A particular ethics question in UWorld is boggling my mind...

[SlaveOfTCMC]

In the psych chapter:

Essentially a male patient ignores the secretary's statement that the office is going to close soon and that the doctor will give him an appointment tomorrow morning.

As the doctor leaves, the patient shows up saying he has a rash on his penis and demands to be seen.

The correct answer is: "politely and firmly tell the patient no means no and wait until tomorrow because it is not an emergency."

Another answer choice was: "Relent and examine the patient"


The rationale was the patient was being inappropriate and that a penile rash is not an emergency.



My counter argument is:

What if the patient is not the best historian/data collector and it turns out he really has another serious penile problem?

What if this patient sues the doctor (however frivolously) and then the malpractice premiums go up even if the case is thrown out?



Okay I know, a test does not reflect real life at times. But I think this question should either be reworded or thrown out.

Leaving too much gray area to make it a "harder" question does not facilitate learning. (especially when no clinical subtleties in management are involved)

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[Sheldor]

In the psych chapter:

Essentially a male patient ignores the secretary's statement that the office is going to close soon and that the doctor will give him an appointment tomorrow morning.

As the doctor leaves, the patient shows up saying he has a rash on his penis and demands to be seen.

The correct answer is: "politely and firmly tell the patient no means no and wait until tomorrow because it is not an emergency."

Another answer choice was: "Relent and examine the patient"


The rationale was the patient was being inappropriate and that a penile rash is not an emergency.



My counter argument is:

What if the patient is not the best historian/data collector and it turns out he really has another serious penile problem?

What if this patient sues the doctor (however frivolously) and then the malpractice premiums go up even if the case is thrown out?



Okay I know, a test does not reflect real life at times. But I think this question should either be reworded or thrown out.

Leaving too much gray area to make it a "harder" question does not facilitate learning. (especially when no clinical subtleties in management are involved)

You know you can submit this feedback to Uworld right? I sent feedback for a question and received a prompt response/explanation.

I agree though, ethics questions can be very frustrating!

 

[bleeker10]

Remember that if they don't give you any extra information, then it is probably a rash, nothing more. If they added he had lymphadenopathy or hematuria/pyuria, then it would be justified to think of something more serious. Maybe the patient got a little carried away when he was intimate with himself and just rubbed it raw.

Also, maybe the patient doesn't even have a rash. Maybe he is using that as a front for something entirely different.

In real life, most people would probably just see the patient. Unfortunately most ethics questions don't have real world answers such as practicing defensive or CYA medicine to prevent lawsuits.

 

[2012mdc]

In the psych chapter:

Essentially a male patient ignores the secretary's statement that the office is going to close soon and that the doctor will give him an appointment tomorrow morning.

As the doctor leaves, the patient shows up saying he has a rash on his penis and demands to be seen.

The correct answer is: "politely and firmly tell the patient no means no and wait until tomorrow because it is not an emergency."

Another answer choice was: "Relent and examine the patient"


The rationale was the patient was being inappropriate and that a penile rash is not an emergency.



My counter argument is:

What if the patient is not the best historian/data collector and it turns out he really has another serious penile problem?

What if this patient sues the doctor (however frivolously) and then the malpractice premiums go up even if the case is thrown out?



Okay I know, a test does not reflect real life at times. But I think this question should either be reworded or thrown out.

Leaving too much gray area to make it a "harder" question does not facilitate learning. (especially when no clinical subtleties in management are involved)

Never add extra info to a question that's not there. The stem doesn't give you any reason to think the patient is lying or that he's a poor historian.

You have to think like the USMLE and not like it's actually real life

 

[Valadi]

Regardless the point they're giving to you is this: Don't let patients bully you, they must be treated equally and no one is to get special privileges. You are not an emergency center. If they want to get seen so badly they may go to the ED. You won't get sued for telling someone you are closed and they should go to the ED - in fact, that is the appropriate thing to do.

Bottom-line, never let patients "demand" anything and get away with it.

 

[SlaveOfTCMC]

Thanks for the tips everyone.

That "do not insert extraneous information" seems like such a fundamental edict of USMLE test taking.

I guess doing certain Qbank questions (that explicitly required you to make assumptions) kind of skewed my thinking a bit there.