s Breast Cancer Awareness team knows that Katie was adopted and that Katie has no known hereditary history of breast cancer. The woman wonders if she should confront Katie about her doctor’s decision. Furthermore, the gynecologist’s office nurse overheard the doctor’s conversation with the insurance company and was disturbed by his actions. She wonders what, if anything, she should do about it. In addition, she wonders if Katie’s view of her doctor’s trustworthiness would change even if his decision was based on Katie’s best interests. Was the gynecologist justified in his actions? Does team play sometimes require just keeping quiet and supporting your colleagues? Why or Why not?