*MEGATHREAD* - The Official 2014 Medicine Interview Preparation Thread

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'?

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?

Weird: when I read that scenario I assumed that the drug addict who had OD'ed was female. Funny how personal prejudices influence the way we interpret these things.

At the start, I would obtain the views of each patient. Whatever they may be, they should inform my decision making. So I would set that stall out early.

I wouldn't discount the lady with the terminal disease without establishing her wishes. Has she opted for palliative care or does she want to continue the fight against the disease in the hope of spontaneous remission? Either way, I would have to consult with the oncology doctors and come up with a joint approach that is in her best interests. I would only offer the dialysis if it broadly supported the oncology care plan that was in place for her.

There are some really poignant discussions to have about the drug addict's age and whether as a young person she has the most "right" to have her life prolonged. However, I would not offer the treatment to her. Not because I am judging her lifestyle, but because I work with drug addicts almost every day (and we are most likely talking about heroin to be in the world of overdoses). Dialysis is a strict regimen that requires discipline in eating and drinking habits between treatments, and most importantly requires that people attend their treatments when scheduled. The lifestyle of a "classic" heroin addict is just too chaotic to be able to comply with such a regimen. For that reason, I would consider the treatment clinically inappropriate and not offer it.

That leaves the marathon runner. If he is able to comply with the regimen and is otherwise healthy and the treatment sustains him until transplant, he could have another 30 years of life ahead of him (arguably more than the 17yo or the lady living with breast cancer).

Decision: old boy gets it.


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You and your BEST friend get your exam results. You haven’t done that well but your mate has done amazing. When u congratulate her she tells u in CONFIDENCE ehat she actually cheated (didn‘t have time to revise). Would you inform the tutor/appropriate person?

Obviously we would have to establish the situation a bit more e.g. why didn’t she have time to revise (was it due to a death in the family or due to spending too much time partying (so its her own fault)
If the latter then the right thing would be to tell the tutor
But I was wondering
Do you think the fact that she trusted you and told you in confidence is very relevant in your decision making? Also the consequences of you keeping quiet, in this scenario, would not really have an impact on anyone else compared to if you told in which case u might not even be able to prove the cheating and you’ve breached the trust etc etc?

This is a weird question in that I personally wouldn't say anything and its not due the person being my best friend.

First of all, if you do report it, that is a very serious claim, and there has to be evidence to suggest they actually did cheat, otherwise, thy probably can't take action. I'm pretty sure my friend would be unwilling to admit they cheated to their tutor, so it would seem a waste.

I think the right thing in this case to do would be to have a serious conversation with them, because they probably know what they did was wrong and so will probably be going through some sort of emotional turmoil.

Obviously cheating is never right, but in this case, reporting them won't do them, exam officers, other people any favours and may just waste their time.

Like I said earlier, the friendship bit doesn't play a massive role, but it is important that you have that in mind, because you don't want to be breaking their trust etc

Okay gdgd yeah I came to the same conclusion but was questioning myself on just keeping quiet. I'm happy with the response you've given. Thanks

In my personal opinion, I wouldn't give a concrete answer of "Yes I am a leader due to..." or the latter, as in medicine, or especially during your progression to a career in medicine, you will be required to acquire skills of being both a leader and a follower. Leadership is a quality which is instilled with experience, as with leadership comes decision making. The necessity of doctors making decisions which can become life changing, in addition to deciding the most suitable treatment plan for a rather complex patient, separates medicine to other professions such as nursing; which focuses more on the practical aspect of patient care.

*Insert an experience on how you developed your leadership skills*

As a medical student, junior doctor, or trainee in a specific speciality, you will need to be able to accept that your knowledge has limits. It's important to acknowledge the fact that we, as medics, will never be able to know everything. This is due to the nature of science in general- its dimensions are limitless. I remember a consultant which used the saying "In medicine, you never stop learning". We need to be taught, we need to be shown aspects of the medical career that we did not even anticipate. We need to be followers; following those who have deemed to have more experience in a field that we aspire to reach.

I am both a leader, and a follower.

x.

x

x

Some very good arguments guys, I may have used the wrong term, however, there are some patients from specific groups where abortion based on gender happens. You have correctly identified that the patient's safety is our utmost importance.
FlavaFavourFruit, you have also mentioned that abortion at 16 weeks, any under circumstances will be legal. It frankly is except in circumstances in sex selective abortions.

Abortion based on gender is actually illegal in the UK, and this is what the patient may have wanted.

"You suspect that their reason for an abortion is due to the 4 month old foetus being female"

Abortion based on gender is actually illegal in the UK, and this is what the patient may have wanted.

Thanks for that!! But I guess abortion is likely coz she's considering suicide

Is it? I was under the impression that the law doesn't actually prohibit sex-selection abortion...I read an article on it recently, I'll see if I can find it.

So it IS legal? :|

Yes you are both right. I was inconveniently referring to a legality of an act that has recently been updated.

But I guess that brings up further questions if sex selective abortion should be legal in the first place.