Goro’s guide to interviews

[deleted158872]

Alright about time we derailed this thread!

ALL ABOARD!!

What made you think I was trolling? My question was genuine and that was a situation I actually experienced.

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[Spector1]

A few years ago when I interviewed for a postbacc, an interviewer put both of his feet on the desk while interviewing me.. Should I complain to someone if similar thing happens in the future?

seems rude but not a reportable offense.

 

[Goro]

We have ZERO problems with accommodations.

We do get annoyed when people spring them on us the first day of orientation.

If we know about them ahead of time, then we have time to get them ready. Do you really want to run around the first week of classes getting your doctor's notes and/or proving you have the disability (because sometimes doctor's notes aren't good enough....you have to get OUR doctor's notes!)

Every year, we have about 3-4 people who are in your shoes. So we give them 1.5x time in the Library, big deal.

So you're correct, you're under no obligation to reveal your disability, and if the Adcom thinks that you can handle the job, even not knowing your disability, then we have to accommodate you.

But it's in your best interest to be up front with us.

I was given conflicting advice by another adcom who I did a mock interview with last week. He is a psychiatrist, and asked me about my MCAT discrepancy (26 first in 2013 and 34 in 2014). I answered truthfully that I have a learning disability, and did the first test without any accommodations, but the second test I had an accommodation, however, I have a 3.95 GPA, and feel confident I can do the work, just struggle a bit with timed standardized tests, but qualify for an accommodation. He said I should bring up this fact much earlier, as he has seen a lot of candidates with testing accommodations and it is not a negative. I've been counseled by others that under ADA, I am under no obligation to disclose this, and adcoms should not factor a disability into the decision. I'm leaning toward bringing it up, but I've only had one MD put this in a positive light. What say you @Goro??

 

[ImmunoLove]

We have ZERO problems with accommodations.

We do get annoyed when people spring them on us the first day of orientation.

If we know about them ahead of time, then we have time to get them ready. Do you really want to run around the first week of classes getting your doctor's notes and/or proving you have the disability (because sometimes doctor's notes aren't good enough....you have to get OUR doctor's notes!)

Every year, we have about 3-4 people who are in your shoes. So we give them 1.5x time in the Library, big deal.

So you're correct, you're under no obligation to reveal your disability, and if the Adcom thinks that you can handle the job, even not knowing your disability, then we have to accommodate you.

But it's in your best interest to be up front with us.

That's good to know. I have a learning disability (well, two, technically, as I'm a bit dyslexic and have ADHD), and though I qualified for accommodations for the MCAT, I was strongly advised against it ("you shouldn't be judged for it but you WILL"), so I took it without accommodations, and nailed it. Truth is the learning disabilities (coupled with the fact English is my third language) actually posed significant constraints earlier on (through even early college years) and it was through the constant uphill battle that I now have honed the skills to hold my own (and, if I may be so bold, usually be the front-runner in class). So while I'm glad I now know what it takes to do well, I am happier to hear that the attitude towards persons with disabilities is shifting in a positive direction. I still hesitate to share my story, however. There's a strange pressure to be superhuman in the premed (and med) community, which I find somewhat ironic.

Definitely agree that accommodations should be requested well ahead of time. There's enough going on the first few weeks of any school, and any hurdle which can be dealt with sooner ought to be dealt with sooner (lest the unexpected stuff rear its ugly head and veer those beautiful plans horribly off course!).

 

[ImmunoLove]

seems rude but not a reportable offense.

Agreed it is at best rude, but no big deal (though I wouldn't do that myself, I'd be fine with it. Perhaps it is a good thing s/he was relaxed enough to stretch their legs!)

 

[Rainbow Zebra]

t

We have ZERO problems with accommodations.

We do get annoyed when people spring them on us the first day of orientation.

If we know about them ahead of time, then we have time to get them ready. Do you really want to run around the first week of classes getting your doctor's notes and/or proving you have the disability (because sometimes doctor's notes aren't good enough....you have to get OUR doctor's notes!)

Every year, we have about 3-4 people who are in your shoes. So we give them 1.5x time in the Library, big deal.

So you're correct, you're under no obligation to reveal your disability, and if the Adcom thinks that you can handle the job, even not knowing your disability, then we have to accommodate you.

But it's in your best interest to be up front with us.

Thank you for your response, and all you do for all us premeds. Yes, I agree, orientation is way too late, as I have all my documentation from the MCAT accommodation, I was going to "spring it on you" when/if I get an acceptance. Part of the strategy of where may I go is where I can get an accommodation (only 1.5X on just timed tests) Some schools websites seem to be more reluctant than others, or make you go before committees, etc.. A bit far down the road to worry about now, need to get through the interviews first. Just wanted some independent confirmation that bringing it up in an interview is okay. As it is a big part of who I am, and the biggest challenge/obstacle, it is sort of "hiding it" by not bringing it up. Can't claim honesty and integrity in the same breathe.

 

[Goro]

I forgot to mention that at interviews, anyone should be prepared to explain a massive improvement in either MCAT and/or GPAs.

t
Thank you for your response, and all you do for all us premeds. Yes, I agree, orientation is way too late, as I have all my documentation from the MCAT accommodation, I was going to "spring it on you" when/if I get an acceptance. Part of the strategy of where may I go is where I can get an accommodation (only 1.5X on just timed tests) Some schools websites seem to be more reluctant than others, or make you go before committees, etc.. A bit far down the road to worry about now, need to get through the interviews first. Just wanted some independent confirmation that bringing it up in an interview is okay. As it is a big part of who I am, and the biggest challenge/obstacle, it is sort of "hiding it" by not bringing it up. Can't claim honesty and integrity in the same breathe.

 

[625233]

I could tell you, but then I'd have to reject you.

Just browse around the Interview Feedback section. I loot a lot of material from there.

 

[Svenson]

Here are some things that get people rejected immediately:
Being unprofessional for any reason. This would include addressing a faculty member by their first name

It's okay to address someone by their first name if that is how they introduce themselves, right?

 

[Gandyy]

It's okay to address someone by their first name if that is how they introduce themselves, right?

I believe so, but I'm not sure. Sir or Ma'am are safe I think.

 

[Svenson]

I was watching a video about medical school interviews and the lecturer said if a doctor introduces themselves with their first name and you continue to call them Dr. X, you are belittling yourself; I'd love to get more input on this.

 

[Gandyy]

I was watching a video about medical school interviews and the lecturer said if a doctor introduces themselves with their first name and you continue to call them Dr. X, you are belittling yourself; I'd love to get more input on this.

Yep, thats what I've heard too.

 

[snowpea28]

Yep, thats what I've heard too.

Wow really? I have literally called an interviewer Dr. XYZ through medical school AND residency interviews. It's the polite thing to do...

 

[Svenson]

Wow really? I have literally called an interviewer Dr. XYZ through medical school AND residency interviews. It's the polite thing to do...

That's what I've always thought - but it does feel kind of weird sometimes if they introduce themselves less formally.

 

[restlessdriven]

@Goro , could you define massive improvement? If you convert my new MCAT percentile to an old MCAT score (debatable practice, I know), there's a 4 point difference. But also, four years between tests. Would I have to explain that?

 

[idontknowwhatnametopick]

@Goro , could you define massive improvement? If you convert my new MCAT percentile to an old MCAT score (debatable practice, I know), there's a 4 point difference. But also, four years between tests. Would I have to explain that?

Just be prepared to explain anything... I got one B+ in college, I'm prepared to explain what happened there, even though technically it's not a low grade at all.

 

[Goro]

It's OK, but it's always more respectful to address faculty members by their honorifics (Dr, Professor, etc)

It's okay to address someone by their first name if that is how they introduce themselves, right?

 

[ImmunoLove]

It's OK, but it's always more respectful to address faculty members by their honorifics (Dr, Professor, etc)

If I'm ever confused, I just straight-up ask "how do you prefer to be addressed" or "by what ought I call you" (in cases where it is ambiguous or the obvious "professional route" is obscure), and usually people don't take offense and are happy to comply. There are other things to worry about when it comes to interviews (and life). When all else fails, asking seems to do the trick, at least some of the time.

 

[Goro]

I have seen co-interviewers ask about increases that low, but I would define a "massive increase as going from a < 3.0 semester or year to one >3.5, or a jump in the MCAT by , say, 7-10 points.

So yes, be prepared. Anything in your app is fair game.

My school doesn't do it, but at the top schools, they seem obsessed with "so, what's up with that C in organic chem?" type minutiae.

@Goro , could you define massive improvement? If you convert my new MCAT percentile to an old MCAT score (debatable practice, I know), there's a 4 point difference. But also, four years between tests. Would I have to explain that?

 

[ImmunoLove]

It's OK, but it's always more respectful to address faculty members by their honorifics (Dr, Professor, etc)

as a side note, I just want to reiterate: you rock goro! Rock on, Sir or Madam! Rock on! Man, you're cool. I hope to have your kind guiding my ignorant self around town (and medicine, and life). You always make me smile, and so does that avatar!

*ok continue with broadening the minds of us premeds, because we sure do need it...*

 

[Goro]

Just send an app to my school, somewhere west of the Missouri River.

as a side note, I just want to reiterate: you rock goro! Rock on, Sir or Madam! Rock on! Man, you're cool. I hope to have your kind guiding my ignorant self around town (and medicine, and life). You always make me smile, and so does that avatar!

*ok continue with broadening the minds of us premeds, because we sure do need it...*

 

[ImmunoLove]

I hope to, if only to meet the Master Him/Herself. No joke. The people are the greatest assets of an institution. I'd be honored to visit such a place (let alone call it my alma mater).

 

[avgn]

Just be prepared to explain anything... I got one B+ in college, I'm prepared to explain what happened there, even though technically it's not a low grade at all.

This is neurotic. No ifs ands or buts. Not even like productive neurotic. Just plain ol' unnecessary neurotic..

I hope your explanation is "I messed up on a couple of tests" or something more honest instead of a lame excuse

 

[idontknowwhatnametopick]

This is neurotic. No ifs ands or buts. Not even like productive neurotic. Just plain ol' unnecessary neurotic..

I hope your explanation is "I messed up on a couple of tests" or something more honest instead of a lame excuse

That's just the class where I realized I don't do well writing essays in a 2 hour exam. I learned a lot in the class though.
I doubt anyone will ask about it but if they do, I'm prepared to explain and not be caught off guard and say the teacher was mean or some other stupid thing.

 

[Mr.Hyde]

@Goro First off thank you for taking the time to do this, secondly just wanted to hear your take on something I've recently heard about interviews. I was talking to a Dr at the hospital I work at and he said something along the lines of " Once you get your interviews, you are on pretty equal footing with everyone else". He continued hinting at that while they don't ignore your stats, primary, and secondary in comparing you to other applicants they just aren't as important/relevant anymore because they've gotten you to the interview. This all came about because I've been worried that my stats aren't as good/ or good enough compared to other applicants, and I took away from the talk that getting to an interview places most applicants on a pretty equal footing.

 

[mehc012]

@Goro First off thank you for taking the time to do this, secondly just wanted to hear your take on something I've recently heard about interviews. I was talking to a Dr at the hospital I work at and he said something along the lines of " Once you get your interviews, you are on pretty equal footing with everyone else". He continued hinting at that while they don't ignore your stats, primary, and secondary in comparing you to other applicants they just aren't as important/relevant anymore because they've gotten you to the interview. This all came about because I've been worried that my stats aren't as good/ or good enough compared to other applicants, and I took away from the talk that getting to an interview places most applicants on a pretty equal footing.

I was just reading through a thread where @Goro was asked a similar question:

Is it true that at the interview stage, you as the candidate for medical school, have an equal chance at getting an acceptance? And that your Acceptance/WL/Rejection is solely based (at that interview point and onward) purely on your interview? I.e. if invited for an interview, GPA/MCAT don't mean anything anymore?

and responded

They still mean something and if interviewers, or other Adcom members have concerns about, say, a low sGPA, it will result in discussion. The whole package is still in play and lacking something can still lead to a wait-list or rejection even following the interview. Usually those deficits get brought up by an interviewer.

But if you get an interview, it means that the Admissions dean thinks you have what it takes. It takes talent to bomb an interview and at my school, about 75% of interviewees receive acceptances.

One of the other adcoms on here, @LizzyM , frequently uses a stairs metaphor to describe this subject in a bit more detail, at least as pertains to her school's specific methodology. Some assorted quotes:

You are new here so you may not have seen my analogy of the staircase. Your grades and scores (combined, if you will, with the formula GPA(10)+MCAT) along with your ECs, essays and LORs place you in one of many broad ranked categories. You can think of them as stairs on a wide staircase. (In other words, many of you can be on the same stair.) If a school selects you for interview, in all likelihood you are high enough on the stairs to be admitted or there is the potential that a good interview could boost you up enough to garner admission. That said, someone with a 4.0/40 and an amazing dossier of activities will start out on a higher stair and be more likely to be admitted if your interviews are about the same. Or, the other applicant could bomb the interview and move far down the staircase while you, with a great interview, move up. If a school looks at an applicant and says, "Even with a great interview, we couldn't possibly admit someone with an undergrad gpa of x.xx", then the school is doing you a disservice by inviting you to interview. If you get an interview, it should be a signal that you are "good enough" on paper and the next step is to determine if you are as good (or even better) in person.
____________________
1. It isn't a ladder rung which suggests that only one person can occupy each rung. It is a wide staircase with many people on each stair.
_________________________________

I've answered this before but here goes: It does vary by school. Imagine that people are standing on a huge staircase with those who have the highest stats and the most remarkable experiences at the top stair and downward to the least among those who are interviewed. After the interview, the applicants can keep their place on their original stair, go up a step or two or go down a step or many steps. In most cases, the people with the higest stats are still at the top but some are sent to the bottom step and some people move up or down according to their performance.
____________________________

My school doesn't really use numbers in this way but let me give you an example that roughly approximates what happens at one school.

Imagine a huge staircase with numbered stairs. On interview day, the applicants are on the stair that corresponds to their LizzyM score. An applicant that is very impressive on interview might be moved up one stair or more. Most applicants are going to remain where they are.. not going up or down. Some student who do or say something absolutely terrible might be sent down 10 steps, or more. In some cases, an applicant that didn't impress the interviewers but wasn't horrible might go down a step or three.

Now where is everyone? Starting at the top of the staircase, we admit students until we max out the number we can safely admit (without becoming oversubscribed). Obviously, scores and grades still matter but those who are great on interview can jump ahead and those who bomb will be demoted to the bottom of the waitlist or outright rejected.

 

[Goro]

The doc was 100% correct and mehc012 summed it up nicely.

Just one more thing I'd like to reiterate, because it seems to be a pre-med urban legend. Once you interview, it's not a zero-sum game. You're not competing for a single seat against the other applicants, only against yourself.

@Goro First off thank you for taking the time to do this, secondly just wanted to hear your take on something I've recently heard about interviews. I was talking to a Dr at the hospital I work at and he said something along the lines of " Once you get your interviews, you are on pretty equal footing with everyone else". He continued hinting at that while they don't ignore your stats, primary, and secondary in comparing you to other applicants they just aren't as important/relevant anymore because they've gotten you to the interview. This all came about because I've been worried that my stats aren't as good/ or good enough compared to other applicants, and I took away from the talk that getting to an interview places most applicants on a pretty equal footing.

 

[SoCalPipeDreamer]

I'm sure this has been answered at some point, please forgive me I couldn't find it!

How acceptable is it to let schools know you'll be "in the area" if they haven't handed out your interview decision yet? Hoping to save some money on flights!

 

[Affiche]

I'm sure this has been answered at some point, please forgive me I couldn't find it!

How acceptable is it to let schools know you'll be "in the area" if they haven't handed out your interview decision yet? Hoping to save some money on flights!

It depends on the school! Some don't care if you're in the area or not while others will let you know if they were considering inviting you to interview and try to accommodate. If you've been complete for some time but haven't received a decision, I would update the school and let them know.

 

[SoCalPipeDreamer]

Would you admit the gal who, when asked a hypothetical, "What would you do in this situation?" answers, "Oh, that wouldn't happen."

Firstly, thank you for being a stalwart supporter of this community!

I was asked an interview question about needing to transfuse a Jehovah's Witness during a botched surgery and I immediately thought that would absolutely never happen to me.
I realize that my answer avoided the spirit of the question, but if I could give a reasonable answer about why I would never be in that situation (innovations in bloodless surgery, I would not have agreed to operate, etc.) would that be OK?

Answering the ethical dilemma is difficult for me because I can see strong arguments for both sides, and I honestly can't say how I would act in that situation. Also, the neurotic part of me feels like my interviewer probably has their own beliefs on the topic, and answering contrary to their beliefs may not end well for me!

Thoughts?

 

[snowpea28]

Firstly, thank you for being a stalwart supporter of this community!

I was asked an interview question about needing to transfuse a Jehovah's Witness during a botched surgery and I immediately thought that would absolutely never happen to me.
I realize that my answer avoided the spirit of the question, but if I could give a reasonable answer about why I would never be in that situation (innovations in bloodless surgery, I would not have agreed to operate, etc.) would that be OK?

Answering the ethical dilemma is difficult for me because I can see strong arguments for both sides, and I honestly can't say how I would act in that situation. Also, the neurotic part of me feels like my interviewer probably has their own beliefs on the topic, and answering contrary to their beliefs may not end well for me!

Thoughts?

No- you still avoided the spirit of the question. You should answer the question with your understanding of ethics. You can go on in this discussion after you give your answer to talk about things like making sure the appropriate documentation is in place etc. and your own personal comfort with performing a surgery knowing that you can't provide a blood transfusion like you mentioned. However, when I conduct interviews I find it extremely bad form for my interviewee to completely avoid giving an answer.

 

[Goro]

This is why it's a good question; there's no right answer.

Actually, there is a correct answer, but you have to have the insider info of being a doctor or med student to know. No, I'm not sharing.

And if you don't think that this will happen to you, think again:

http://www.ncbi.nlm.nih.gov/pubmed/?term=jehovahs+witness+blood+transfusion

Firstly, thank you for being a stalwart supporter of this community!

I was asked an interview question about needing to transfuse a Jehovah's Witness during a botched surgery and I immediately thought that would absolutely never happen to me.
I realize that my answer avoided the spirit of the question, but if I could give a reasonable answer about why I would never be in that situation (innovations in bloodless surgery, I would not have agreed to operate, etc.) would that be OK?

Answering the ethical dilemma is difficult for me because I can see strong arguments for both sides, and I honestly can't say how I would act in that situation. Also, the neurotic part of me feels like my interviewer probably has their own beliefs on the topic, and answering contrary to their beliefs may not end well for me!

Thoughts?

 

[mikil100]

I have an interview coming up. Considering my background in nursing, I know I will be asked why I want to make the switch from nursing to medicine. A lot of my reasoning (and what I intend to tell interviewers) is that I want increased autonomy, as well as more options. I also attribute it to starting nursing at a very young age and not being entirely sure what I wanted to do with my life. Is this a sufficient answer?

 

[Almighty Saguaro]

I have an interview coming up. Considering my background in nursing, I know I will be asked why I want to make the switch from nursing to medicine. A lot of my reasoning (and what I intend to tell interviewers) is that I want increased autonomy, as well as more options. I also attribute it to starting nursing at a very young age and not being entirely sure what I wanted to do with my life. Is this a sufficient answer?

I'm guessing this is directed at Goro but I can kind of relate to your allied health background (well, nursing isn't "allied health," but you know what I mean) so I'll venture my unsolicited $0.02

Increased autonomy by itself seems OK to me, but I would personally take it a step further and mention that I want the challenge of more responsibility and more of a leadership role in the healthcare team. Especially if your area of medical interest is related to your area of nursing practice/exposure, then it might make for a more coherent narrative if you frame it as wanting to expand your role in a field/setting that you already work(ed) in and enjoy(ed).

An important thing, I think, would be to avoid bashing nursing, because it's obviously a respectable and important profession (i.e. it might be better to focus on what you like about medicine than what you don't like about nursing...just seems to keep everything more positive).

If you say something about starting nursing because you weren't "sure what [you] wanted to do with [your] life," I think a logic follow-up question might be "what makes you so sure now?" so you might want to prepare a convincing response for something like that.

 

[mehc012]

Firstly, thank you for being a stalwart supporter of this community!

I was asked an interview question about needing to transfuse a Jehovah's Witness during a botched surgery and I immediately thought that would absolutely never happen to me.
I realize that my answer avoided the spirit of the question, but if I could give a reasonable answer about why I would never be in that situation (innovations in bloodless surgery, I would not have agreed to operate, etc.) would that be OK?

Answering the ethical dilemma is difficult for me because I can see strong arguments for both sides, and I honestly can't say how I would act in that situation. Also, the neurotic part of me feels like my interviewer probably has their own beliefs on the topic, and answering contrary to their beliefs may not end well for me!

Thoughts?

I just don't understand how it's actually a question. Patients have to consent for blood transfusion; they have you fill out transfusion paperwork even if you are going in for something with a completely minimal chance of bleeding, at all. If that patient is on my table and bleeding out, you betcha they were asked to consent for transfusion. If they didn't consent, and I agreed to operate anyway, well...they don't get transfused. It is/was their choice, not mine.

 

[Almighty Saguaro]

I just don't understand how it's actually a question. Patients have to consent for blood transfusion; they have you fill out transfusion paperwork even if you are going in for something with a completely minimal chance of bleeding, at all. If that patient is on my table and bleeding out, you betcha they were asked to consent for transfusion. If they didn't consent, and I agreed to operate anyway, well...they don't get transfused. It is/was their choice, not mine.

Agreed!
The question might as well be "if a patient asked you not to do a procedure on him/her under any circumstances, would you do it if he/she were suddenly unconscious?"
You lay out the options for a patient, give your professional opinion, and have them ultimately decide what is the best treatment for them, no? Anything else just reeks of paternalism to me

Call me naive but I fail to see an ethical dilemma here

 

[Nietzschelover]

Agreed!
The question might as well be "if a patient asked you not to do a procedure on them under any circumstances, would you do it if they were suddenly unconscious?"
You lay out the options for a patient, give your professional opinion, and have them ultimately decide what is the best treatment for them, no? Anything else just reeks of paternalism to me

Call me naive but I fail to see an ethical dilemma here

I think the dilemma is that you are trained to do everything you can to save a patient's life. If the patient is going to die because you are not going to do what is medically indicated and you could save the person's life, that at least feels like a dilemma even with a signed non-consent form. What if the patient comes in unconscious before signing the consent but you know the person would not give it? Or the wife, also a JW, starts hysterically screaming to give him the F*&king transfusion? Can a surgeon, with a conscious JW, decline to do the procedure without said consent, knowing the risks involved?

 

[Affiche]

I think the dilemma is that you are trained to do everything you can to save a patient's life. If the patient is going to die because you are not going to do what is medically indicated and you could save the person's life, that at least feels like a dilemma even with a signed non-consent form. What if the patient comes in unconscious before signing the consent but you know the person would not give it? Or the wife, also a JW, starts hysterically screaming to give him the F*&king transfusion? Can a surgeon, with a conscious JW, decline to do the procedure without said consent, knowing the risks involved?

That seems too in depth for an interview question. We haven't had a course in medical ethics yet, so my guess is that the interviewer is just looking for a response that shows respect for the patient's autonomy.

 

[Stagg737]

I just don't understand how it's actually a question. Patients have to consent for blood transfusion; they have you fill out transfusion paperwork even if you are going in for something with a completely minimal chance of bleeding, at all. If that patient is on my table and bleeding out, you betcha they were asked to consent for transfusion. If they didn't consent, and I agreed to operate anyway, well...they don't get transfused. It is/was their choice, not mine.

This could happen in the emergency room. We discussed a case like this in our bioethics class in which a patient was a JW and would very likely die without a blood transfusion. To complicate the case further, the patient was a 13 year old JW whose parents stated they did not want her to have a transfusion. The question is, do you give the transfusion which will save the minor's life and go against their religious belief or do you respect the autonomy of a 13 year old and let them die. According to our bioethics professors and our dean (who is a JD), there is a correct answer for this situation medically/legally, however it may vary from state to state.

That seems too in depth for an interview question. We haven't had a course in medical ethics yet, so my guess is that the interviewer is just looking for a response that shows respect for the patient's autonomy.

It is in depth, but I think it's valid. I don't think any interviewer is specifically looking for you to respect patient autonomy either, as one could make a very compelling argument to against that. I think the more important aspect here, as with most interview questions, is that one is capable of giving a response which shows depth of thought and not just "I think X because it seems right".

 

[Lawpy]

Actually, there is a correct answer, but you have to have the insider info of being a doctor or med student to know. No, I'm not sharing.

According to our bioethics professors and our dean (who is a JD), there is a correct answer for this situation medically/legally, however it may vary from state to state.

Dat suspense.

 

[Almighty Saguaro]

I think the dilemma is that you are trained to do everything you can to save a patient's life. If the patient is going to die because you are not going to do what is medically indicated and you could save the person's life, that at least feels like a dilemma even with a signed non-consent form. What if the patient comes in unconscious before signing the consent but you know the person would not give it? Or the wife, also a JW, starts hysterically screaming to give him the F*&king transfusion? Can a surgeon, with a conscious JW, decline to do the procedure without said consent, knowing the risks involved?

"Doing everything you can to save a patient's life" is problematic because 1. the patient's wishes/desires/values/beliefs/culture are left completely out of the equation because 2. It assumes that saving the patient's life is the most important thing; but says who? As a physician, you might think so, but if you're trying to help the patient, shouldn't you go by his/her definition of help?

Besides, let's not forget that giving the patient the blood comes with absolutely no guarantees of a different outcome and may in fact lead to complications. Yet as a physician choosing to transfuse, you recognize and accept the risks. So why shouldn't a patient's choice to NOT have a transfusion be respected since they too understood and accepted the associated risks?

Edit: it's perhaps a different issue if the patient is a minor or incapable of expressing his/her preferences, but neither of these conditions were in the original post.

 

[HybridEarth]

If I am asked a question that I have fair reason to believe that is borderline offensive or "illegal" in an interview setting (e.g. religious beliefs, what other schools I'm interviewing at, etc.), what is the best way to respond? I've never been in that situation before, so I don't know how to best react if placed in that situation. Is it even OK to ask if the question is "illegal"?

 

[mehc012]

I think the dilemma is that you are trained to do everything you can to save a patient's life. If the patient is going to die because you are not going to do what is medically indicated and you could save the person's life, that at least feels like a dilemma even with a signed non-consent form.

It really doesn't feel like a dilemma, at least to me. It's a ****ty situation to be in, but the patient made their choice clear.

What if the patient comes in unconscious before signing the consent but you know the person would not give it?

I can't see how I would know this unless the patient left some sort of advance directive or MedAlert indicating it. If they left a directive, you follow it. If there's nothing official, but indications that they would not transfuse, I suppose I would try to manage them without transfusion as long as I could while making efforts to find documentation/family, but if it comes down to crunch time...no papers = all efforts taken. I'm not going to risk someone's life on the off chance that my assumptions about their life and choices based on little evidence turn out to be correct.

Or the wife, also a JW, starts hysterically screaming to give him the F*&king transfusion?

If they didn't leave written directives, and she has power of attorney? The patient trusted her with their decisions...she theoretically knows them best. If their freaking wife says to transfuse them, it seems a bit egotistic to start claiming that I know better what the patient would want, no? If she turns out to be wrong, or changed her mind for the wrong reasons, that's between the two of them.

Can a surgeon, with a conscious JW, decline to do the procedure without said consent, knowing the risks involved?

That's an interesting one! If it were me, I suppose it would come down to whether I thought the patient was at greater risk undergoing the surgery without the option of transfusion than doing nothing.

The case of minors is also an interesting one...that gets hairy fast!!

 

[Nietzschelover]

It really doesn't feel like a dilemma, at least to me. It's a ****ty situation to be in, but the patient made their choice clear.
I can't see how I would know this unless the patient left some sort of advance directive or MedAlert indicating it. If they left a directive, you follow it. If there's nothing official, but indications that they would not transfuse, I suppose I would try to manage them without transfusion as long as I could while making efforts to find documentation/family, but if it comes down to crunch time...no papers = all efforts taken. I'm not going to risk someone's life on the off chance that my assumptions about their life and choices based on little evidence turn out to be correct.
If they didn't leave written directives, and she has power of attorney? The patient trusted her with their decisions...she theoretically knows them best. If their freaking wife says to transfuse them, it seems a bit egotistic to start claiming that I know better what the patient would want, no? If she turns out to be wrong, or changed her mind for the wrong reasons, that's between the two of them.
That's an interesting one! If it were me, I suppose it would come down to whether I thought the patient was at greater risk undergoing the surgery without the option of transfusion than doing nothing.

The case of minors is also an interesting one...that gets hairy fast!!

I wasn't suggesting that going against the patient is the right answer but just that it's complicated. The 13 year old is REALLY complicated. A minor and her stated wishes and perhaps your knowledge that she only has those stated wishes because of parental immersion in those beliefs. And then the parents/guardians have those beliefs also. At any rate, especially in situations that are no elective in terms of necessity for saving a life, do we really want to say that patients always get to decide? Who is the medical expert, here? The patient? Do you think the JW might thank you afterwards, or would he sue? These are just rhetorical, but angles to think about.

 

[ImmunoLove]

This is why it's a good question; there's no right answer.

Actually, there is a correct answer, but you have to have the insider info of being a doctor or med student to know. No, I'm not sharing.

And if you don't think that this will happen to you, think again:

http://www.ncbi.nlm.nih.gov/pubmed/?term=jehovahs+witness+blood+transfusion

(woot I know I know...more or less....! I won't tell either!!! Just happy I actually would get this one "right", so I want to celebrate that rare occasion with a little victory dance all by my lonesome as I sit here under piles of ppwk: charts to review and secondaries to do. Ugh)

 

[Nietzschelover]

That seems too in depth for an interview question. We haven't had a course in medical ethics yet, so my guess is that the interviewer is just looking for a response that shows respect for the patient's autonomy.

No, I think the interviewer is looking to see that you know it is a mess, that there are multiple sides to the issue, and that you are sensitive to the right things aside from whether you get the answer legally "right" or not.

 

[Affiche]

No, I think the interviewer is looking to see that you know it is a mess, that there are multiple sides to the issue, and that you are sensitive to the right things aside from whether you get the answer legally "right" or not.

I disagree lol answering that you would do something illegal is not okay.

 

[Lawpy]

(woot I know I know...more or less....! I won't tell either!!! Just happy I actually would get this one "right", so I want to celebrate that rare occasion with a little victory dance all by my lonesome as I sit here under piles of ppwk: charts to review and secondaries to do. Ugh)

*suspense intensifies*

 

[ImmunoLove]

I wasn't suggesting that going against the patient is the right answer but just that it's complicated. The 13 year old is REALLY complicated. A minor and her stated wishes and perhaps your knowledge that she only has those stated wishes because of parental immersion in those beliefs. And then the parents/guardians have those beliefs also. At any rate, especially in situations that are no elective in terms of necessity for saving a life, do we really want to say that patients always get to decide? Who is the medical expert, here? The patient? Do you think the JW might thank you afterwards, or would he sue? These are just rhetorical, but angles to think about.

Agreed that the minor JW question differs from the adult JW in a critical way which must be weighed in a different (ethical) context, and the precedents in various regions do indeed hold different views (not so, typically, with the adult JW).

 

[mehc012]

I wasn't suggesting that going against the patient is the right answer but just that it's complicated. The 13 year old is REALLY complicated. A minor and her stated wishes and perhaps your knowledge that she only has those stated wishes because of parental immersion in those beliefs. And then the parents/guardians have those beliefs also. At any rate, especially in situations that are no elective in terms of necessity for saving a life, do we really want to say that patients always get to decide? Who is the medical expert, here? The patient? Do you think the JW might thank you afterwards, or would he sue? These are just rhetorical, but angles to think about.

Absolutely, I want to say the patient gets to decide! People should be allowed to make stupid, bone-headed decisions for themselves. As an example, I think helmet laws are inappropriate, even though I would never ride a motorcycle without one.

If it's not a life-saving situation, I am not obligated to participate if I am not comfortable with their decision, but I cannot make the decision for them.

As I said, for minors it gets really hairy really quickly.