The Medicine Interview Preparation Megathread 2012 Entry

What are the advantages of studying anatomy using cadavers?

If you want to be a surgeon, it is really good practice for developing basic techniques and getting over the initial difficulties of cutting someone open.

It helps foster an appreciation/respect for a human body.

It's a great visual tool, as it is a 3-D representation.

It is useful for developing teamwork with fellow med students as you usually share a cadaver with a group of people.

You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of very distinct bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises.

should you call Child Protective Services and report the mother?

Firstly i think its important to talk to the child, i presume he is young (between 5-14) and ask him whether he thinks the treatment has made him feel better...
after all if he believes that it will work and genuinely thinks so AND his mother has not forced the treatment on him (so asked his consent) then i dont believe there is much you can do... The child agrees with the procedure and has ALLOWED his mother to do so...
even if its not evidence based medicine i think it plays a role in reassuring the patient and could make them 'mentally' better, which can play a huge role in physical well being..

But this all depends on his competence, is he able to make a decision on the treatment? does he know the side effects and problems that can happen (such as the bruising?) That would be subjective to the child, and ill have to asses that when talking to him, possibly by asking if he's had it done before...whether its ever gone wrong before, has it ever been successfull
alternative treatment is not regulated and therefore not standardised, if the mother has had no training or performing the treatment incorrectly its dangerous for the child, so must be explored.
i think i would report it to child protection services, but tell them all the information i have gathered and my judgement on the intentions of the mother as well as the competence of the child towards the treatment...only because they are allowed to check with any other children and members of the household and do a thorough examination...


what do you think of that answer peeps?....any advice would be much appreciated with +rep

got my big imperial interview tomorrow....so bare fretting over the ethics...would you say thats a balanced argument?

A woman was diagnosed with motor neurone disease (the same
disease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble breathing.she asks for the drug...

Do you prescribe and administer the drug?

Firstly i want to try and empathise with her situation, i cant begin to imagine the pain and emotional strain this disease is having on her and her family, for one to choose death over treatment. I do acknowledge that the patient wants to not suffer anymore, especially since the prognosis is really bleak and her final days seem like a formality. Furthermore she is competent and has done her research into a potential drug and i presume (which i would clarify at consulation) is aware of its side effects and potential outcomes so does have a fair arguement...

HOWEVER, I as a doctor am legally bound, i cannot actively euthanise a patient, i need to discuss my interntions with another doctor (preferably a senior). Am i administering the medicine in that dose for pain relief? or am i administering that medicine in that Dose for her hasty death?....if its the latter then i MUST NOT do so, its illegal (i think) ...regardless of her pain and suffering, it is my duty and responsibility to alleviate suffering and ensure a good quality of life while she is alive, to me the number of days/weeks/months/years of survival left are irrelevant..

what do you think of that answer peeps?....any advice would be much appreciated with +rep

would you say thats a balanced argument?

I'd say you give her the drug. At this point there's nothing you can do to extend her life so you should be seeking to allieviate suffering. It's perfectly legal to administer pain relief in a patients final hours. I don't know how the woman's situation affects the dose you would give, or if there is certain mg/kg that is defined as euthanasia or whatever, but as far as I'm aware this is fairly standard practice in these kinds of situations.

Edit: Yes, your answer is balanced but I think you're being to cautious. As I said, giving pain relief to dying patients is standard practice as far as I am aware.

Very balanced. But tbh I think you're being a bit nice. I would certainly be discussing it with the local child protection liaison team - they may decide not to take it further, but that's up to them. With the mum I would tell her (probably not quite this bluntly) that it's hurting him and not doing him any good. It would be very difficult to ascertain whether he can consent to this, especially with the mum present.

you know at the end of an interview you're always asked if you have any questions. What's appropriate to ask? can you mention a sport that you do and ask if there is a student union/club you'd be able to join? or is that a bad idea?

hi, im new to the thread.
Im not the kind of person who is into politics etc, and one issue im struggling to understand is the NHS reforms and the Health bill, and the negativity with andrew lansley.

PLEASE PLEASE PLEASE can someone explain these, and what EXACTLY IS GOING ON WITH THE NHS AT THE MOMENT!!

i understand LITTLE jists of it, like stuff about giving GP's more decisions making role etc..

but otherwise.. I have no idea what is going on and the article and news i read just dont seem to make sense to me.

xxx

lool probs should have left out the bit in brackets .

Firstly, I would look at the cause of the reduced quality of life. It could be a social aspect for instance, the patients family has abondend the patient. In this case I would talk to the patient and try to comfort her/him. Sometiems all a patient wants is someone to listen which is a major component of effective communication. However if the reduced quality is down to the treatment I would listen to the patients concerns and assure the patient that I will review her terminal illness care as I would like to keep the patient in as much comfort as possible. Furthermore, I then would proceed contact my seniors and discuss the treatment plan with the mdt. If we all collectively come up with a different treatment, I would implement that.

Correct me or add to any of it please

Haha! You're probably right but I think they've finished interviewing now

And great answer - thank you; I was thinking too much into it

Another question: If I'm asked what is a current issue facing the NHS or current news regarding the NHS, could I talk about the changes in pensions or is that not directly affecting NHS?

You could tho the pension change is a very big change for everyone rather than just an nhs iddue if you know what I mean. Tho it could be a nhs problem if, the bma,s ballot does not work and maybe more drastic actions could be taken by the employees... Then again the war is against the change in pension not the patients as it was stated in an article =D.

Okay, do you possibly have a link to that article? :P