A. Informing Mr. Jonsen that Ahmed will be present despite his objection should be avoided and is not supported by the Code. Opinion 5.059, "Privacy in the Context of Health Care" states "physicians must be mindful of patient privacy, which encompasses information that is concealed from others outside of the patient-physician relationship." Ahmed is not Mr. Jonsen's physician, and Mr. Jonsen's care is not dependent on Ahmed's presence.
B. Referring Mr. Jonsen to another (non-teaching hospital) ER should be avoided; it is not supported by the Code and is not a reasonable option. At this point, Mr. Jonsen's medical state has not been established, and his demand for privacy is supported by Opinion 5.059, "Privacy in the Context of Health Care," which states that "physicians must seek to protect patient privacy in all of its forms, including (1) physical...(2) informational...(3) decisional...and (4) associational."
C. Instructing Ahmed to leave the room is preferable; it is supported by the Code and may be the best course of action in this situation. Opinion 5.059, "Privacy in the Context of Health Care" states that "physicians should be aware of and respect the special concerns of their patients regarding privacy." Also, Mr. Jonsen's vehement refusals indicate a steadfast commitment to maintaining his privacy.
D. Continuing to try convince Mr. Jonsen to allow Ahmed in the room is acceptable—up to a point—and is supported by the Code. Opinion 5.059, "Privacy in the Context of Health Care" states that "privacy is not absolute, and must be balanced with the need for the efficient provision of medical care and the availability of resources." Because every medical student's education depends on observing clinical practice, some patient privacy will be compromised. Attempts at persuasion should not be carried to the point that they harm Dr. Macklin's relationship with Mr. Jonsen.