Behavioral science question

[Phloston]

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Uworld has a question (ID# 1145 [441137]) that basically tells you a triple screen's been done on a pregnant woman, and the fetus is subsequently diagnosed with Down syndrome. The woman starts crying and says, "God is punishing me! God is punishing me!"

Anyway, the question is, "which of the following is the most appropriate response to her exclamation?"

3 of the answers are clearly ******ed. Then the remaining two are:

Answer = "This is a difficult situation. Please let me explain this condition to you in better detail." 68% chose this.

I selected: "What have you done to deserve being punished?" 11% chose this. Priceless.

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I'm a bit stunned, quite frankly, because I swear I've encountered other practice questions in the past where, if a patient mentions God, the first step is to quickly gain a better idea of his or her beliefs within the context of patient care before delving into explanations about treatment and diagnoses.

UWorld says that the latter is wrong because it might be considered prying into her personal life, and it is most important to proceed by educating the patient about the disease process. I honestly don't feel the latter answer choice is particularly close-ended or wrong. After all, I would think understanding your patient a bit personally would be favorable.

Obviously I'm behavioral-inept.

Any thoughts on this?

 

[islandCrazy]

I actually remember this question and thinking that the choice "What have you done to deserve being punished?" sort of validates the mothers thoughts as oppose to address the real problem which is her lack of knowledge of Down syndrome. I mean the question doesn't say "Why do think that way" but instead "What did you do" which is quite the accusation.

By the way if you haven't read Conrad Fischer's 100 cases- its great. I have gotten stars on Behavioral in the last two NBME and it has been the only thing I have done for Behavioral since the NBME before that in which I used Kaplan.

 

[Aconitase]

i just did the same Q in a question set yesterday! it is pertinent that the patient be given time to process and respond to the situation at hand. eliciting the patient's feelings on a traumatic revelation is always the most appropriate response in such a situation. second to this is educating the patient. that is why the correct answer is appropriate here. if you ask her why god is punishing her you are almost justifying her cry for help in this moment of weakness. also, it becomes a bit invasive to ask as well since the patient may feel she now has to reveal troubling past incidents to adequately answer the Q. hope that helps 🙂

 

[Phloston]

I actually remember this question and thinking that the choice "What have you done to deserve being punished?" sort of validates the mothers thoughts as oppose to address the real problem which is her lack of knowledge of Down syndrome. I mean the question doesn't say "Why do think that way" but instead "What did you do" which is quite the accusation.

By the way if you haven't read Conrad Fischer's 100 cases- its great. I have gotten stars on Behavioral in the last two NBME and it has been the only thing I have done for Behavioral since the NBME before that in which I used Kaplan.

Is this what you're referring to?

http://www.amazon.com/Kaplan-Medica...1246&sr=8-1&keywords=Conrad+Fischer+100+cases

 

[Phloston]

i just did the same Q in a question set yesterday! it is pertinent that the patient be given time to process and respond to the situation at hand. eliciting the patient's feelings on a traumatic revelation is always the most appropriate response in such a situation. second to this is educating the patient. that is why the correct answer is appropriate here. if you ask her why god is punishing her you are almost justifying her cry for help in this moment of weakness. also, it becomes a bit invasive to ask as well since the patient may feel she now has to reveal troubling past incidents to adequately answer the Q. hope that helps 🙂

I think I just need some serious help in the behavioral department.

 

[islandCrazy]

Is this what you're referring to?

http://www.amazon.com/Kaplan-Medica...1246&sr=8-1&keywords=Conrad+Fischer+100+cases

Yes that was the version I used, however I see from Amazon that there is a new one that just came out this month.

 

[Phloston]

Yes that was the version I used, however I see from Amazon that there is a new one that just came out this month.

I'm glad you mentioned this text. Thanks a lot. I've decided that I'll use it as side-reading after I finish the Step1 haha. The only reason is that I Google Book-previewed it, and it seems like a fairly conceptual, rather than a bullet-point-based text, that is without a doubt a fantastic read, but in the final two months I should probably just focus on questions and FA.

 

[tundri]

I hear it can be read in a day as a story book. I bought it due to the fact that many high scorers, let me rephrase that, many IMG high scorers, included it on their list of reference and none regretted buying/reading it.

 

[medflava]

Uworld has a question (ID# 1145 [441137]) that basically tells you a triple screen's been done on a pregnant woman, and the fetus is subsequently diagnosed with Down syndrome. The woman starts crying and says, "God is punishing me! God is punishing me!"

Anyway, the question is, "which of the following is the most appropriate response to her exclamation?"

3 of the answers are clearly ******ed. Then the remaining two are:

Answer = "This is a difficult situation. Please let me explain this condition to you in better detail." 68% chose this.

I selected: "What have you done to deserve being punished?" 11% chose this. Priceless.

-----

I'm a bit stunned, quite frankly, because I swear I've encountered other practice questions in the past where, if a patient mentions God, the first step is to quickly gain a better idea of his or her beliefs within the context of patient care before delving into explanations about treatment and diagnoses.

UWorld says that the latter is wrong because it might be considered prying into her personal life, and it is most important to proceed by educating the patient about the disease process. I honestly don't feel the latter answer choice is particularly close-ended or wrong. After all, I would think understanding your patient a bit personally would be favorable.

Obviously I'm behavioral-inept.

Any thoughts on this?

The obvious answer is the first one, because the second answer portrays that the doctor is blaming the patient for her actions. Down Syndrome could be due to having the baby at a later age or drinking and it's the mother's mistake but the doctors job is to be supportive and not question the patient in a way that will make him/her look like an antagonist toward the patient.

 

[islandCrazy]

The obvious answer is the first one, because the second answer portrays that the doctor is blaming the patient for her actions. Down Syndrome could be due to having the baby at a later age or drinking and it's the mother's mistake but the doctors job is to be supportive and not question the patient in a way that will make him/her look like an antagonist toward the patient.

Are you confusing Down syndrome and Fetal Alcohol Syndrome? Or is that a proven cause, because its the first time I have encountered that association and I can't find it online.

 

[Phloston]

The obvious answer is the first one, because the second answer portrays that the doctor is blaming the patient for her actions. Down Syndrome could be due to having the baby at a later age or drinking and it's the mother's mistake but the doctors job is to be supportive and not question the patient in a way that will make him/her look like an antagonist toward the patient.

Are you confusing Down syndrome and Fetal Alcohol Syndrome? Or is that a proven cause, because its the first time I have encountered that association and I can't find it online.

That's because Down syndrome has nothing to do with drinking.

The poster might just have English as a second language, because if you reconstruct the sentence, it could be assumed that he meant both Down syndrome and drinking are both mistakes, yet independent of one another. Even if that is what he meant, to say that Down syndrome is a mistake on the woman's end because she gets pregnant >35 years of age is foolish.

 

[ijn]

Are you confusing Down syndrome and Fetal Alcohol Syndrome? Or is that a proven cause, because its the first time I have encountered that association and I can't find it online.

I mean, when a 45 y/o cougar blacks out drinking at the club and finds herself knocked up the next morning, I think you can blame the alcohol.

 

[islandCrazy]

I mean, when a 45 y/o cougar blacks out drinking at the club and finds herself knocked up the next morning, I think you can blame the alcohol.

Oh hell no, are you telling me I got to learn the lyrics to "Blame it on the Alcohol" for the USMLE.

 

[zstranger2]

That's because Down syndrome has nothing to do with drinking.

The poster might just have English as a second language, because if you reconstruct the sentence, it could be assumed that he meant both Down syndrome and drinking are both mistakes, yet independent of one another. Even if that is what he meant, to say that Down syndrome is a mistake on the woman's end because she gets pregnant >35 years of age is foolish.

You are very stupid and incredibly immature. The only thing worse than your incompetence is your morals. Stupid as a wall.

 

[thehundredthone]

I mean, when a 45 y/o cougar blacks out drinking at the club and finds herself knocked up the next morning, I think you can blame the alcohol.

Ian Thorpe would be envious of those swimmers.

You are very stupid and incredibly immature. The only thing worse than your incompetence is your morals. Stupid as a wall.

Definitely, I mean, how dare he say that you can't blame the woman. Wait, what?

 

[Big Baller]

I just came across similar question in kaplan qbank and the latter one is the answer. the reasoning was that you always want to get as much info from patient as possible and the latter one does that. dont know why uworld has a different answer.

 

[Phloston]

I just came across similar question in kaplan qbank and the latter one is the answer. the reasoning was that you always want to get as much info from patient as possible and the latter one does that. dont know why uworld has a different answer.

Yeah, I believe UWorld is wrong, no offense to them.

Not only Kaplan, but BRS Behavioral also had a question or two very similar to this. I recall there having been a section of a chapter about spiritual considerations, and particularly with Mexican or Native American patients, their concepts of spirituality can differ considerably, so before proceeding with any discussion about diagnoses or explanation of treatment, it's important to ask the patient why he or she is being "punished." This is not accusatory; it's affirmation of the patient's feelings by asking why he or she feels as he or she does. By failing to have the patient elaborate upon his or her statement, the physician is neglecting to extract potentially vital information from the patient regarding his or her beliefs. Furthermore, the former statement bypasses the spiritual considerations.