classic interview question: how to tactfully respond

[Concubine]

Advertisement - Members don't see this ad

This type of question has been hard for me to formulate a good response. I was hoping someone here that has experience responding to this type of question might have some input. There are many ways of phrasing the question, and it comes in many forms. I'll just do one example:

Two patients come in at the same time needing a heart transplant. One is 65 year old male with a history of smoking, unhealthy lifestyle, etc. Another is a 13 year old boy with X heart condition but otherwise normal. Who do you give the heart too?

Thanks in advance!

 

[drizzt3117]

This type of question has been hard for me to formulate a good response. I was hoping someone here that has experience responding to this type of question might have some input. There are many ways of phrasing the question, and it comes in many forms. I'll just do one example:

Two patients come in at the same time needing a heart transplant. One is 65 year old male with a history of smoking, unhealthy lifestyle, etc. Another is a 13 year old boy with X heart condition but otherwise normal. Who do you give the heart too?

Thanks in advance!

On these type of questions, always make the interviewer clarify whether both people are equally good candidates healthwise to receive the heart.

Assuming they say that they are, then it's basically a question where they want you to pick an answer and justify it. Most people are going to say the kid because due to his overall better health it's likely he's going to live longer. That's a perfectly defensible answer, IMO.

You could also say that assuming they're both equally good candidates, then the first one in line should get the heart. That's also a justifiable answer.

 

[Bacchus]

The 13 year old, of course. His potential for society is probably greater than the other person. I know that sounds harsh, but at 65 one is not as productive as a 13 year old could be. Also, at age 65, the adult is increasing in age and the transplant may not be as successful. Additionally, the 13 year old has a better chance of survival during surgery rather than the 65 year old that is plague by health problems. I think if you follow the organ donor rules, the 13 y/o patient will be higher on the recipient list.

 

[drizzt3117]

The 13 year old, of course. His potential for society is probably greater than the other person. I know that sounds harsh, but at 65 one is not as productive as a 13 year old could be. Also, at age 65, the adult is increasing in age and the transplant may not be as successful. Additionally, the 13 year old has a better chance of survival during surgery rather than the 65 year old that is plague by health problems. I think if you follow the organ donor rules, the 13 y/o patient will be higher on the recipient list.

It depends. They might not be higher on the list if their condition isn't as immediately life threatening.

 

[mountainhare]

This type of question has been hard for me to formulate a good response. I was hoping someone here that has experience responding to this type of question might have some input. There are many ways of phrasing the question, and it comes in many forms. I'll just do one example:

Two patients come in at the same time needing a heart transplant. One is 65 year old male with a history of smoking, unhealthy lifestyle, etc. Another is a 13 year old boy with X heart condition but otherwise normal. Who do you give the heart too?

Thanks in advance!

One tactful answer is: I'd give the heart to whoever is higher on the transplant list because, great as the temptation is to play God, medicine isn't an appropriate place for my prejudices about which patient is more likable, which patient is a "better" person, which patient is more "valuable to society," etc., to come into play. The decision should be based on a committee vote that considers objective factors like who is more likely to survive the operation, who is more likely to comply with post-op treatment, etc., rather than my own personal prejudices.

However, I think a doctor once told me that when a committee gets together to decide these things, they usually put smokers at the bottom of the list since those people are less likely to comply with post-op doctor's orders that require them to stop smoking. So choosing the non-smoker is certainly fine as long as you justify it on pragmatic grounds like these, rather than trying to justify it moralistically (e.g., don't say "I'd give it to the non-smoker because smokers don't deserve heart transplants"). Choosing the younger person because he is more likely to survive the operation is fine, too, but I'd advise against using a justification like "The younger person is more useful to society," for the reasons stated above.

 

[Bacchus]

It depends. They might not be higher on the list if their condition isn't as immediately life threatening.

Right, but I feel age would be the limiting factor in this situation. I'm assuming unhealthy lifestyle may mean overweight/obese, sedentary, etc. That all be played into account, "serious" surgery would be more practical for the young lad.

I will add to what I said before that of course this is from the outside looking in. I know if the 65 y/o was my father I'd have him take the organ over the 13 year old. Its protecting a loved one. But then again, this is a natural feeling.

Edit: I would assume the situation is critical if the 13 y/o needs a heart transplant. That being said, give it to the 13 y/o.

 

[BlackSails]

13 year old, no question.

The old man will get at most, 20 years out of the heart. Probably less because of his lifestyle. The kid will get many more years out of it, and will make better use of the heart.

 

[drizzt3117]

Right, but I feel age would be the limiting factor in this situation. I'm assuming unhealthy lifestyle may mean overweight/obese, sedentary, etc. That all be played into account, "serious" surgery would be more practical for the young lad.

I will add to what I said before that of course this is from the outside looking in. I know if the 65 y/o was my father I'd have him take the organ over the 13 year old. Its protecting a loved one. But then again, this is a natural feeling.

I don't disagree with your answer, and I'd probably make the same choice, but if you answer in that way in an interview, you're opening yourself up to being hit hard by an interviewer.

For example, If the committee finds them equally good candidates, but the older guy has been waiting six years for a heart while the kid was just disagnosed with his condition, their age is already likely taken into consideration by the committee and the negative factors you mentioned may have contributed to the reason that he's already had to wait six years.

 

[btc8]

There's obviously no right answer. You can say, "Oh, the 13 year-old; it's so obvious." Whatever your answer, as long as you justify it, the interviewer can hold nothing against you. That's why they have committees for these things; but in my opinion, both are equally apt to receive the heart, regardless of the previous conditions, as there's always a risk involved in transplantation of any kind.

Another sad thing is that the transplant will ONLY go to those who can afford it..but that's another issue entirely...Hmmm, I think I see why I bombed my first interview at a school as I tend to evade questions...lol

 

[badasshairday]

Interview questions like these are like high school algebra; you get the points by showing your work to justify your answer.

 

[adamMD]

Whatever you say, DO NOT make your decision based on age. That should have NOTHING to do with your decision. Every person should be equally important in the eyes of a physician.

 

[Vihsadas]

I'd probably start out by saying that the question is fundamentally flawed for two reasons:

1) It wouldn't be my call when I'm a physician, that decision would be for UNOS to make.
2) It's highly unlikely that a 13 year old and a 65 year old would be fighting for the same heart due to differences in their body mass.

BUT!
If those weren't legitimate concerns, then the answer is very simple. You cannot discriminate based on race, creed, color, religion, sex, or age. You should discriminate based on the only relevant factor:That an organ is a gift. It is an immense gift and entails huge responsibility.

Because of the huge shortage of heart donors, it's one of the most precious gifts that medicine can give to a patient. Therefore, the patient more likely to take care of this gift, and keep it in working order for as long as possible should be the recipient of the organ. In this case, the lifestyle of the older man excludes him based on this criteria, and the heart would go to the child.

 

[etf]

hmm...how to ration a scarce resource. how have we been doing it for millennia (hint, it's what makes america great). answer: $ (or in the case of an organ txplant, $$$$$$$$$$)