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    (Original post by FlavaFavourFruit)
    Another question!

    A man has been admitted into hospital. The rest of his family are in the waiting room(wife, 2 kids aged 16 and 12).
    Unfortunately, the man suffers a cardiac arrest and dies within hours of being admitted.

    The son has a GCSE exam tomorrow.

    How would a doctor go about breaking the sad news? Does he tell the whole family.

    (This is a real life example, although I didn't get to see what happened!)
    There's quite a few things to consider:

    This is quite a sensitive topic, and so the wife should probably be approached first so that the doctor can explain everything carefully, and possibly console her. But then again, the wife may not want to tell her kids, who have every right to know what's happened with their dad, but also, the emotional impact it'll have on them would be quite consuming.

    I think the GCSEs should be at the bottom of this priority list because effectively, they can be taken again etc, but they won't get this moment. The whole family needs to be together in this occasion.

    So I think the best course of action overall would be to individually call in the mother and speak to her and take it from there, after all she needs to be prepared for when the kids then find out -soon hopefully.
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    (Original post by Joannywhite)
    Oh the question was meant for MMI medical school interviews in the U.S and i didn't know that.
    I'm pretty sure it would be illegal over there too, but maybe that's less of a problem for them. Or maybe that's what you're meant to spot?!
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    (Original post by Joannywhite)
    Question:

    "A man has been responsible for taking care of his wife who is in a vegetative state for 6 years after a car accident. She can breathe on her own but that is the extent of her abilities. He requests that her feeding tube be removed. What should you, as her physician do? Why?"

    I'm not quite sure about the rules and regulation of Physicians assisting their patient to die, however from my understanding I will approach this scenario by at first discussing with the Man and sympathising with what he has to say and the difficulty I'm sure he has been through for many years. For him to have withstood and continued to support his wife for six years shows that he really cares about her and therefore I will make sure the making of this decision is not a reflex action.

    I will discuss with him about the wife and see if we can assist him with parts of the care and looking after of the wife. The patient is not in a capacity to look after herself so I will have to consult other professionals which have been looking after her & make a decision in the best of her interest. The decision is most likely to be against the husbands wishes if she shows any signs of improvement. We will also look at her quality of life at the moment and regulate to what is known as acceptable quality of life and make a decision based on this.

    If the decision goes against the husbands wish, this could be further discussed in court.
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    I was reading the sceanrio from a few weeks ago about the 14 year old who wants an abortion but doesn't want you to tell her parents. Don't you have to inform her parents even if she says she is not being abused due to the fact that she is a minor because the legal age for sex is 16?
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    (Original post by CasualSoul)
    I was reading the sceanrio from a few weeks ago about the 14 year old who wants an abortion but doesn't want you to tell her parents. Don't you have to inform her parents even if she says she is not being abused due to the fact that she is a minor because the legal age for sex is 16?
    Nope, you have to respect confidentiality
    however if a 15 year old requested contraceptive pills, I wonder what you would do then :beard:
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    (Original post by CasualSoul)
    I was reading the sceanrio from a few weeks ago about the 14 year old who wants an abortion but doesn't want you to tell her parents. Don't you have to inform her parents even if she says she is not being abused due to the fact that she is a minor because the legal age for sex is 16?
    For this predicament, you would act in the best interest of the patient. Those words are the core of your practice and what I believe, stems from the Oath of Hippocrates. Regardless of her age, you would act in what you believe is right for the patient, using your medical team and own clinical judgement. If the patient does not want to tell her parents, you have an initial duty of keeping this information confidential. Breaking confidentiality in such an early stage of the doctor-patient rapport causes a breach in trust, and may discourage the pregnant minor to visit the hospital for further treatment. It is important that you respect her request and inform her for the need of safe sex during or after her pregnancy through the use of condoms or other means.

    However, if you believe that the patient is at a potential risk of being in danger: physically, emotionally or even psychologically, you have a duty to protect the patient. If this means informing her parents, then so be it. However, before this occurs, you will have to have an in depth discussion with the patient about the benefits this will do such as the emotional support she will receive from her family.

    All in all, in the UK, if the girl is seen as competent by medical staff, no disclosure to parents is allowed
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    (Original post by FlavaFavourFruit)
    Oh that's interesting! :beard:

    If the migrant can't cover the cost, community service lol um well I guess they'll have to pay when they return home and nhs will have to employ an agency which chases up money from migrants?? Lol

    No, illegal immigrants shouldn't be eligible to NHS treatment unless it's an emergency, then kick them out of the country once they're fit :mwuaha:
    They are different types of migrants with differing visa statuses. Legal economic migrants whether from the EU or outside, already pay taxes so they wouldn't need to be charged for any extra costs. The only immigrants that are then left are those that are either illegal, on student visas or visitors and tourists. Illegal immigrants are very vulnerable, I can only ever see them turning to the NHS incases of emergency or with very serious health issues. As a doctor, I wouldn't condemn any man, to die because of a piece of paper. If we suddenly started deporting illegal immigrants on their occasion of visiting NHS services, then very few would be willing to come forward which can have serious ramifications for infectious illness like TB/HIV to the whole population. Migrants on student visa, already pay a lot of money to come to this country and contribute hugely to the education economy. Charging on the NHS, could put them off. Also when some of the graduate, they also decide to stay on in this country, further contributing to the tax system that funds the NHS. Migrants who come on visitor visa, have legal relatives who have a right to stay in this country, so should be treated at least in emergency situations. Only immigrants I would charge, are tourists. As a tourist, I would think before you travel to any country you should take out travel insurance that covers health incidents.

    Overall, I think the NHS, should look elsewhere for methods of raising money.
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    Question

    You are a surgeon operating on a 30 year old patient with one of the latter stages of bowel cancer. You provide her with a local anaesthetic, thus she is still aware of her surroundings. Right in the middle of the unfinished complex surgical procedure, she suddenly instructs you to stop operating, that she "won't carry on" and that she is "fed up". The patient is loud, frustrated and becomes rather incoperative. What would you do?
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    (Original post by frogs r everywhere)
    Question

    You are a surgeon operating on a 30 year old patient with one of the latter stages of bowel cancer. You provide her with a local anaesthetic, thus she is still aware of her surroundings. Right in the middle of the unfinished complex surgical procedure, she suddenly instructs you to stop operating, that she "won't carry on" and that she is "fed up". The patient is loud, frustrated and becomes rather incoperative. What would you do?
    I would assess her capacity, tell her that if I stop it, there could be risks/complications since the surgery is complex. The fact that her decision to stop surgery may be irrational but she still has capacity.

    I would empathise with her, cancer brings all sorts of physical, emotional and psychological issues and I can understand her but the timing is wrong. I believe it is in her best interest to carry on with the surgery. I would consult my team to persuade her, perhaps get a psychiatrist too? She could be depressed :/

    As a doctor, we should do no harm and I think by stopping this surgery mid-way, it could lead to further problems. We aim to do good and our duty of care is always to the patient.
    I would weigh up the pros and cons of stopping mid-way and if it is too risky, I would insist on carrying on but she has capacity...so what can I do?

    I can't section her! Or sedate her!
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    (Original post by prafto)
    Interview Question:
    You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?

    Classic.
    All three lives are valueless and will be missed equally by friends and family.
    Nevertheless, I would give the life saving treatment to the 17 year old because I believe he deserves a second chance and because if I could convince him as his doctor through therapy and rehab to give up his addiction then potentially he gains the most life years.

    With the cancer patient, you could try to justify her receiving the machine over the 17 year old, knowing that she didn't choose to have breast cancer which is mostly genetic therefore would appear more deserving but that needs you to assume that the 17 year old's drug taking is per choice. More information would be required- what if the drug addict was bone with a drug addiction through her mother, what if a distressing life event just swayed him on the wrong path? Now what he would need is mentoring, naturing and a chance to try.

    The 70 year old, creates a positive image immediately because he is a Marathon runner but should I assume straight away his kidney failure is caused by old age or another disease he can't control. No matter, the 17 year old would still deserve a chance because he gains the most life years and because the 70 year old has already lived what in some parts of the world would be termed a full life.
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    (Original post by FlavaFavourFruit)
    Nope, you have to respect confidentiality
    however if a 15 year old requested contraceptive pills, I wonder what you would do then :beard:
    Ohh right
    Hmm it would be in the best interests to give her the pill as it would prevent an unwanted pregnancy/ having an abortion if she got pregnant but then you'd have to ask questions so you could ensure she wasn't being abused. Oh NHS website says this 'If you're 14 to 16 and want contraception, an abortion or tests for sexually transmitted infections (STIs), the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe that you fully understand the information you're given, and your decisions'

    (Original post by frogs r everywhere)
    For this predicament, you would act in the best interest of the patient. Those words are the core of your practice and what I believe, stems from the Oath of Hippocrates. Regardless of her age, you would act in what you believe is right for the patient, using your medical team and own clinical judgement. If the patient does not want to tell her parents, you have an initial duty of keeping this information confidential. Breaking confidentiality in such an early stage of the doctor-patient rapport causes a breach in trust, and may discourage the pregnant minor to visit the hospital for further treatment. It is important that you respect her request and inform her for the need of safe sex during or after her pregnancy through the use of condoms or other means.

    However, if you believe that the patient is at a potential risk of being in danger: physically, emotionally or even psychologically, you have a duty to protect the patient. If this means informing her parents, then so be it. However, before this occurs, you will have to have an in depth discussion with the patient about the benefits this will do such as the emotional support she will receive from her family.

    All in all, in the UK, if the girl is seen as competent by medical staff, no disclosure to parents is allowed
    Well explained. Thanks
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    (Original post by CasualSoul)
    Ohh right
    Hmm it would be in the best interests to give her the pill as it would prevent an unwanted pregnancy/ having an abortion if she got pregnant but then you'd have to ask questions so you could ensure she wasn't being abused. Oh NHS website says this 'If you're 14 to 16 and want contraception, an abortion or tests for sexually transmitted infections (STIs), the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe that you fully understand the information you're given, and your decisions'


    Well explained. Thanks
    Thanks for that! I thought so too, if we don't give them the pill , they're just gonna do it without protection which will lead to other issues!
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    (Original post by frogs r everywhere)
    For this predicament, you would act in the best interest of the patient. Those words are the core of your practice and what I believe, stems from the Oath of Hippocrates. Regardless of her age, you would act in what you believe is right for the patient, using your medical team and own clinical judgement. If the patient does not want to tell her parents, you have an initial duty of keeping this information confidential. Breaking confidentiality in such an early stage of the doctor-patient rapport causes a breach in trust, and may discourage the pregnant minor to visit the hospital for further treatment. It is important that you respect her request and inform her for the need of safe sex during or after her pregnancy through the use of condoms or other means.

    However, if you believe that the patient is at a potential risk of being in danger: physically, emotionally or even psychologically, you have a duty to protect the patient. If this means informing her parents, then so be it. However, before this occurs, you will have to have an in depth discussion with the patient about the benefits this will do such as the emotional support she will receive from her family.

    All in all, in the UK, if the girl is seen as competent by medical staff, no disclosure to parents is allowed
    There are other options apart from telling her parents. All GP practices should have a clinical lead person for safeguarding children, so you could discuss the situation with them if you have concerns. If you're still unsure then there will be people higher up either in social services or the local hospital/community paediatrics team who you could discuss the scenario with, without initially disclosing any patient-identifying information until you've established whether you feel the child is at risk.

    It's feasible that a 14 year old asking for an abortion and not to tell her parents is perfectly capable of making those decisions for herself, is not being abused and just got unlucky with contraception, but I'm not sure I'd be sure enough in my own judgement of that not to get others involved. Obviously at the abortion clinic they may well also want to ask all these questions both to the girl and to the relevant child protection team.
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    (Original post by FlavaFavourFruit)
    Thanks for that! I thought so too, if we don't give them the pill , they're just gonna do it without protection which will lead to other issues!
    Exactly
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    (Original post by mynameisntbobk)
    There's quite a few things to consider:

    This is quite a sensitive topic, and so the wife should probably be approached first so that the doctor can explain everything carefully, and possibly console her. But then again, the wife may not want to tell her kids, who have every right to know what's happened with their dad, but also, the emotional impact it'll have on them would be quite consuming.

    I think the GCSEs should be at the bottom of this priority list because effectively, they can be taken again etc, but they won't get this moment. The whole family needs to be together in this occasion.

    So I think the best course of action overall would be to individually call in the mother and speak to her and take it from there, after all she needs to be prepared for when the kids then find out -soon hopefully.
    Hi there

    what if the mother doesn't want the kids to know but then the 16 year old kid directly ask you what the current status of their dads health is?
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    (Original post by CasualSoul)
    Hi there

    what if the mother doesn't want the kids to know but then the 16 year old kid directly ask you what the current status of their dads health is?

    Very tricky situation. While you want to respect the mothers wishes, the child does have every reason to know, so I would hopefully try to persuade the mother to talk to him about it. Obviously as time goes on, the children will keep having more questions, which could then lead to hefty tension, so I advise it would be better to get it out of the way now.

    Saying this, the 16 year old is exactly that, a 16 year old, so if the mother refuses, and he still wants to know, then I would probably calmly explain it to him. He is old enough to concept after all.
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    Oh I have just found this thread! Thank goodness


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    (Original post by FlavaFavourFruit)
    You're applying here so of course they expect you know some details about the nhs. It doesn't have to be thorough but as long as you can talk about something on the nhs eg GPs surgeries hours proposal, A&E crisis etc. it would suffice..
    Thanks for the reply, this is what I am doing, by reading the BBC health news, however I always have so much to study that I do that on sleep time and this isn't always possible. So I'm afraid that I might miss something major I wish a question such as how does the NHS compare to the system of your country because I know too much for this, but the British headlines don't always reach me, it's just not like living in the country, as these news will reach you somehow if you are a local. I don't expect you to understand this, as you have to live it to understand what I say :/ Anyways, enough rant, I hope that I will be able to keep up to date with the BBC news, but if you have any other site to suggest me, I would be grateful


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    (Original post by isklikas)
    Thanks for the reply, this is what I am doing, by reading the BBC health news, however I always have so much to study that I do that on sleep time and this isn't always possible. So I'm afraid that I might miss something major I wish a question such as how does the NHS compare to the system of your country because I know too much for this, but the British headlines don't always reach me, it's just not like living in the country, as these news will reach you somehow if you are a local. I don't expect you to understand this, as you have to live it to understand what I say :/ Anyways, enough rant, I hope that I will be able to keep up to date with the BBC news, but if you have any other site to suggest me, I would be grateful


    Posted from TSR Mobile
    On my phone, I have a news application where I subscribed to sky news, the guardian health news and latest news from NHS choices. Just subscribe to as many health news RSS feeds as possible.

    And btw, did you guys know that Simon Stevens has taken over from sir David Nicholson as chief executive of NHS England? Quite a big change I think!

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    With the whole MMR vaccine thing was the issue that the father wanted the kids to be vaccinated and the mother did not? In other words if both parents had NOT wanted their kids to be vaccinated then that would just have to be accepted and the court could not have force them. As I read something on the NHS website and it says as a parent one is allowed to decide whether their baby/kid gets vaccinated and if it is refused it will simply be noted on the childs medical history?

    Also if the girl was 16 and refused treatment am I right in thinking that nothing could be done. Due to the fact that she is an adult and so providing she knows all the facts i.e. the pros/ cons/ possible consequences of her decision then she has a right to say whether or not she takes the treatment as it is her body after all ?
 
 
 
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