MEGATHREAD - The Official 2014 Medicine Interview Preparation Thread

Original post by FlavaFavourFruit

The boy is competent. Confidentiality is important but it can be broken if the patient is at risk of harm...does this scenario mean the boy is at risk of harm if he plays, I believe so.

You don't go breaking confidentiality in every case where a patient decides to make a decision that could potentially put them at harm. If they're competent and are still adamant they'll play the match (in this case), you explain the risks, document it well, and leave him to it.

It's different if it's a communicable disease, if required to do so by a court order, if it's in the interest of the public etc.

Have a read - http://www.qub.ac.uk/methics/BrooksK.pdf

Reply 381

FlavaFavourFruit

Original post by Helenia

Explain the consequences, ensure he understands them, document meticulously and leave him to be a stupid teenage boy. :p:

Yes, in an ideal world you do, but that's obviously not possible if a patient's been admitted as an emergency and can't give consent. You have to make a best guess at what they would want their family to know - if you had a relative on ICU and the doctors wouldn't tell you a thing wouldn't you be going crazy? Usually it's better to give information face to face rather than over the phone, both for giving practical support and for identification purposes. It's rather messy though.

Original post by TattyBoJangles

You don't go breaking confidentiality in every case where a patient decides to make a decision that could potentially put them at harm. If they're competent and are still adamant they'll play the match (in this case), you explain the risks, document it well, and leave him to it.

It's different if it's a communicable disease, if required to do so by a court order, if it's in the interest of the public etc.

Have a read - http://www.qub.ac.uk/methics/BrooksK.pdf

Thanks girls!! And I'll have a read of that link tatty :smile:

Reply 382

FutureHeartSurg

9

Hey everyone. With the recent trend of med schools to switch to MMI's, do any who've had them have any advice as to preparation and/or an overview of their experience ?

Reply 383

Pittawithcheese

6

Original post by FlavaFavourFruit

Question:

A patient, aged17 is badly injured in his back and the doctor advises him to take a couple of weeks break from physical activity. The patient has a football competition in 5 days time, he insists that he has to play and he begs the doctor to not tell his coach.

What do you do?

I would try to remember that it is important to treat the patient, not just the disease/injury.

If he is insistent that he wants to play the football match, then rather than bury my head in the sand and just say: "no you shouldn't" and absolve myself of responsibility I would try to negotiate a compromise that sees him do what he wants whilst protecting his health as much as possible. I would outline the risks of course, but perhaps suggest that he tells his coach about his injury so his participation in the match can be managed. Maybe just play one half in a low-impact role, wearing supportive equipment, and telling him to not dose-up on NSAIDs beforehand so that he can stop if it hurts.

I would not breach confidentiality.

The example I use to base my decision process on, is my own experiences of post-surgical recovery after having children. The doctor said: "Don't lift anything heavy for 6 weeks" but I had to tell her that I already had a 2year old at home and would not be able to avoid lifting him for a month and a half. So she adjusted her advice along the line of: "Try to kneel down to cuddle him then, and if you must pick him up, try not to carry him as that will do you damage".

Much better advice than "Don't pick up your toddler as you've just had a baby", which I would have naturally ignored....

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Reply 384

letsbehonest

15

Original post by FlavaFavourFruit

Question:

A patient, aged17 is badly injured in his back and the doctor advises him to take a couple of weeks break from physical activity. The patient has a football competition in 5 days time, he insists that he has to play and he begs the doctor to not tell his coach.

What do you do?

I would advise him of all of the possible consequences and try to dissuade him from taking part in the physical activity but if he is adamant that he wants to take part in the match then I would not tell the coach because of confidentially. It should not be broken in this case. It is the patients body and if the patient understands the risk he if putting himself at that is a choice he makes. As a doctor my role is to act in the best interest of the patient and I think I have accomplished this by informing him of all the risks.

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Reply 385

username1155925

14

Original post by FlavaFavourFruit

Question:

A patient, aged17 is badly injured in his back and the doctor advises him to take a couple of weeks break from physical activity. The patient has a football competition in 5 days time, he insists that he has to play and he begs the doctor to not tell his coach.

What do you do?

Telling the coach breaks all the confidentiality rules, he isn't even the patients next of kin or a family member. I would explain fully the risks and possible consequences of playing football, and ask if he really thought playing this one match was worth risking, say, never being able to play football again? If he's still adamant, and I'm guessing he would qualify as competent enough to make his own decisions, then that's all I can do. Maybe if the injury was bad enough I'd ask him to consider letting me talk to his parents. Maybe they could persuade him not to play, or at least try and make sure nothing goes wrong if he plays.

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Reply 386

thefiretailedpony

5

Thanks for all the info on MMIs.

Original post by FlavaFavourFruit

Question:

A patient, aged17 is badly injured in his back and the doctor advises him to take a couple of weeks break from physical activity. The patient has a football competition in 5 days time, he insists that he has to play and he begs the doctor to not tell his coach.

What do you do?

I would make sure that I have listed ALL of the risks, it does seem a bit unlikely someone would put their long-term health at risk, even a teenager. And if the risks are not so serious, I guess it depends on the injury, then it wouldn't be a good idea at all to inform anybody of his condition w/o consent. If the risks are serious such as paralysis or Idk, I would consider informing his next of kin, as it's in his best interest and he's still technically a kid, and also inform them that he wishes to take part in the competition and that I believe that to be a bad idea and why. Then they can talk to the coach if they see fit, that would not be a breach or something.

As people have said before, I'd kinda try to make him put in balance not playing that game vs never playing again (if it's the case; depends, 'cus it might not be, and I don't think we should exaggerate just to dissuade him from playing).

If the advise was just cautionary, I wouldn't inform anyone. And in any case I'd ask him to go see me/a doctor/an orthopedist or smth(?) after every game or training and to stop ASAP during the math if he so wishes.

Worth nothing, coach might not be happy if he plays and can't do his best, or injures himself further, or even without anything happening, that he was not informed and he didn't get a choice in whether or not the guy should play. I'd say this too, maybe he will think that could happen with his coach.

PS: Didn't read the link about confidentiality yet, after I do I'll see what, if smth, changes in my answer.

Reply 387

CasualSoul

16

Do you think doctors in different specialties should be given different pay? :dontknow:

(edited 10 years ago)

Reply 388

pandagere

2

Original post by CasualSoul

Do you think doctors in different specialties should be given different pay? :dontknow:

I would say yes.

1) Certain specialities require greater training than others. For example, neurology requires core medical training after the foundation years, and then further training in the actual field.
2) It also depends on the number of emergencies the doctor would get. Specialities like dermatology have virtually no acute illnesses, so maybe they should get less pay than a physician who has more emergency situations.

Reply 389

CasualSoul

16

Original post by pandagere

I would say yes.

1) Certain specialities require greater training than others. For example, neurology requires core medical training after the foundation years, and then further training in the actual field.
2) It also depends on the number of emergencies the doctor would get. Specialities like dermatology have virtually no acute illnesses, so maybe they should get less pay than a physician who has more emergency situations.

Hey they are quite good points to put forward for the pros :u:

I was also thinking that in doing so more doctors could be recruited in the less popular specialities (e.g. psychiatry) or the specialities which would require more doctors in the future e.g. i geriatrics

...now for the cons lool

(edited 10 years ago)

Reply 390

pandagere

2

Original post by CasualSoul

Hey they are quite good points to put forward for the pros :u:

I was also thinking that in doing so more doctors could be recruited in the more unpopular specialities (e.g. psychiatry) orthe specialities which would require more doctors in the future e.g. i geriatrics

..now for the cons lool

Well considering the mental health services are being increasingly blamed for poor care, it would make sense to encourage psychiatry.

However, medicine shouldn't really be financially-driven...would increasing the pay be the right incentive for undergraduates to specialise in a certain field?

Reply 391

CasualSoul

16

Original post by pandagere

Well considering the mental health services are being increasingly blamed for poor care, it would make sense to encourage psychiatry.

However, medicine shouldn't really be financially-driven...would increasing the pay be the right incentive for undergraduates to specialise in a certain field?

yeah that is exactly what I was thinking. If you go into a speciality because of the money but never really wanted to go into the speciality it will not be good for the doctor and most definitely won't be good for the patient. That could be used as a good con :u:

.

(edited 10 years ago)

Reply 392

CasualSoul

16

Hi, I was wondering :

if you're given a Do you think type question. Rather than saying yes/no then explaining your choice. Is it best to be like

Well on one hand....

however on the other hand

i.e. try to show that you see advantages/ disadvantages of both and then only if you are really pushed to make a yes/no choice then you can do so

OR

is it just best to be decisive and either say yes or no and then explain accordingly?

(edited 10 years ago)

Reply 393

mynameisntbobk

18

Original post by CasualSoul

Hi, I was wondering :

if you're given a Do you think type question. Rather than saying yes/no then explaining your choice. Is it best to be like

Well on one hand....

however on the other hand

i.e. try to show that you see advantages/ disadvantages of both and then only if you are really pushed to make a yes/no choice then you can do so

OR

is it just best to be decisive and either say yes or no and then explain accordingly?

I personally think its better to give both sides of a situation as opposed to what you just feel. It kind of shows that you're weighing all possible outcomes and consequences before coming to a conclusion, which you should do (or should be expected to do) as a doctor

Reply 394

CasualSoul

16

Original post by mynameisntbobk

I personally think its better to give both sides of a situation as opposed to what you just feel. It kind of shows that you're weighing all possible outcomes and consequences before coming to a conclusion, which you should do (or should be expected to do) as a doctor

Right I'll take that approach then but make sure I remember to conclude.

thanks- tried to give rep but I've run out :angry:

Reply 395

FlavaFavourFruit

Original post by CasualSoul

Right I'll take that approach then but make sure I remember to conclude.

thanks- tried to give rep but I've run out :angry:

Give some to me then :flutter:

Reply 396

CasualSoul

16

Original post by FlavaFavourFruit

Give some to me then :flutter:

I don't have any left :bigsmile:

LOL

Reply 397

DELETED ACCOUNT

15

Question

You have a foreign patient who is 4 month old pregnant. She and her partner are asking for an abortion on the basis of their cultural belief. You suspect that their reason for an abortion is due to the 4 month old foetus being female. She is becoming very distressed and threatens you that she will perform suicide if she isn't aborted.

Would you ever carry out the abortion?

(edited 10 years ago)

Reply 398

FlavaFavourFruit

Original post by frogs r everywhere

Question

You have a foreign patient who is 4 month old pregnant. She and her partner are asking for an abortion on the basis of their cultural belief. You suspect that their reason for an abortion is due to the 2 month year old foetus being female. She is becoming very distressed and threatens you that she will perform suicide if she isn't aborted.

Would you ever carry out the abortion?

The fact that she's foreign shouldn't matter at the moment. She's explicit stated she will commit suicide if her needs aren't met.

I would first of all look at the number of weeks the foetus is at so it will be 16 weeks which means abortion any under circumstances will be legal.

Assess her capacity and if she completely understand the information I've told her, the risks then I would use my judgement to decide if she has capacity. My suspicious are just suspicions, they are not facts and I wouldn't raise them at all. Cultural beliefs can mean a lot of things...

The mothers safety and well being is very important, we have a duty to care and do good for our patients. I have to respect her autonomy if she's competent.
Before carrying this abortion, I would have to probably consider any psychological factors affecting her and perhaps get a psycharist to assess her because suicide isn't abnormal...
2 doctors have to agree before an abortion can be carried out.

I would abort the baby...because if I don't, I see the patient could be harmed from this decision and she may go to illegal abortion clinics.

(edited 10 years ago)

Reply 399

Secret.

14

Original post by FlavaFavourFruit

The fact that she's foreign shouldn't matter at the moment. She's explicit stated she will commit suicide if her needs aren't met.

I would first of all look at the number of weeks the foetus is at so it will be 16 weeks which means abortion any under circumstances will be legal.

Assess her capacity and if she completely understand the information I've told her, the risks then I would use my judgement to decide if she has capacity. My suspicious are just suspicions, they are not facts and I wouldn't raise them at all. Cultural beliefs can mean a lot of things...

The mothers safety and well being is very important, we have a duty to care and do good for our patients. I have to respect her autonomy if she's competent.
Before carrying this abortion, I would have to probably consider any psychological factors affecting her and perhaps get a psycharist to assess her because suicide isn't abnormal...
2 doctors have to agree before an abortion can be carried out.

I would abort the baby...because if I don't, I see the patient could be harmed from this decision and she may go to illegal abortion clinics.

If it had been say 30 weeks, I understand this is illegal but as serious harm or even death could come to the mother would you go to a court and get the appropriate permission, and would this generally be yes due to her 'ultimatum'?