behavioral science q

[XRanger]

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There was a question on uworld and kaplan about a woman who found out that her newborn has down syndrome and she cries screaming "God must be punishing me!" What should you do next?
Uworld says the answer should be wait for her to collect herself and tell her more about down syndrome. Kaplan says the answer is you should first ask "why do you think God is punishing you?"

Which one do u think is the right answer?

 

[iA-MD2013]

Kaplan

 

[indsha008]

I think UWorld is right. Whats the need of a conversation of why god is punishing her. She exclaimed it rather than affirmatively saying that she was punished by God.

 

[engineeredout]

I think the correct answer should have been that a D&C would solve all her problems.

 

[audereestfacere]

I have an unrelated behav sci question:

According to Conrad Fischer's (Kaplan) ethics book, this is an appropriate response: "I cannot date you and be your doctor - maybe in the future we can date, after you get another doctor."

He goes on to explain that only psychiatrists are subject to the limitation of not being able to date their patients EVER.

Does that sound right? It sounds wrong to me. I'm asking because another answer choice in that question was "I can't date you, ever", but that was not the correct choice.

 

[AlexMorph]

When it comes to USMLE and beh. sci. questions, play it as safe as possible. This means no dating patients ever no matter what. And going back to previous question, just explain Downs. Don't ask why she thinks God is punishing her.

 

[ArcGurren]

I have an unrelated behav sci question:

According to Conrad Fischer's (Kaplan) ethics book, this is an appropriate response: "I cannot date you and be your doctor - maybe in the future we can date, after you get another doctor."

He goes on to explain that only psychiatrists are subject to the limitation of not being able to date their patients EVER.

Does that sound right? It sounds wrong to me. I'm asking because another answer choice in that question was "I can't date you, ever", but that was not the correct choice.

I'm pretty sure the safe response is "No, absolutely not" for the Step 1. Kaplan has a lot of weird explanations for behavioral and I don't trust most of them... mostly b/c I have faculty at my school who I trust much more (you'll know who I'm talking about in regards to Behavioral).

 

[xlr8]

**nbme question by the way**

there was also one from an nbme where a newborn's grandmother was getting angry that the child was not getting chamomile tea (a remedy they insisted upon). i thought the best thing to do was to explain to them what the negative effects of it entailed, apparently it was something else (arrange to give it at another time i think?)

i didnt quite understand that, unless the answer i chose was wrong because the tea actually has no adverse effects (which i dunno)

 

[AlexMorph]

**nbme question by the way**

there was also one from an nbme where a newborn's grandmother was getting angry that the child was not getting chamomile tea (a remedy they insisted upon). i thought the best thing to do was to explain to them what the negative effects of it entailed, apparently it was something else (arrange to give it at another time i think?)

i didnt quite understand that, unless the answer i chose was wrong because the tea actually has no adverse effects (which i dunno)

Ya...I don't know of any adverse effects of it. When it comes to harmless crap like that, just let the patient have it. It makes them feel better.

 

[iA-MD2013]

There was a question on uworld and kaplan about a woman who found out that her newborn has down syndrome and she cries screaming "God must be punishing me!" What should you do next?
Uworld says the answer should be wait for her to collect herself and tell her more about down syndrome. Kaplan says the answer is you should first ask "why do you think God is punishing you?"

Which one do u think is the right answer?

Really? Uworld is right? I would have totally gone with Kaplan's answer on the real deal. Then again, I watched I did use kaplan notes for behavioral science

 

[ArcGurren]

Ya...I don't know of any adverse effects of it. When it comes to harmless crap like that, just let the patient have it. It makes them feel better.

I remember the question, I think it made up some adverse effect for chamomile tea (or maybe it's true idk... apparently necrotizing enterocolitis risk for premies) - I chose the answer of basically explain to the grandmother that it can't be done right now, but work with her to work it in when it can be done.

 

[SlaveOfTCMC]

I have an unrelated behav sci question:

According to Conrad Fischer's (Kaplan) ethics book, this is an appropriate response: "I cannot date you and be your doctor - maybe in the future we can date, after you get another doctor."

He goes on to explain that only psychiatrists are subject to the limitation of not being able to date their patients EVER.

Does that sound right? It sounds wrong to me. I'm asking because another answer choice in that question was "I can't date you, ever", but that was not the correct choice.

In real life maybe....

but for the Boards...

choose

"I cannot have a relationship with you, but I still want to be your doctor. (Motions for a witness/nurse to enter the room)"

is the right answer for this one.

 

[da8s0859q]

Ya...I don't know of any adverse effects of it. When it comes to harmless crap like that, just let the patient have it. It makes them feel better.

+1. I think the answer was something along the lines of coming to a compromise -- the doc makes sure the patient gets what's needed right this second, and plan to give the tea shortly after.

But yeah, the safest, most sanitized, most "fuzzy" answer is generally the right one, as long as the question isn't about HIPAA exceptions or anything like that. At least that's been my experience thus far.

 

[XRanger]

Another discrepancy between kaplan and uworld. This one about a patient who comes to see a physcian and the physician is about to run some tests to determine if the patient has cancer, and the patient says "Doc, if it's cancer, I don't want to know". what should you say next?
Uworld says "If you don't want to know, then I won't tell you. Is there anyone in your family whom I can talk to in your place?
Kaplan says ask "why do you not want to know?"

Kaplan says the patient must be told of the diagnosis, but I thought a patient can refuse information? which one is correct here?

 

[unsung]

There was a question on uworld and kaplan about a woman who found out that her newborn has down syndrome and she cries screaming "God must be punishing me!" What should you do next?
Uworld says the answer should be wait for her to collect herself and tell her more about down syndrome. Kaplan says the answer is you should first ask "why do you think God is punishing you?"

Which one do u think is the right answer?

I've seen that Q somewhere else before too. I think High Yield (??). Do you have the UWorld ID#?

But I think Kaplan's right, actually. Her answer could be something expected, like how she feels guilty for something she's done or what not. OR, it could be "The Devil has been speaking to me, telling me to...". You never know.

Anyway, the "right" response almost always seems to be to elicit more information.

Like the patient who "feels ugly" after mastectomy... we're not supposed to jump to the conclusion of offering her info about reconstruction. We're supposed to find out why she feels ugly, what's going on with her relationships, etc. Or the non-compliant diabetic patient "Tell me what you understand about diabetes." 😉

 

[iA-MD2013]

I agree with unsung!

 

[da8s0859q]

Another discrepancy between kaplan and uworld. This one about a patient who comes to see a physcian and the physician is about to run some tests to determine if the patient has cancer, and the patient says "Doc, if it's cancer, I don't want to know". what should you say next?
Uworld says "If you don't want to know, then I won't tell you. Is there anyone in your family whom I can talk to in your place?
Kaplan says ask "why do you not want to know?"

Kaplan says the patient must be told of the diagnosis, but I thought a patient can refuse information? which one is correct here?

I think UW's right, though realistically I think both are perfectly fine answers. But I don't remember if "why don't you want to know?" was an answer choice on UW's question.

 

[TexasPhysician]

I think UW's right, though realistically I think both are perfectly fine answers. But I don't remember if "why don't you want to know?" was an answer choice on UW's question.

I think Kaplan is right but I'm biased being a psychiatrist. I would first ask why the patient believes she is being punished. Is she depressed, upset, delusional, or just uneducated about Down's? You don't know yet. When a patient is deeply upset, I think it is vital to explore the patient's concerns. Then explain Down's to the patient when she is more calm. If you are concerned that God is punishing you, how much are you paying attention to general disease education right now?

 

[da8s0859q]

I think Kaplan is right but I'm biased being a psychiatrist. I would first ask why the patient believes she is being punished. Is she depressed, upset, delusional, or just uneducated about Down's? You don't know yet. When a patient is deeply upset, I think it is vital to explore the patient's concerns. Then explain Down's to the patient when she is more calm. If you are concerned that God is punishing you, how much are you paying attention to general disease education right now?

Definitely, but I was actually referring to a different question -- the one in UW where a guy asks to not be told if it's cancer. Kaplan and UW disagree on the approach, but I don't remember if UW had Kaplan's answer in the choices anyway.

 

[Mace1370]

Definitely, but I was actually referring to a different question -- the one in UW where a guy asks to not be told if it's cancer. Kaplan and UW disagree on the approach, but I don't remember if UW had Kaplan's answer in the choices anyway.

I just did this question (it is question id 1237). UWorld's wrong option was "tell me about your depression", which is a little different than Kaplan's correct answer of "tell me why you don't want to be told." Uworld said "tell me about your depression" was incorrect because it assumes the patient has depression.