paul411

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Very interesting interview at UTMB Galveston about "hope" and after-life. More of a lecture, really.

Note: It's LONG so tl;dr at end

Starts out with10 minutes or so of "tell me about yourself". Then,

Weird part
Obviously, this is from memory so it's not exact but, if anything, I am doing injustice to the interviewer's (Dr. J) storytelling ability...

Interviewer:"I'm going to ask you a question. For this question, I'm going to make some assumptions. I'm going to assume that you have completed your medical education, residency, etc. You are a certified doctor. You work at a hospital.

You're in a hospital room alone with a dying man laying on his bed. Everything possible has been done to save this man's life but in vain. He WILL die before you leave that room and there is nothing you can do to change that.

Now, you are standing by his side. You have already done all the standard procedures and practices for telling someone that they are about to die. You said all the things you are supposed to say that you learned from education and experience.

As you are about to leave the room, the man reaches out, grabs your white coat and whispers with the little voice and energy he has left, "Doctor, can you give me any hope?"

Now... Can YOU give this man hope?"


Me: :eek: "uh, well... how exactly do you mean?" (hoping to get some hint of what he's expecting...)

Interviewer: "Well... what is hope? Hope is the anticipation of a positive outcome in the future. Correct?"

Me: Mmhm *nod*

And, before I could even finish acknowledging him,

Interviewer:"So, for example, when you leave your house to go buy groceries, you HOPE that you will make it safely to your destination. You are anticipating that you will arrive at your destination safely and finish your task. In this case, buying groceries. Or, for example, when you cross the road, you anticipate that you will reach the other side safely"

He then offered several more ******edly obvious examples which I don't fully recall. I can only remember the grocery and street-crossing.

Essentially, he continued to lecture me about hope and made it very clear verbally and non-verbally what he was shooting for: he drew an imaginary line on the desk with his finger and pointed out the beginning of the line as the beginning of one's life and the end of the line as one's death. Then, he said that as one moves forward in life, linearly from the starting point, one HOPES for things in the FUTURE (that are further ahead on this line).

Now, coming back to this hypothetical dying man scenario, he said that the dying man is pretty much at the end of this line: he's about to die. So far, Dr. J pointed out that hope is "anticipation of a positive outcome in the future" and that this man is at the end of the line.

"Can you give this man hope?"

Me: "Based on what you've told me so far, I assume you are alluding to my beliefs on the after-life (or after-death, I guess)."

I don't know for sure what happens after we die but I'm reasonably convinced that nothing much happens: you cease to exist and, this, your brain and it's thoughts, feelings, and emotions cease to exist. Your sentience is no more. You are forever gone.

So, I explained to Dr. J that I don't believe in any of the current theories of after-life and that, from a scientific perspective, it is impossible (and I guess irrelevant) to know.

"Therefore, I cannot offer the man any hope for life after death because I am not sure about what happens after we die and I don't want to lie to my patient."

Interviewer: "If you aren't sure, you obviously cannot give the man hope because that would be false hope. I was at a convention once about caring for patients about to die. There were scientists, doctors, clergy people, and people from just about all related professions. I went there and asked them this same question and not a single of them could answer me and surprisingly, most of them did not want to talk about when pressed further. As a physician, you offer hope. You are in the business of giving hope. You give a pill to a patient, you give them hope that their sickness will go away. You are not a complete physician unless you can give that dying man hope. Now of all the people at this convention, not a single one could answer my simple question. Yet, I have a friend. He's not a very smart man. He pumps gas at a gas station for a living in a little town. If I brought him into the dying man's room, he would be able to offer the man some hope.

Now... Can you give this man hope? Just think about that and that's all the time we have for this interview. Do you have any questions for me?"


Me: "... how would you give the man hope?"

Interviewer: *pensive look* "Come see me when you're in medical school and I'll let you know"

At this point, he might as well have put on sunglasses, taken them off, and played CSI music...

So I shook hands, still jolted, "Thank you Dr. J, I'll be taking you up on your offer real soon" and GTFO.

Also, the lecture was generously laden with rhetorical questions:
Interviewer: "... and do you know what they said?"
Me: "... what?"
Interviewer: "BLABLABLA"

I feel like I missed some details but the crazy part of the interview/lecture lasted for a good 25-30 minutes.

tl;dr Dr. J wanted to know if I can give a dying man hope. Hope about the after-life, that is (he didn't explicitly state this but he was implying is pretty damn hard). He lectured me about what hope is, how his simple friend who pumps gas for a living can give hope about after-life but so many doctors, scientists, etc. cannot. When I asked him about whether he could give hope in the same scenario he told me to come see him after I get into med-school.


I still don't know what to think of this interview or how I "should have" answered it (best possibly answer?)

What do you make of it?
 
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Mithril

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You comfort the man. You make his last moments as peaceful as possible. If he has children or family, you tell the dying man that he has had a profound impact on them; that although he may be gone, he will not be forgotten by them and will carry on his legacy. You then talk to the patient about how death is just another part of life that everyone must go through one day or another and how even though no one knows for sure if there is anything after death, there is nothing for him to fear because the people who care about him are around him, etc.

At least that's how I'd handle the question. It doesn't need to have any religious connotation to it (I'm an atheist); it just needs to be sensible.
 

theli

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Since death in this scenario is inevitable, and your interviewer defines hope as anticipation of a positive outcome in the future, the logical conclusion is that he is asking can you make this man feel like death is a positive outcome in his future.

So if you say yes, then you can explain your answer with death would be the end of his pain and suffering and attempt to comfort him then he dies with some hope that death is better than his current state.

If you say no, then you can explain your answer with death is worse than any living scenario then your patient dies with no hope.

Either way hope is really just a positive state of mind that I would have no problem giving a dying patient even if I have to lie.
 
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paul411

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WTF? Were you in the bible-belt?
Living in Texas, I'm used to the barrage of bible-belt bull**** but I didn't expect it to show up in a medical school interview and especially not in this context.
 
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I think it was an interesting interview. He wanted to see how you would act in a difficult situation.

It made me think of what I would say. I had the answer in less than 5 seconds. I would say: "you've gotten the best treatment and we've done the best we can. Now it is all up to you, think positively!" :D
 
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NickNaylor

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I think it was an interesting interview. He wanted to see how you would act in a difficult situation.

It made me think of what I would say. I had the answer in less than 5 seconds. I would say: "you've gotten the best treatment and we've done the best we can. Now it is all up to you, think positively!" :D
I agree. Depending on how you said it, your comment asking if he was alluding to your beliefs on the afterlife may have come across as defensive, and they may have caused him to be a bit more aggressive with you. I think it's a fair question. His responses really aren't even crazy.
 

WorldChanger36

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I think you could have reshaped the question to put it into the field you are stronger in. He asked if you could give this man hope and of course you can. Hope for his life no but hope for humanity yes. Hope that one day dying will no longer be as it is now. Hope that one day humans will do the right things in life, will learn from the mistakes of the past and build a better world. Hope that medicine will find cures, treatments and answers for the problems of life and death. Have hope that given time that through science there is not a single thing we can't find out or make better.
The man's life is over but humanity is just beginning and the man can take comfort in knowing he is part of that. We all are moving humanity forward and with proper training at "X" school of medicine, I will be part of the hope that the forward movement of humanity will be positive, ethical and empathic towards the needs of others. ( bit cheesy but you get the point)

Any situation can be turned to a question that you can answer in a way that reflects your qualities.
 
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After a few minutes of pleasantries, my interviewer (an elderly PhD) got to the first (and only) real question of the interview:

"You are a doctor. You go into the room of a very ill patient. He is alone, and you know he will be dead by the time you leave the room. He looks up and asks you, 'Is there any hope, doc?' What do you tell him?"

I think for a bit and respond that I would never lie to a patient, that I would sincerely explain to him that, given his condition, there was very little hope of recovery.

The interviewer launched into a 10 minute lecture about how hope is the most important thing in the world, how it motivates everything we do, how people look to their doctors for hope and how it is a doctor's job to give them that hope. Then he asked me the exact same question again.

I decided to stick to my guns (sort of) and gave a somewhat wishy-washy version of my first answer. He didn't like that and went into a tirade about how nobody ever wanted to confront this problem. Then he asked me the question AGAIN.

I gave him this look like "what the hell do you want from me?" I don't even know what I actually said. He ended the interview after that and showed me the door, didn't give me the opportunity to ask questions or anything. To this day I don't know what he was fishing for.
http://forums.studentdoctor.net/showthread.php?t=359690&page=27

You will find that a few people encountered this same question (and thus, likely the same interviewer) in the "worst interview answers!!!" thread. So you are definitely not alone in finding this question quite difficult.
 

LizzyM

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This is the first I've ever heard of such a question but in a geographic area where there is a large proportion of people who believe in the literal interpretation of the Bible or other religious teachings about life after death such as reincarnation, it might be asked to determine if you could be culturally sensitive to a patient who holds such beliefs.
 

Catalystik

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IMO, the answer to the question has nothing to do with your personal beliefs or science, rather I'd look at it as a vehicle for you to convey your humanistic qualities. Wht would you have said or done if this person were your grandfather rather than a stranger?

I like LizzyM's take on the question, too. Cultural sensitivity is another important quality to convey to an interviewer.
 

phltz

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IMO, the answer to the question has nothing to do with your personal beliefs or science, rather I'd look at it as a vehicle for you to convey your humanistic qualities. Wht would you have said or done if this person were your grandfather rather than a stranger?

I like LizzyM's take on the question, too. Cultural sensitivity is another important quality to convey to an interviewer.
I disagree. If you read in the Worst Interviews thread, you'll see that a lot of people have had unpleasant experiences with this guy. He's not looking to see if people are culturally sensitive to dying Christians, he's using his position of authority and power as an interviewer to try to pressure interviewees into agreeing with his personal religious beliefs. These are totally different things. UTMB Galveston ought be be embarrassed that he's using his position as an interviewer to religiously proselytize. The fact that they continue to allow him to do it speaks very poorly of the medical school.
 

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Very interesting interview at UTMB Galveston about "hope" and after-life. More of a lecture, really.

Note: It's LONG so tl;dr at end

Starts out with10 minutes or so of "tell me about yourself". Then,

Weird part
Obviously, this is from memory so it's not exact but, if anything, I am doing injustice to the interviewer's (Dr. J) storytelling ability...

Interviewer:"I'm going to ask you a question. For this question, I'm going to make some assumptions. I'm going to assume that you have completed your medical education, residency, etc. You are a certified doctor. You work at a hospital.

You're in a hospital room alone with a dying man laying on his bed. Everything possible has been done to save this man's life but in vain. He WILL die before you leave that room and there is nothing you can do to change that.

Now, you are standing by his side. You have already done all the standard procedures and practices for telling someone that they are about to die. You said all the things you are supposed to say that you learned from education and experience.

As you are about to leave the room, the man reaches out, grabs your white coat and whispers with the little voice and energy he has left, "Doctor, can you give me any hope?"

Now... Can YOU give this man hope?"

Me: :eek: "uh, well... how exactly do you mean?" (hoping to get some hint of what he's expecting...)

Interviewer: "Well... what is hope? Hope is the anticipation of a positive outcome in the future. Correct?"

Me: Mmhm *nod*

And, before I could even finish acknowledging him,

Interviewer:"So, for example, when you leave your house to go buy groceries, you HOPE that you will make it safely to your destination. You are anticipating that you will arrive at your destination safely and finish your task. In this case, buying groceries. Or, for example, when you cross the road, you anticipate that you will reach the other side safely"

He then offered several more ******edly obvious examples which I don't fully recall. I can only remember the grocery and street-crossing.

Essentially, he continued to lecture me about hope and made it very clear verbally and non-verbally what he was shooting for: he drew an imaginary line on the desk with his finger and pointed out the beginning of the line as the beginning of one's life and the end of the line as one's death. Then, he said that as one moves forward in life, linearly from the starting point, one HOPES for things in the FUTURE (that are further ahead on this line).

Now, coming back to this hypothetical dying man scenario, he said that the dying man is pretty much at the end of this line: he's about to die. So far, Dr. J pointed out that hope is "anticipation of a positive outcome in the future" and that this man is at the end of the line.

"Can you give this man hope?"

Me: "Based on what you've told me so far, I assume you are alluding to my beliefs on the after-life (or after-death, I guess)."

I don't know for sure what happens after we die but I'm reasonably convinced that nothing much happens: you cease to exist and, this, your brain and it's thoughts, feelings, and emotions cease to exist. Your sentience is no more. You are forever gone.

So, I explained to Dr. J that I don't believe in any of the current theories of after-life and that, from a scientific perspective, it is impossible (and I guess irrelevant) to know.

"Therefore, I cannot offer the man any hope for life after death because I am not sure about what happens after we die and I don't want to lie to my patient."

Interviewer: "If you aren't sure, you obviously cannot give the man hope because that would be false hope. I was at a convention once about caring for patients about to die. There were scientists, doctors, clergy people, and people from just about all related professions. I went there and asked them this same question and not a single of them could answer me and surprisingly, most of them did not want to talk about when pressed further. As a physician, you offer hope. You are in the business of giving hope. You give a pill to a patient, you give them hope that their sickness will go away. You are not a complete physician unless you can give that dying man hope. Now of all the people at this convention, not a single one could answer my simple question. Yet, I have a friend. He's not a very smart man. He pumps gas at a gas station for a living in a little town. If I brought him into the dying man's room, he would be able to offer the man some hope.

Now... Can you give this man hope? Just think about that and that's all the time we have for this interview. Do you have any questions for me?"

Me: "... how would you give the man hope?"

Interviewer: *pensive look* "Come see me when you're in medical school and I'll let you know"

At this point, he might as well have put on sunglasses, taken them off, and played CSI music...

So I shook hands, still jolted, "Thank you Dr. J, I'll be taking you up on your offer real soon" and GTFO.

Also, the lecture was generously laden with rhetorical questions:
Interviewer: "... and do you know what they said?"
Me: "... what?"
Interviewer: "BLABLABLA"

I feel like I missed some details but the crazy part of the interview/lecture lasted for a good 25-30 minutes.

tl;dr Dr. J wanted to know if I can give a dying man hope. Hope about the after-life, that is (he didn't explicitly state this but he was implying is pretty damn hard). He lectured me about what hope is, how his simple friend who pumps gas for a living can give hope about after-life but so many doctors, scientists, etc. cannot. When I asked him about whether he could give hope in the same scenario he told me to come see him after I get into med-school.


I still don't know what to think of this interview or how I "should have" answered it (best possibly answer?)

What do you make of it?
I say its pretty obvious. The interviewer was a religious man. Most docs are not because the strong belief in science contradicts just about everything religion teaches. He wanted some christian answer that makes people feel good and positive that some outer force will intervene and make the mans booboo's go away. You gave the right answer. My friend beat the odds of dying (of course not as severe as your story) and his family prayed and prayed. After MANY serious surgerys hes here now and everyone believed it was the hope and prayers...people like these feel good stories:love: which is what your interviewer was kinda fishing for.*Personal sidenote* funny how if my friend's surgery had complications and went wrong the surgeons would have got sued to hell but when their skills go perfectly the props go to an invisible force guiding their hands.:confused:
 

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The correct answer, in my opinion, would be to NOT give the patient hope. False hope is the cruelest thing that you can do to a patient as a doctor. What you can give is certainty, and with certainty comfort.
 

LizzyM

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The correct answer, in my opinion, would be to NOT give the patient hope. False hope is the cruelest thing that you can do to a patient as a doctor. What you can give is certainty, and with certainty comfort.
I think that if the patient is a believer (and that is something that is generally asked on admission and recorded in the medical record), you can say, "[patient name], we've done what we can do. Now it is time to let go and let [deity name] take over."

If you can't comfort the dying in this way, it is going to be hard to practice most effectively in some places.
 

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paul411

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I guess we should make a club. You're officially initiated!! At least 3 SDNers, including you, have been interviewed by this guy. You're not alone :)
Oh thank God (or whatever my interviewer believes in) that I wasn't the only one he did this to!

I wonder how many people he interviews get it...
 

circulus vitios

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What a ******ed situation. I would have stared at him in disbelief for a solid 15 seconds, shook my head, called him a ******, then walked out of the room.
 
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paul411

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To those that suggested possible responses that rest on logic and humanism, he explicitly stated that all such niceties were already delivered, and false hope is precluded.

He drew a line, showed me death as the end of the line, and told me hope at that point HAS to do something with what follows linearly after-death... I don't understand how some of you can see this as not-alluding-to-after-life... am I missing something?

Anyways, I just emailed Dr. J hoping to clear things up for myself. This still kind of bothers me every time I think about it.
 
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If you can't comfort the dying in this way, it is going to be hard to practice most effectively in some places.
It isn't easy for some people to live in some of those places either. It's probably better to avoid school or training in locations where there are strong cultural or belief differences between oneself and the local patient population that could lead to discomfort on either side.
 

phltz

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To those that suggested possible responses that rest on logic and humanism, he explicitly stated that all such niceties were already delivered, and false hope is precluded.

He drew a line, showed me death as the end of the line, and told me hope at that point HAS to do something with what follows linearly after-death... I don't understand how some of you can see this as not-alluding-to-after-life... am I missing something?

Anyways, I just emailed Dr. J hoping to clear things up for myself. This still kind of bothers me every time I think about it.
This should bother you. Doctors hold a position of incredible authority and trust. People are dependent on doctors at many of the most vulnerable parts of their lives - during birth, loss, injury, sickness, and death. Doctors often have an intimate knowledge of details their patients' personal lives that no one else does - not priests, spouses, parents, children, or friends. For a doctor to use this trust, authority, and intimacy to religiously proselytize to a man at his most vulnerable, scared, dying moment is such an immense abuse of power, words fail me. In the described scenario, no mention was made as to the religious beliefs of the dying man. With no knowledge of the patient's religious beliefs, it is inappropriate to start talking to him about an afterlife. This interviewer was encouraging you to commit an egregious and inexcusable breach of ethics.

This man consistently and habitually encourages interviewees at his school to abuse their trusted positions as doctors. This is bad enough on its own, and should give you serious doubts about whether or not you want to attend this institution. What's more, he consistently and habitually uses his position as an interviewer, one that comes with considerable power, to religiously proselytize to and pressure the vulnerable interviewees that are in a position where they need to win his favor. This is also completely unprofessional, unethical, and inexcusable.

The ethical breach he is encouraging people to make is at least abstract and hypothetical. Every time he does this, though, he is committing a very real abuse of power. This man should never have had a chance to do this twice - the very first time this came to the attention of the admissions staff, he should have been yanked from having anything to do with interviews. Thankfully, as a PhD, he probably doesn't actually get a chance to abuse patients in the hospital. He should have been bounced back to the lab and kept away from dealing with any actual, living humans.

You may not want to rock the boat here, and so it'd be quite reasonable for you to just want to quietly go about your business. However, if I were in your position, I would write to the director of admissions. I would tell her than I had a very troubling experience at my interview, that I have grave doubts about whether the school is right for me, and that I would appreciate her helping me to clear it up. I would then describe the situation, and explain why I found it to be inappropriate.

This whole situation is really ****ed up, and it's clearly just going to keep happening unless someone does something about it.
 

LizzyM

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You may not want to rock the boat here, and so it'd be quite reasonable for you to just want to quietly go about your business. However, if I were in your position, I would write to the director of admissions. I would tell her than I had a very troubling experience at my interview, that I have grave doubts about whether the school is right for me, and that I would appreciate her helping me to clear it up. I would then describe the situation, and explain why I found it to be inappropriate.

This whole situation is really ****ed up, and it's clearly just going to keep happening unless someone does something about it.
I agree. The dean of admissions at that school should hear about this from someone who has interviewed with this gentleman. Ideally, it would be someone who has been admitted elsewhere and for whom the admission decision at that school is a moot point.
 

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Well, assuming they haven't already been discussed; it could/would be an appropriate time to discuss palliative care and familial support options. Ensuring the patient that they you will do your best to make them as comfortable as possible in the days to come, and ensuring that the family will be in good hands w/r/t grief counseling, etc. Knowing that you would suffer a minimum and your family be cared for in your absence as necessary would certainly offer hope.

Of course, that's not what the interviewer was getting it at with his terrible approach to the question.
 
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Are we really sure that he was fishing for an after-life type answer?

Because there are different ways of answering this question for patients with different beliefs about being dead:

A) Christian belief : the afterlife answer gives hope
B) Atheist patient: even though life does not go on, there is "hope" because life is passed on through his DNA (to his kids and grandkids). His earthly works (depending on what his profession was) also carry on his spirit.

It seems like a reasonable thing to do is to find out what the person's beliefs are and then "give hope" through either of these ways.

EDIT: option "B" is not really a "nicety", but a legitimate way of looking at the world for someone who is not religious. So, I think that he might have accepted this answer if it was well explained and defended. No?
EDIT2: I agree completely that false hope is a very bad thing. being deceived into carrying on a pointless hope? that's just cruel
 
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Some of this is directed at OP and some at a few of the other posters.
**
Read through your entire conversation with the interviewer again. Your interviewer never once mentioned religion. He never talked about deities or life after death. He never asked you what your beliefs were. I absolutely agree that he was probably trying to figure out your convictions, but in what way was he proselytizing? He never berated you nor diminished you for not believing in a higher power, but merely responded to the fact that (as you yourself put it) could not reasonably offer the man hope. ok. Couple questions for you:

1) Why should it bother you what this man believes?
2) Is this your response to every person that approaches you with a faith based issue? It's pretty hard to go anyplace in the world where faith's not going to be affecting how many people go about their lives. I didn't know tolerance was limited only to those of faith and that you yourself had no right to defend your own viewpoints more if you were so offended. I do applaud your efforts for not making it into an argument at that time since that seems to be a big part of the response he was looking for.

People express opinions. I would bet my coat you say strong things that others disagree with and would argue with you over. Your interviewer definitely trumps with magnitude of time and place, but come on. These are some attitudes we should be expecting from people who will soon "have an intimate knowledge of details their patients' personal lives that no one else does - not priests, spouses, parents, children, or friends."

Lastly, if you weren't being judged on your beliefs, then why the fuss. If your interviewer goes to committee and says "don't accept. he's a nonbeliever" or even regards your application differently because of your response then by all means raise hell. Until then, really? LizzyM, the fact that schools are even trying to mask/avoid issues like these at interviews is a little sad since you'll inevitably experience this and every other social, political, or ethical argument you want over the next few decades of your life. I think at this point in the game you should be able to stand on your own without being incessantly coddled and sheltered from harder issues.
 

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This is awesome. That is the kinda med school prof I hope to have one day. He sounds like a real character.
 

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What I have learned thus far in life is that with every situation the variable of chance is always present. I want to re-iterate this because i proclaim that chance is involved in any and every situation. There are two fates of chance, a favorable and an unfavorable outcome. Sometimes one of the two outcomes are more likely to happen. But what is it that keeps us holding on to the idea that the other outcome may occur?

Hope

The man may live, if just for a few more extra moments. It is possible to bestow hope that is not false. In fact, there is never such a thing as "false hope" if you think about it. "Unrealistic" hope maybe, but never false. Theres always a chance.

Don't give up. Keep fighting.
 

phltz

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Medical Student
1) Why should it bother you what this man believes?
2) Is this your response to every person that approaches you with a faith based issue? It's pretty hard to go anyplace in the world where faith's not going to be affecting how many people go about their lives. I didn't know tolerance was limited only to those of faith and that you yourself had no right to defend your own viewpoints more if you were so offended. I do applaud your efforts for not making it into an argument at that time since that seems to be a big part of the response he was looking for.
I have no problems with the man's belief. I have a problem with him using his position of authority and power to try to pressure people into expressing agreement with his belief. If you read about some other people's experiences with him, you'll see that's what he's doing.
 

Dianyla

in denial
10+ Year Member
May 26, 2006
1,404
11
41
Portland, OR
Status
Pre-Medical
Interviewer:As you are about to leave the room, the man reaches out, grabs your white coat and whispers with the little voice and energy he has left, "Doctor, can you give me any hope?"

Now... Can YOU give this man hope?"
I really don't see what's so hard about this question. It's a ridiculous question, that deserves a ridiculous answer.

So just tell the dying patient that heaven is like Hooters with topless chicks serving him bottomless hot wings. :smuggrin:
 

IlDestriero

Ether Man
10+ Year Member
Nov 24, 2007
7,579
7,094
The ivory tower.
Status
Attending Physician
Or, maybe, he was just trying to push your buttons and see what you did under some pressure with questions on a controversial topic that you wouldn't likely have a canned answer for. It seems he was successful. Perhaps if you had mentioned religion, afterlife, etc he would have confronted you with the false hope argument. And, no one mentioned taking the time to find out what the dying man himself believed, which would seem, to me, to be critical to your answer.
Or you could go whine to the Dean about the religious nutcase faculty member that never actually said anything about religion?:confused: But that's what he meant by the invisible line on his desk...
 

Remuneration

10+ Year Member
5+ Year Member
Oct 8, 2008
129
0
Status
Pre-Health (Field Undecided)
Give the patient "On the Geneaology of Morals."

Nurse, two ccs of Nietzche, stat!