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Craziest HIV related interview question EVER

Discussion in 'Pre-Medical - MD' started by mikeinsd, Mar 7, 2007.

  1. mikeinsd

    mikeinsd predictably unpredictable
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    Ok so for whatever reason the HIV topic is sure blowing up in these past two days or so, which reminded me of a question that a friend got while interviewing at a DO school last year (I do not remember which one)...

    So, lets say you are a doctor in a small town. You are walking down the street and you see that a patient of yours appears to have passed out or something and you asses that they need mouth to mouth (dont ask me why, i dunno). You also recognize your patient as being HIV+. In addition (i kid you not) you have just come from the dentist, where you had a tooth pulled, thus you have an open wound in your mouth. Now, you have exactly two minutes to act, you dont have your medical tools (mouth barrier, etc), and you cannot get anyone else to help you, because there is no one around.

    what do you do?

    when i heard this question, i got so scared about interviewing... luckily i never ran into anything nearly as crazy
     
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  3. Disinence2

    Disinence2 Emergency Medicine
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    Thats a mild question. There much much scarier ones out there.

    I'd say the wrong answer is that you would risk everything and give mouth to mouth, to maybe save the guys like... Most interviewers would see right through this as total BS.

    I'd say the first rule of First Aid is Universal precations. It makes no difference that you know the person is HIV posative because your going to assume everyone you find is. I'd call 911 and do everything i could for them without putting myself in danger.

    If you want to risk your life to save poeple then you can join the fire department.
     
  4. AtreyuRocks

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    Well, first of all if you just had a tooth pulled and have an open wound, you cannot "blow or suck" thus you really could not effectively give mouth to mouth anyways, so get on the phone and try mumbling your location to the 911 operator. Also, why the hell are you walking down the street if you just had oral surgery? Typical protocol does not allow you to even leave the premises on foot, only by wheelchair and then in a vehicle driven by another person! Anyways, I always have weird answers to these things, but that would be my answer... :)
     
  5. BeanerMD

    BeanerMD Junior Member
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    I can vouch for this story- I also had a good friend interview at a DO school and get this question. Another example of crazy but true....
     
  6. greytmedic

    greytmedic Faster than you
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    It is actually recommended for by-standers who do not have body substance isolation equipment and are concerned about transmittable diseases to just perform chest compressions. This keeps circulating the blood with whatever O2 was in the lungs and also provides the very slight ability to get some O2 into the lungs by the mechanical pumping of the chest, although very ineffective it is better than nothing.

    :idea: Otherwise, since you're a doctor you could run into the hardware store that is sure to be on the main street in a small town that you would most certainly be walking down from the dentist. Get some rubber gloves, a pin knife, and a section of tubing. Then run back to the pt and perform a cricothyrotomy using the above equipment and ventilate through the tubing. Just make sure you remove your mouth from the tubing immediately after blowing in.
     
  7. TleilaxuMD

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    :laugh::laugh::laugh:

    Or you could buy an air compressor and just shoot the air into his mouth.
     
  8. spicedmanna

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    Only if it is BS, that is. That's a horrible question to ask during an interview. Seriously, though, if you are a healthcare worker, you do have a duty to act if you are already engaged in treatment with a patient as long as the risks to immediate bodily harm are negligible (bystanders do not have a duty to act and are protected by the Good Samaritan law). It is extremely unlikely that you will contract HIV by giving mouth-to-mouth; there have been zero documented cases according to the AHA. You are more likely to contract Hep, or TB, in resuscitation efforts than HIV. There are provisions that protect healthcare workers if the scene is not safe; these apply to the threat of physical harm, however. You should most definitely have and use proper BSI, if you can obtain it. However, since BSI isn't available, you should proceed without it, using due caution, if the assessed risk is minimal and you have the duty to act. Nobody would fault you, however, if you judge that the risk is more significant, and it is clear (as mud) that proceeding would cause you bodily harm; you are practicing to a standard of care, and if any reasonable person with the same level of training in the same situation would judge the situation similarly, then you should be fine skipping mouth-to-mouth. In this case, if the person is pulseless, you may wish to open the airway to make it patent, skip mouth-to-mouth, and begin compressions. Instruct someone to call 9-1-1 immediately so that proper care can be administered.
     
  9. mikeinsd

    mikeinsd predictably unpredictable
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    everyone except tllaalalMD - thanks, could never have come up with most of this stuff... I think my friend just said, that given no other choice, she would just do it and be as careful as possible... at anyrate she goes to the school now, so i guess it worked out...

    tlalalMD - check back in when you have somehting constructive say ;) and have a nice day!:D
     
  10. karmega5

    karmega5 MS2
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    So- on the topic of hopefully never-in-a-million-years questions, what if the paramedics arrive, and are about to begin treatment, can you warn them (healthcare worker to healthcare worker) that the patient is HIV positive? I know they're supposed to be careful no matter what, but would you be violating confidentiality?
     
  11. mikeinsd

    mikeinsd predictably unpredictable
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    i think the above point about universal precautions covers it... but at the same time my gut would want to tell them... I think if actually faced with the situation i would pull them aside and tell them quitely and hopefully in confidence... but i never have been one to follow rules perfectly and i will likely get in trouble for it someday...
     
  12. spicedmanna

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    No, you would not be violating confidentiality; it is part of the transfer of care. The paramedics need to know the patient's medical history to provide proper treatment. Also, under the Ryan White law any heathcare worker that comes into contact with an HIV+ patient, who has had the potential of body fluid contact, etc., has the right to know. That's what I remember, anyway.
     
  13. Law2Doc

    Law2Doc 5K+ Member
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    The OP said assume you are a doctor, not MacGyver.:)
     
  14. NickRiviera

    NickRiviera MS-Never
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    Fantastic memory, you're right on the money with this comment and the last one.
     
  15. Dr. C. Troy

    Dr. C. Troy Member
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    These HIV related questions are actually kind of boring if you ask me.

    It seems to be rather uncreative on the interviewers' parts to keep coming up with new "what if death or HIV" questions.

    I mean, there are things like the partial liver transplant, and other I'm sure that there would be some interesting ethical questions that could arise from procedures of that nature.
     
  16. NickRiviera

    NickRiviera MS-Never
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    Actually, this is very effective within the first few minutes and the AHA has discussed removing ventilation completely during the first few minutes of an arrest. After someone has been down for a few minutes though, compressions alone are not useful for oxygenation. There have also been studies dealing with "priming the pump" through compressions to get ATP to the heart so a defib shock will be more likely to convert VF as the DFT (defib threshold) is now lower.
     
  17. spicedmanna

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    Thank you. Looks like all that EMT training is paying off, after all. :D :thumbup:
     
  18. Haemulon

    Haemulon Slippery When Wet
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    I believe that Good Samaritan laws help to protect citizens from being sued if they DO act in good faith by trying to help. It doesn't protect people for NOT acting. However, I agree with others on here that have said you do not have to act if there is a significant risk to life or health. Law2Doc, what is your take (I obviously could be wrong)?
     
  19. NickRiviera

    NickRiviera MS-Never
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    The laws are different per state but some states have a misdemeanor charge if you do not act. However, acting can include calling 911 on your cell phone while driving by.

    On a side note, Defibtech just today recalled a bunch of their AEDs. So, we're all going to die anyway.
     
  20. el aye

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    Gastric inflation :)


    As for the question, you do not do mouth-to-mouth without BSI. As mentioned above you can still do chest compressions and that will be better than nothing, but just hope that the EMS response is quick. Going through with mouth-to-mouth is reckless because you are putting yourself at risk and the odds of the patient coming back with or without brain damage is not very good.
     
  21. squeaky

    squeaky Hopeful
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    I interviewed for a pharmacy sales clerk position back in high school, and I was caught off guard with the following HIV question:

    Hypothetically, if you were working in the pharmacy, and you see your best friend's boyfriend/girlfriend getting HIV drugs for himself/herself, and you know for sure your best friend do not know about the boyfiend/girlfriend's illness, what woud you do?

    I remember saying something like, well, I would respect the person's privacy and not say anything and go on with my business. But afterward, the interviewer suggested that not disclosing that you have HIV to your sexual partner is illegal or something, and the more correct thing to do was to inform the supervisors at the pharmacy so proper law enforcement action could be taken.

    needless to say, I didn't get that job.......
     
  22. Jejton

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    Regardless if the risks are negligble, they are there, and the first rule in medicine - be it as an EMT or as a doctor - is that you place your safety above all else. That is why EMT's dont leave their ambulance at the scene of reported gunfire until a police officer clears the scene, even if a person is bleeding out on the street in front of you. You will never ( ok you might find some ultra altruistic idiot ) see a doctor perform mouth to mouth on a stranger, or an aquaintance known to be HIV+, without the proper precautions. ER and Grey's Anatomy are not real life.
     
  23. Jejton

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    I dont think that is quite correct. Last year a phlebotomist stuck himself with a needle he used to draw my blood. He needed my signed waiver to give him permission to have my blood tested for HIV and Hep B. Without it, he would have had to take prophylactics and just wait and see.
     
  24. Jejton

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    You are mixing up different things. The Good Samaritan laws protect NON-MEDICAL bystanders from liability if they act in good faith. Medical personel are not covered by it and are actually held liable IF they act and it is found that they acted in such a way to harm the person. Now, the number of successful lawsuits might be low ( I havent actually looked it up ) but I wouldnt be surprised if the attempts at litigation were high. As far as a duty to act, I believe that there is some kind of legal duty to act for a medical personel but it would be hard to pursue it in court because who is to know if you just drove by that accident on the highway. I am not a legal expert though so anyone with some facts can chime in here.
     
  25. babycapybara

    babycapybara Junior Member
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    Do they really expect you to know all these laws in detail before med school? I would think this would be stuff you learn as you go along. As for not getting the pharmacy sales job when you were in high school..that's strange..they should at least give you a manual to study before hand and then ask you these questions.
     
  26. Law2Doc

    Law2Doc 5K+ Member
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    You are incorrect. Good Samaritan laws in most states protect medical bystanders as well. The goal is to encourage people to help. There is no point discouraging the people who could actually usefully help.
     
  27. DreamyKid

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    first, saliva carries very virtually 0 HIV transmitting power. Therefore unless the guy is bleeding in the mouth, your open mouth wound would not necessarily be in danger. And also, like one of the earlier posts said, you can't blow or suck, even if you really wanted to :D
     
  28. geekOCD

    geekOCD passionate people rock
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    Actually, it's not illegal to not disclose your status, it's illegal to infect someone knowing your status and not protecting yourself. So, if this boyfriend was using condoms with his girlfriend, it's fine. If he wasn't using condoms and his girlfriend hasn't gotten HIV? Still fine. Only after his girlfriend gets HIV can you potentially prosecute him for knowing his status, not protecting himself, and thus infecting her willingly.
     
  29. spicedmanna

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    You are correct about scene safety and the threat of physical harm, but your analogy isn't. The healthcare worker's safety is definitely of primary concern. However, if the risk to the hc worker is negligible, as I mentioned in my prior post, and the hc worker has a duty to act, the hc worker should proceed with caution (as always) and treat the patient appropriately, or transfer the care to someone of equal, or greater, skill. To do otherwise would constitute abandonment and people have been successfully prosecuted for that in some states; this is not to mention that it is unethical. You must not withhold treatment in a truly emergent situation if you can reasonably act without threat of harm.

    There is a famous case where a town Sheriff withheld CPR from a patient in arrest. The patient was gay and the Sheriff thought that the patient might have AIDS. Not only did he refuse to act, he actively blocked others from assisting the patient until paramedics arrived. If I recall correctly, he was held liable for his actions.

    Now, if the hc worker assesses the situation/scene and thinks that he, or his partner, is at significant risk, nobody would fault you if you protected yourself. You will be held to a standard of care. If any reasonable person with your level of training in the similar circumstances would have acted similarly, you'd stand well legally. You delivered a good standard of care. That's what you'll be judged on.

    The AHA has determined that zero people have contracted HIV from CPR. Zero. Again, there have been no documented cases of people contracting HIV from giving mouth-to-mouth. Therefore, your risks are practically nil. However, you could contract other things, such as TB and Hep, so you should most certainly use proper BSI. The scenario indicated that no BSI was available, however. If you deem there to be a negligible risk, then proceed with CPR as per protocol, using due caution. If you assess the situation and think the risks are greater, and think your actions would constitute a proper standard of care given the circumstances, then open the airway and begin chest compressions. This will work fine anyway, since you witnessed the arrest. Call for additional resources immediately.
     
  30. Psycho Doctor

    Psycho Doctor *** Angel
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    huh? :confused: I had 4 wisdom teeth pulled at once and I walked out, drove to the drug store and had my RX for furonal with codeine filled as I waited for it in pain; then I drove home and studied for an exam. I never heard you need a wheel chair to leave the office.
     
  31. Psycho Doctor

    Psycho Doctor *** Angel
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    which schools asked this question?
     
  32. AtreyuRocks

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    haha. no general i am assuming. what state do you live in?
     
  33. Psycho Doctor

    Psycho Doctor *** Angel
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    that's what I was thinking. Just because most pre-meds have some clinical experience it does not mean they are physicians, EMT certified, or even CPR certified.
     
  34. Psycho Doctor

    Psycho Doctor *** Angel
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    how many people get general anesthesia to have a tooth pulled? maybe i'm the odd one here.

    GA, why?
     
  35. Psycho Doctor

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    that's correct. I saw this happen in a clinical setting and the doctor had to get permission for the patient's blood to be tested after a healthcare worker got a needle stick by a used needle.
     
  36. AtreyuRocks

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    definitely. most of the time they just want to see how you respond to the question. and maybe to see what you know or don't know. but maybe they want to see how far their question gets passed around and are scrolling forums merely to point, laugh, and cry out: "AH HA!"
     
  37. spicedmanna

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    The Ryan White Act authorizes notification to emergency response personnel, but does not authorize testing. The hospital had to gain informed consent for the test, but was required to notify the hc worker if HIV was present and he was placed at risk.
     
  38. AtreyuRocks

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    CA here. general and local that lasted over 48 hours. probably also because of severe impactions. anyways, CA is super-strict on everything, i forget how states differ on things... but in my defense i did say typical, lol. everytime i say things like that, i remember how insane CA is... thanks for bringing me back to the fact that CA is nuts, and the rest of the country isn't so
     
  39. spicedmanna

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    No, I don't think adcoms expect that you would know the medicolegal aspects of these situations, necessarily (if they even know about these aspects themselves!). I think they are looking for how you reason to a stressful, unfamiliar scenario, and perhaps how you would justify and/or defend your choice. They want to know more about you, how thoughtful you are, etc. Of course any other knowledge you might come with would be a nice bonus, I would think.

    I agree, though. I think this question is kind of rediculous.
     
  40. Psycho Doctor

    Psycho Doctor *** Angel
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    TB, yes, Hep B, yes, but Hep C no. HIV is known to be transmitted via bodily fluids, including saliva. Hepatitis C is transmitted primarily blood to blood contact.
     
  41. spicedmanna

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    Thanks for the clarification. Yeah, I was referring to TB and Hep B. HIV is known to be transmitted via bodily fluids, but there have been no documented cases of transmission during CPR/mouth-to-mouth.
     
  42. AtreyuRocks

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    Recent studies suggest that Hep C could be transmitted through saliva, including toothbrush sharing (who does this? i don't know...)

    EDIT: I'm not saying that mouth to mouth will do the trick, just putting it out there, but like i said who shares toothbrushes anyways?
     
  43. Critical Mass

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    Can we use the nose as an airway?
     
  44. Psycho Doctor

    Psycho Doctor *** Angel
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    "Hepatitis C is not transmitted by touching, kissing, hugging or closeness. Hepatitis C is not present in saliva so cups, plates, utensils and other household items can be considered safe. However, washing and general cleaning of these household items can protect from many other illnesses and should remain a part of every household's common hygene practice."

    http://www.hepatitisaustralia.com/pages/Hepatitis_C_Transmission.htm
     
  45. greytmedic

    greytmedic Faster than you
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    Yes, just watch out for the boogers.
     
  46. Psycho Doctor

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    HIV is transmitted thru mucosal membranes so the nose wouldn't be safe.
     
  47. AtreyuRocks

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    I would agree. I think the toothbrush studies are most likely due to gingivitis/plasma and not so much the saliva...

    "There is a very low but real risk of passing on the virus through other body fluids such as saliva, semen, vaginal secretions or breast milk.
    How is hepatitis C not spread?

    Hepatitis C is not known to be spread by:
    • Coughing or sneezing;
    • Contact such as hugging and kissing;
    • Using the same dishes or cutlery;
    • Swimming in a chlorinated pool when you have cuts, scrapes or are menstruating;
    • Being bitten or stung by an insect which then bites or stings someone else;
    • Contact of healthy intact skin of others by your body fluids such as saliva, urine, feces or vomit."
    that website is really confusing... i guess they are trying not to scare people but at the same time trying to warn people of all the risks? check it out...
    http://www.bchealthguide.org/healthfiles/hfile40a.stm

    Hepatitis C – contamination of toothbrushes: myth or reality?

    Nonetheless studies have been done on the HCV presence in saliva: High Serum Hepatitis C Virus (HCV) RNA Load Predicts the Presence of HCV RNA in Saliva from Individuals with Chronic and Acute HCV Infection


    I am not trying to say that you will get HCV from mouth to mouth, but more that it is possible. But even so, even in these studies the possibilities are so slim, it seems almost ridiculous. Thanks for the other info though. I wonder if the "consensus" on this issue also varies by country or if emerging research will ever settle this debate in the near future...
     
  48. 112258

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    This differs by state law. In VA its a felony if you know you are infected and have sex/other acts with someone. In MD its a misdemeanor if you transmit it or intend to transmit it.

    Did you just say HIV is transmitted by saliva???? That is very very incorrect and saying facts like this (so matter of factly) encourages the spreading of wrong information....Saliva contains HIV antibodies (which is how the oral rapid tests detect it) but HIV has never been documented as spreading through saliva.
     
  49. Psycho Doctor

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    ok you're right; although HIV can be found in saliva it is low risk of actually being transmitted that way. sorry
     
  50. DropkickMurphy

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    Your safety before the patients. That's rule #1.

    But then I've only give mouth to mouth one time and that was to a baby that had fallen into a pool (I got to the scene in my POV before the rescue truck did), so it's not like the HIV status of the guy has anything to do with my decision (refer to Psycho Doctor's comment).
     
  51. DropkickMurphy

    DropkickMurphy Membership Revoked
    Removed

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    I smell troll.
     

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