The Medicine Interview Preparation Megathread 2012 Entry

I found this MMI style scenario on the internet:
You are a cardiologist at a local hospital, who just finished a shift and has a tight run to your daughter’s high school graduation ceremony. As you headed off to the door, Mark, a patient who knew you well, saw you from the waiting room and grabbed your attention. “Doctor! I have a bad chest pain. Please stay for a bit. I’ll feel much better if you were here.”
Enter the waiting room and talk to Mark.

I have a bit of a dilemma.
At first I was thinking: give painkillers to alleviate the pain. then get another doctor to take the case, so the patient will still get seen.
Then I thought would that be suitable to say in a med interview (i don't want to sound like I am not committed, dedicated...!)
so maybe I should miss the graduation because as a doctor, patients are my first priority. The chest pain could be something serious.

What do you think?

Yes, I certainly wouldn't leave the patient; chest pain can be fatal at times, and as you said, patient safety is the doctors' primary concern. However, since you're short on time, you should assess his chest pain but at the same time contact a colleague whom you know may be free. When your colleague arrives, quickly hand-over your assessment and let them take over.

In this situation, I think it's important to balance patient safety with resource (time) allocation.

What Panda said, but don't forget that you have to be seen to strike a good home/life balance. While your patient is your first concern, I would make it clear that you would hand them over to a collegue when it became possible and then go to the graduation. Patients come first but you can't completely sacrifice your family life for your work.

another question!

IF YOU HAD £200,000, WOULD YOU INVEST IT IN ORGAN TRANSPLANTS, IVF OR HIP REPLACEMENT SURGERY?

I was thinking along the lines of:

1. BENEFIT TO INDIVIDUAL:
organ transplant- be a a matter of life and death for the individual- it would save their life,
IVF- allow someone to have a child,
Hip replacement surgery- improve someone's quality of life

2.AFFECT ON SOCIETY
have to consider how many people the £200,000 pounds can benefit and what is the cost of each organ transplant, IVF or hip replacement.

Does the £200,000 include the aftercare for those who have had a transplant ( immunosupressing drugs)? If not costs will rise above the budget.

Consider what impact each of these people will have an society after they have had the treatment.
organ transplant-->return to work/get a better job but who is the organ for? an ex-alcoholic?.
IVF--> have childdren who can then contribute to society once they grow up.
hip replacement-->return to work but depends on age. if people getting the surgery are really elderly and do not work anymore then society as a whole won't be impacted that much. I think I will choose to invest in organ transplants, providing that the £200,000 includes other costs, as for people requiring a transplant, it can be a matter of life and death.

These are my thoughts so far...I know that there is no right or wrong answer but I need to be able to justify myself properly.

There is another issues, organ transplants will eventually fail and the costs for immunosuppressents, antibiotics etc can be very high per patient compared to IVF and hip replacements (from what I remember at least).

oh good point!! hmm, that makes me rethink my decision...IVF perhaps? but how many IVF people can £200,000 benefit? I don't even know how much IVF costs! thanks!

Found another question!

Your mother rings you and asks you to come round to help with a major family decision.
Your grandfather is 70 years old and has been diagnosed with a condition that will kill
him some time in the next five years. He can have a procedure that will correct the disease and
not leave him with any long-term problems, but the procedure has a 10% mortality rate.
He wants to have the procedure, but your mother does not want him to.
How would you help mediate this issue?

Finding this quite tricky so far. I know that the patient's decision should be respected (autonomy) and that they can't be coerced by my mother (or the consent to have the procedure done or not done will not be valid). But how do I persuade my mother to support the decision? or do I just have to acknowledge that she is against the idea but tell her that at the end of the day it is his decision. But it is quite a sensitive situation because I don't want to start a fight with her! There is 90% chance he will survive! q
help!

To be blunt, what your hypothetical mother thinks is neither here nor there. All you can do is explain thoroughly the pros and cons of what the patient has decided.

Found another question!

Your mother rings you and asks you to come round to help with a major family decision.
Your grandfather is 70 years old and has been diagnosed with a condition that will kill
him some time in the next five years. He can have a procedure that will correct the disease and
not leave him with any long-term problems, but the procedure has a 10% mortality rate.
He wants to have the procedure, but your mother does not want him to.
How would you help mediate this issue?

Finding this quite tricky so far. I know that the patient's decision should be respected (autonomy) and that they can't be coerced by my mother (or the consent to have the procedure done or not done will not be valid). But how do I persuade my mother to support the decision? or do I just have to acknowledge that she is against the idea but tell her that at the end of the day it is his decision. But it is quite a sensitive situation because I don't want to start a fight with her! There is 90% chance he will survive! q
help!

There's your answer right there. If the man is of sufficient mental capacity to make an autonomous decision without proxy, then his wishes should be respected. And as toosexy said, explain pros and cons to mother, and also to grandpa just to doubly ensure that he understands the pros/cons. Also, realistically speaking...a 10% mortality rate is pretty tame...especially if the procedure has a strong chance of correcting the issue entirely, so this isn't much of an ethics case nor a medical dilemma to begin with.

just came across a strange qs: What role would you take in a pbl group?
erm, there are diff roles? I thought it was just working in a team...

I'm not sure how on the ground it is done - but the PCTs do blacklist drugs and say it is not cost-effective. They effectively have a lower threshold than NICE do for what they consider cost-effective.

What are some improvements you would make to the NHS?
Really struggling with this one...