Behavioral Science Questions: Tricky,any method?

Discussion in 'Step I' started by winsicle, May 5, 2007.

  1. winsicle

    winsicle Member
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    Is there a list of rules somewhere that can guide us through how to answer these questions?

    I always seem to be b/t a couple of answers, and feel that either one may be justified, so how should i go about answering these: and the WWJD method doesn't seem to work

    thanks in advance!

    (btw i'm primarily talking about the ethical situations, i.e. what do you say/do next)
     
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  3. DoctorFunk

    DoctorFunk Get down with the boogie
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    I think there is supposed to be an algorithm to use for these problems in Kaplan's Behavorial book. I haven't had a chance to use it yet so I can't vouch for its usefulness, but at least there's one out there!
     
  4. Bioengineer

    Bioengineer The Usurpator
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    it's in First Aid
     
  5. KNightInBlue

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    One helpful piece of advice I got months back and always refer back to when I come across questions regarding "what do/dont you say/do?" - I am sure you've heard of WWJD (What would Jesus do?), there's now a modern variant of it - WWWD (what would W (aka 'dubya') do?).........and just do the exact opposite
    basically, pretend like u r from san francisco, not Texas
     
  6. ertugrul

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    :laugh:
     
  7. shivasHeroLike

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    what is the algorithm?
     
  8. TrapperJohnMD

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    WOW, I think you hit my method right on the head. Last year whenever I came across a BS question I stopped, took a deep breath, and ask myself 1-3 questions:

    1) "What would a liberal, multiracial, lesbian/bi/tranny, femenist woman do?"

    If that didnt work I would ask:

    2) "Which of these answers is the least likely to be correct in the real world of medicine?"

    If that failed I asked:

    3) "Which one of these answers ignores the fact that the patients BMI is 60 because they eat more than an elephant --because judging them is wrong and it is no ones fault they are obese?"

    This strategery landed me almost 2 SD above the class average in BS. What a bunch of BS. :smuggrin:
     
  9. PeepshowJohnny

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    I don't know of any formula to follow but there's a few rules to it.

    A) Never refer...ever. There is no behavioral science question where you should refer the patient to a psychiatrist or a social worker or another specialist. The answer in these situations is always face the bullet.

    along with the previous...

    B) Let the patient work it out with you there. A lot of emotional situations will have options about leaving an agnry, depressed, hysterical patient until they compose themselves. This is NEVER the correct answer. Also, never try to interrupt them. Just sit their and let them vent.

    Here's an example:

    "Mrs. S is your patient who you removed a suspicious mole from her back on the last visit. On a return visit, you inform her that her pathology results demonstrate that the mole was malignant melanoma and that by the depth it is likely it has already metastasized. Mrs. S begins crying in hysterical sobs and screams "Why God me?".
    Your next course should be
    A) Tell the patient you are very sorry, and give her a few moments a lone to grapple with her diagnosis.
    B) Give her the names of an oncologist and a grief counselor.
    C) Sit quietly with the patient until she is ready to talk and offer her a box of tissues.
    D) Ask if she would like to meet with a religious figure.

    Of course, the answer is C.

    Other rules:

    NEVER make the patient make an unpopular decision in front of the family. If you have to get rid of a family member to be confidential YOU be the badguy and ask them to leave, don't make the patient do it.

    If something is going wrong and a patient is mad at you, ALWAYS first apologize and comment on their feelings. Seriously I had so many questions where the answer was "I can see you're angry, I'm sorry that your wait was so long." NEVER explain away the reason "I'm seeing many patients today and running late.
     
  10. tuscanito

    tuscanito Junior Member
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    jeez man you are helpful!
     
  11. any other tips? For some reason I am consistently getting these types of questions wrong. there always seem to be several okay answers. Today I was taking a practice exam that asked about a situation in which a child was wetting the bed after his mother had a new baby. Three answers seemed fine to me:
    A. personally talk to the child
    B. tell the mother to spend quality time with the child
    C. tell the mother to talk to the child about bed wetting

    I chose A but it was wrong because "this is obviously an embarrassing situation for the child and talking to him might make him feel more embarrassed". I almost chose B (the correct answer) but then felt like it wasn't directly addressing the situation. Tips?
     
  12. BobBarker

    BobBarker Member
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    On NBME 3 their is a tricky BS question that is similar to this....


    "Patient speaks spanish, and is accompanied by his bilingual 6 year old daughter. He says "dolor" and clutches his belly. You proceed by..

    A. Asking his daughter to help translate.
    B. Using a spanish med dictionary to help.
    C. Getting a spanish speaking nurse to translate.
    d. Using pictures to help explain to the patient.


    I went with the "real world" answer which was A, but I'm not sure if it was correct. What are you guys' thoughts?
     
  13. polyposis

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    ^^Since the daughter is 6 years old, I don't think physicians would ask her to translate in the real world (maybe if she were 16?). Who knows, at 6 her vocab in Spanish and English could both be limited. I think it makes more sense to get a Spanish speaking nurse to translate, she's acting as translator so she's not a "referral" and you don't have to worry about something getting lost in between. Also he may not want his daughter to know what is wrong so there's some confidentiality problems there.
     
  14. ambiguous

    ambiguous Junior Member
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    I'm gonna agree and say no to the daughter option as well as the nurse. I heard the rule of thumb for the USMLE is "DO EVERYTHING YOURSELF!" NEVER REFER to other specialists and NEVER USE NURSES.

    I also recall once that the pain scale chart with those face pictures are used for kids (obviously) as well as non-english speaking patients. Thus, I'm gonna guess D for this question. Does anyone know the real answer?
     
  15. could someone post this algorithm? or any other step-wise method of solving these problems?
     
  16. virilep

    virilep What can Brown do for u?
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    I went with C... hmmm.
     
  17. Docster

    Docster Junior Member
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    I'd choose 'D'. BRS Behavioral has a great table of DOs and DON'Ts when it comes to 'ethics-legal' questions. In this specific case, the exam probably presumes you know what the word 'dolar' means, but if it was some other unfamiliar word then you would still not use the nurse on the Step I exam. Asking the daughter is not an option b/c of confidentiality issues. I guess the med dictionary could be a viable option, but the pictures option makes it seem more like you're taking responsibility/initiative (which is a DO in BRS) instead of relying on an outside resource.
     
  18. Pathinterpreter

    Pathinterpreter Learning to seek the way.
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    "after his mother had a new baby"!. The question also said the mother was not spending too much time with the kid, so the correct answer is B.

    Another rule I might add is "Get enough information before you act". A lot of "Tell me more about.." would be a correct answer. I find very good the Do's and Don'ts on BRS BS.

    Good luck!
     
  19. ambiguous

    ambiguous Junior Member
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    So I just completed the NBME 3 and saw this question. You seemed to have left out the main answer choice in your list. It was "Have a professional spanish interpreter present during your examination."

    I went with that answer over the using pictures one. Anyone think otherwise?
     
  20. osli

    osli Senior Member
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    Agreed. Haven't taken NBME 3 yet, but I would have chosen the same. Never use family for interpreters if at all possible (may be necessary in emergency situations). Big no-no. Shifts the balance of "power" (for lack of a better word) in the room. The interpreter is the only one that knows both sides of the conversation and holds extreme power... family should never be put in that situation as there is a huge conflict of interest. Nurses have another job to do, and it isn't translate. Pictures are good for an emergency, but if the daughter was there that would be the better option for anything so emergent you can't get a translator. For all other situations... if a translator is in anyway available, use one. In fact, you are sometimes required to provide one.
     
  21. DragonWell

    Moderator Emeritus 10+ Year Member

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    No, I think that was definitely right. For all the reasons mentioned above as well as confidentiality issues - it's not OK to share the patient's problem with the daughter without permission.
     
  22. doc20

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    kaplan has a list of rules or algorithm whatever you wanna call it, i think towards the end of notes, go through it, you can answer a lot of questions based on that
     
  23. alpha06

    alpha06 Senior Member
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    What about this Q, I saw on NBME 4:

    A 50y/o surgeon is about to do a procedure. His breath smells of alcohol and they tell him to leave. He is brought before a committee where he admits he drinks heavily on a daily basis. Which of the following long-term plans is most likely to help the physician maintain sobriety?

    A. cognitive therapy for depression
    B. participation in AA
    c. therapy w/ antidepressant
    d. therapy w/ GABA
    e. therapy w/ disulfram
    f. therapy w/ opiate agonist


    I picked...e. The algorithm didn't work for me on this one.... It was either "e" or send him to AA.
     
  24. InternationlDoc

    InternationlDoc Imported like a Ferrari
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    AA therapy looks like "long term" therapy vs any pharmacotherapy. I'd pick b.
     
  25. Clin2008

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    As of Rules, Kaplan MedEssentials 2nd edition has a couple of list with 20 rules each on (1)physician-patient relationship, and (2) ethical and legal issues. I have found them quite useful.
    Now let's get to the physician with alcoholism question. There is no clear evidence that this patient is depressed, and in the "long term" AA would be most helpful! Think cheap ;-)
     
  26. alpha06

    alpha06 Senior Member
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    I'm still not getting it. Why can't drugs be "long-term"?

    Yes, its not cheap, but it works....:rolleyes:
     
  27. DwyaneWade

    DwyaneWade Reiging *** Cynic
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    AA. Drugs are never long-term therapy for alcoholism on Step 1.

    I think that was NBME 4, not 3. I remember that question and I haven't taken 3 yet.
     
  28. alpha06

    alpha06 Senior Member
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    Yeah, you're right. It was 4. :)
     
  29. Rogue Synapse

    Rogue Synapse The Dude Has Got No Mercy
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    There's some study out there that shows that AA is the only intervention that results in a statistically significant improvement in alcoholism outcome after some arbitrary "long-term" time period. They love to ask about things that have been "officially proven" versus stuff that we know works, but there hasn't been a giant longitudinal study on it.
     

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