Do you agree with this sample MMI question and answer?

[Padfoot]

I found this sample online on BeMo Academic Consulting's website at http://bemoacademicconsulting.com/blog/files/sample-mmi-question-answer.html -

Prompt: "You are the only ER doctor on duty and are responsible for all decision making during this shift. This night you have two patients rushed into the ER who desperately require a kidney transplant. One patient is an 80 year old university professor who is suffering from acute kidney failure related to his age; the other patient is a 20 year old university student who has been brought in for yet another episode of kidney problems related to excessive drinking of alcohol at a school party. There is only one kidney available that matches both patients. Who do you give the kidney to?"

Sample Answer: "Well in this situation as the ER physician, I understand that I have to make a very difficult decision. Of course, I am sympathetic and appreciate that both individuals are suffering immensely with pain as a result of their conditions. However, my decision-making will solely be guided by my expertise, clinical experience, and the scientific literature, and not by the personal backgrounds of the patients. Furthermore, the decision as to who receives the kidney will ultimately be based on which of the two gentlemen will benefit most from this transplant, and will have a better chance of receiving the kidney and surviving the post surgical complications. Immediately, if possible, I would place both of the gentlemen on dialysis in order to buy some time so that I can assess the situation further and gather more information.

Since in this case there’s only one kidney available that matches both patients, then the decision is tougher and will require further investigation. I can at this point review both patients records, take a detailed history, send for appropriate tests, perhaps consult with other colleagues and specialists in the field, and more importantly examine the current literature on the effects and outcomes of kidney transplants on 80 year old males with acute renal failure vs. those in a 20 year old, for example. Once I have gathered all of the evidence, and objectively analyzed all of the risks and benefits associated with the transplant for both patients, I would then provide the kidney to the individual who, from a scientific and clinical point of view will have a better chance of receiving the kidney and surviving the post surgical complications. If that is the young student then he will be the candidate. If it turns out that the older gentleman will have better outcomes, then the kidney will be given to him. Whoever does not receive the kidney, will continue to be monitored by us and maintained in a stable condition until the next available kidney for transplantation."

So, the above would be considered a strong and appropriate response. As you can see, the answer was nicely organized, coherent, concise, and more importantly, was delivered in a systematic manner. As discussed in our earlier strategy, in answering this question, we remained objective and non-judgmental, and did not allow the personal attributes of the patients interfere with our decision-making.

I found it strange that they didn't consider the student's drinking issue, doesn't that make the likelihood of a positive outcome lower?

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[ChillDawg]

Am I the only one who found that answer to be verbose and annoying?

I think it would be fair to consider whether or not the student's drinking problem would affect their outcome, and it seems like a total cop-out to not mention it in the answer in the name of being nonjudgmental. Of course, withholding judgement is important, but when a behavior pattern has an effect on outcomes, it should be considered, in my opinion.
If you alluded to that point during an MMI, I highly doubt it would be considered wrong as long as you don't come off as preachy.

MMI answers usually always have more than one acceptable answer.

 

[philosonista]

Indeed, I find it strange too. I'm also amazed this response takes a purely utilitarian approach. Rarely do I see utilitarian sentiment chosen so boldly.

From what I know, these answers are just supposed to show you can grapple with both sides fairly, whereas this answer seems to have a rather limited (and pompously written) view.

 

[Cotterpin]

They said they would "objectively analyze all of the risks and benefits associated with the transplant for both patients," so I would think that the student's heavy drinking would be included in that. I don't think the bit about the patients' "personal attributes" is about the drinking. I took that to mean medically irrelevant attributes. Like who you think is a better person or something.

 

[pstrick]

They completely avoid what the question is really asking.
They talk about getting patient history, dialysis, transplant list, and a bunch of other junk outside the scope of the question.

There's absolutely nothing in that response that shows the person answering the question is a human capable of feeling any sort of emotion.

If I were in an MMI, I would answer as though the question were, "Do you give the kidney to the dude who is going to die anyway, or to the drunk who is going to ruin the kidney? Defend your answer."

That's just me. I'm not even applying until the next cycle, so I have no idea how the interviewing actually works.

 

[el_duderino]

You wrote an essay but didn't answer the question. I'd probably stop you halfway through and say "yeah.... but which one gets it?"

And don't go into an MMI with a rehearsed answer like this. You'll look like a fool. Answer the question the way a human being would. The prompts are just to get you talking so the interviewer can get a sense of who you are and how your brain works.

 

[Cotterpin]

You wrote an essay but didn't answer the question. I'd probably stop you halfway through and say "yeah.... but which one gets it?"

And don't go into an MMI with a rehearsed answer like this. You'll look like a fool. Answer the question the way a human being would. The prompts are just to get you talking so the interviewer can get a sense of who you are and how your brain works.

OP didn't write that. It was a sample response.

 

[DrBowtie]

This is so stupid. The real answer is as the ER doc you admit both to medicine with nephrology consults and move onto the next patient.

 

[Bsch1951]

.

 

[710976]

That ad is so B***S***

 

[Dr. Death]

I hate MMI. Dumbest interview style ever.

 

[w0rldw3y3d]

I would ding you for talking too much and trying too hard to make an impression. In an ER you won't always have time for fluffy BS, and you'd need to make a decision fast. How about a simple answer like, "whichever patient came in first" and then justify it with a line or two.

 

[Cotterpin]

He clearly knows OP didn't write that. He's saying OP's response shouldn't be affected by the sample answer.

Does he know? Clearly? He said, "You wrote an essay . . ." and never once indicated that OP did not actually write it.

 

[midwestisbest]

I would ding you for talking too much and trying too hard to make an impression. In an ER you won't always have time for fluffy BS, and you'd need to make a decision fast. How about a simple answer like, "whichever patient came in first" and then justify it with a line or two.

In the ER, says the example, I would "...more importantly examine the current literature on the effects and outcomes of kidney transplants on 80 year old males with acute renal failure vs. those in a 20 year old, for example."

I'm just imagining 2 residents staring over the attending's shoulder as s/he furiously reads uptodate

 

[Lost in Translation]

And just when I thought it was impossible to be more pretentious than @MediPhil. OP, don't you dare use an answer like that. I remember listening to an ENT dept head saying he rejected a HMS candidate because the HMS student had an actual, rehearsed answer for one of these "WWYD?" questions. It makes you come off as a prick.

 

[Commile]

ya this is a pretty dumb one

 

[Dr Tony T. Chopper]

Nice filibuster there, Rand Paul.

 

[BidingMyTime]

Alcoholism can be treated, old age not so much. The 80 year male is already past his statistical life expectancy....the 20 year had decades to go. Assuming all else is equal between the 2 regarding the kidney match and health, why should an 80 year old ever be considered for a transplant over a 20 year old?

 

[Dr Tony T. Chopper]

Because the 20 y/o is a risk to him/herself and an extremely irresponsible candidate for the transplant. There is little insurance that the kid wont ruin the kidney with his historically destructive lifestyle. The old man, on the other hand has been, I assume, responsible for his health and would projectedly make better use of the transplant. I'd say the old man is categorically more deserving.

Alcoholism can be treated, old age not so much. The 80 year male is already past his statistical life expectancy....the 20 year had decades to go. Assuming all else is equal between the 2 regarding the kidney match and health, why should an 80 year old ever be considered for a transplant over a 20 year old?

 

[txplcoord]

I coordinate organ transplants for a living. The problem with this question is first and foremost that this situation would NEVER happen. But ignoring that, the main thing to consider, realistically, is what is the donor's medical history. Is the donor young? old? did they do a kidney biopsy and what was the result? did the donor have hypertension or elevated creatinine? my answer is I would give the kidney to whichever recipient is a better match for the donor, and that means more than just the HLA/cross matching. I'm not going to give a 65 year old kidney with a borderline biopsy to a 20 year old. But I also realize that's not really the point of the question which is what makes this question suck so much.

 

[ImmunoLove]

Real answer: neither. We have a list. And yeah, substance abuse is most certainly a critical criteria, as the primary cause of allograft dysfunction/failure is due to patient noncompliance (eg not taking rejection meds), and noncompliance skyrockets in individuals with active drug problems.
Also the prof would end up with an extended criteria kidney typically (assuming that in neither case a directed donation is available). At least this is what would happen in California, where we don't have enough kidneys to go around...

 

[ImmunoLove]

Indeed, I find it strange too. I'm also amazed this response takes a purely utilitarian approach. Rarely do I see utilitarian sentiment chosen so boldly.

From what I know, these answers are just supposed to show you can grapple with both sides fairly, whereas this answer seems to have a rather limited (and pompously written) view.

It's a lousy utilitarian approach, imo.

 

[bc65]

Here's what happens in a real MMI scenario:

Applicant should identify the issue: deserving 80 yo vs irresponsible 20 yo. Discuss the dilemma briefly. Say that in reality you would stabilize and refer to nephrology and later to the transplant and/or ethics committee, where they know how to make such decisions.

You will of course be told that you are the committee, so you have to decide.

You discuss the factors you consider important, as above.

THEN: The real questions start.

Let us assume that after doing all the math and probabilities, considering the likelihood that the kidney will work, life expectancy, chance of alcohol abuse, etc, it turns out that the projected years of survival of the kidney is exactly the same for each recipient. Now which will you pick?

OK, what if both were deserving people?

What if the 20 yo had a 3 yo child, and he was a good father? Shouldn't that child's benefit be taken into account? A year or two with a father would make a big difference.

What if I told you that the 20 yo had a 42 mcat and a 4.0 gpa and had a full ride to HYS med school. Would that matter? Why should it? Why shouldn't it?

What about the 80 year old's grandchildren? Aren't a few years with him very valuable? If so, why should he get a kidney but not an 80 yo without grandchildren? What if the 80 yo was a good person now, but when he was 20 he also had a hx of severe alcoholism? Did you know about that hx? Did you try to find out? If he recovered, why can't the 20 yo? Doesn't the 20 yo deserve a chance?

What if the 80 had a criminal hx for shoplifting when he was 30? Should that count against him? It was a long time ago, so why should it? If not, then why hold the 20 yo's hx against him? What if the charge against the 80 yo was more serious? etc.

Any decent MMI interviewer would be able to tie you in knots regardless of the answer you give. The point is, the initial question is just an opening to a potentially more complex discussion, or at least, it should be. Some interviewers might just ask the scenario question and leave it at that. Most will probably take it further into a more complex discussion, for which you really can't prepare. Just be yourself and discuss. Answer each scenario as best you can, and enjoy the encounter just as you would a tennis or ping-pong match. Sure, you can anticipate how you will serve the ball, but your opponent will hit it back to wherever they want to send it. You have to be prepared for that and always try to enjoy the experience.

The MMI is really no different from a regular interview, except that the initial question is standardized so as to make comparison and grading a bit more reliable.

 

[Krupke]

Here's what happens in a real MMI scenario:

Applicant should identify the issue: deserving 80 yo vs irresponsible 20 yo. Discuss the dilemma briefly. Say that in reality you would stabilize and refer to nephrology and later to the transplant and/or ethics committee, where they know how to make such decisions.

You will of course be told that you are the committee, so you have to decide.

You discuss the factors you consider important, as above.

THEN: The real questions start.

Let us assume that after doing all the math and probabilities, considering the likelihood that the kidney will work, life expectancy, chance of alcohol abuse, etc, it turns out that the projected years of survival of the kidney is exactly the same for each recipient. Now which will you pick?

OK, what if both were deserving people?

What if the 20 yo had a 3 yo child, and he was a good father? Shouldn't that child's benefit be taken into account? A year or two with a father would make a big difference.

What if I told you that the 20 yo had a 42 mcat and a 4.0 gpa and had a full ride to HYS med school. Would that matter? Why should it? Why shouldn't it?

What about the 80 year old's grandchildren? Aren't a few years with him very valuable? If so, why should he get a kidney but not an 80 yo without grandchildren? What if the 80 yo was a good person now, but when he was 20 he also had a hx of severe alcoholism? Did you know about that hx? Did you try to find out? If he recovered, why can't the 20 yo? Doesn't the 20 yo deserve a chance?

What if the 80 had a criminal hx for shoplifting when he was 30? Should that count against him? It was a long time ago, so why should it? If not, then why hold the 20 yo's hx against him? What if the charge against the 80 yo was more serious? etc.

Any decent MMI interviewer would be able to tie you in knots regardless of the answer you give. The point is, the initial question is just an opening to a potentially more complex discussion, or at least, it should be. Some interviewers might just ask the scenario question and leave it at that. Most will probably take it further into a more complex discussion, for which you really can't prepare. Just be yourself and discuss. Answer each scenario as best you can, and enjoy the encounter just as you would a tennis or ping-pong match. Sure, you can anticipate how you will serve the ball, but your opponent will hit it back to wherever they want to send it. You have to be prepared for that and always try to enjoy the experience.

The MMI is really no different from a regular interview, except that the initial question is standardized so as to make comparison and grading a bit more reliable.

I had 3 MMIs and have been accepted to schools using MMIs, and honestly no one tried to trip students up like that or be argumentative.

OP , the important thing is that if you don't want the organ to go to the 20 yr old you make sure that you explain that it is out of fear that the patient wont comply and not that you are judging the patient as less valuable. This question is only testing you on whether or not you can be objective and non-judgmental towards patients. This scenario tests the same qualities as "is it okay to add more drug-focused questions when talking to a tatooed patient or more sex questions when talking to a gay patient?"

Each MMI scenario is meant to test whether or not you possess a specific quality. The specifics of your answer do not matter as long as you are clear, reasonable, and show you possess the quality that station is testing for

Tl;dr: you don't need to agree with the example abswer as long as your answer comes off as non-judgmental

 

[bc65]

YMMV. Asking follow up questions is neither argumentative nor designed to trip you up. It's a conversation. 8 or 10 minutes is a long time. Your answer will probably take no more than a minute or two. If there are no follow up questions, there will be a long period of silence.

I wouldn't agree that each scenario is testing a specific quality. Certainly, there are scenarios that test teamwork ( where applicants work in pairs ) and those with actors might have specific goals, but the regular questions are likely chosen at random from a big pool. Perhaps these are categorized by type, but if so I would be surprised. This certainly might vary from school to school.

 

[SPQR MD]

I found this sample online -

Prompt: "You are the only ER doctor on duty and are responsible for all decision making during this shift. This night you have two patients rushed into the ER who desperately require a kidney transplant. One patient is an 80 year old university professor who is suffering from acute kidney failure related to his age; the other patient is a 20 year old university student who has been brought in for yet another episode of kidney problems related to excessive drinking of alcohol at a school party. There is only one kidney available that matches both patients. Who do you give the kidney to?"

Is this a trick question? As an ER physician you don't give out kidneys to people. You have specialists who are more qualified in kidney transplantation make the decisions.

 

[Krupke]

YMMV. Asking follow up questions is neither argumentative nor designed to trip you up. It's a conversation. 8 or 10 minutes is a long time. Your answer will probably take no more than a minute or two. If there are no follow up questions, there will be a long period of silence.

I wouldn't agree that each scenario is testing a specific quality. Certainly, there are scenarios that test teamwork ( where applicants work in pairs ) and those with actors might have specific goals, but the regular questions are likely chosen at random from a big pool. Perhaps these are categorized by type, but if so I would be surprised. This certainly might vary from school to school.

It might vary school to school, but my last interviewer at my 1st MMI explicitly said to me that each station was meant to test one quality. I kept this in mind going into my other MMIs at other schools and I was able to see which quality was being tested in each scenario and gear my answer towards showing that quality. That method has worked consistantly well for me

 

[bc65]

Apparently it's true at some schools, but not at all. I would be hard-pressed to identify a particular quality being tested for many of the questions I have seen.

I can say this for sure, at least at some schools: You are not judged by the content of your answer alone, but also on your communication skills, affect, demeanor, etc, just as in a traditional interview. The only difference is that the initial question is standardized.

The scenarios that involve actors, or the ones where you work with a fellow applicant, are different. The same qualities are being evaluated, but in those cases empathy and teamwork, respectively, are being looked at preferentially.

 

[The Knife & Gun Club]

I get that it's meant to test thought process but that is perhaps the stupidest most unrealistic MMI question I've ever heard.

They could both be fine on dialysis for years, and under no circumstances should any doctor make the decision for allocating organs for transplants.

Plus doing surgery on someone with alcohol poisoning or an 80 year old in critical condition is pretty damned stupid

 

[midwestisbest]

.

 

[heebeejeebies]

MMI questions shouldn't target competency in areas that are supposed to be developed DURING medical school. Beyond that the number of assumptions to be made is ridiculous, I don't like this question.

I'm my MMI experiences, questions don't care about the right answer, half my prompts explicitly told me what the answer SHOULD be, the discussion flowed from there...

 

[Goro]

You know what he meant. Maybe poorly worded, so replace ER doc with "transplant coordinator". The scenario is a standard question and a good one at that.

Is this a trick question? As an ER physician you don't give out kidneys to people. You have specialists who are more qualified in kidney transplantation make the decisions.

One of the reasons people like MMIs is that there's published data that it's a good format for spotting altruism/humanistic traits. You can't teach these in medical school


MMI questions shouldn't target competency in areas that are supposed to be developed DURING medical school. Beyond that the number of assumptions to be made is ridiculous, I don't like this question.

 

[SPQR MD]

You know what he meant. Maybe poorly worded, so replace ER doc with "transplant coordinator". The scenario is a standard question and a good one at that.

Actually, I didn't. I was wondering if the question was really about a 'test your knowledge of medicine' question in disguise. In any case, this highlights the importance of taking seriously the portion of the MMI where the interviewers asks if you understand the prompt.

 

[heebeejeebies]

One of the reasons people like MMIs is that there's published data that it's a good format for spotting altruism/humanistic traits. You can't teach these in medical school


MMI questions shouldn't target competency in areas that are supposed to be developed DURING medical school. Beyond that the number of assumptions to be made is ridiculous, I don't like this question.

Oh I definitely agree, being from the great white north I've had the merits of MMI lectured into me by the very people who developed it, and I agree with it being superior to the 1 on 1.

But a crux of the MMI (as far as I've been taught it) is the avoidance of forcing students to make clinical decisions in almost any capacity. This question would be better phrased as "You are a 4th year medical student (in this same situation), your attending believes the 80 year old deserves the kidney more, you disagree, how do you approach him/her to make your case?" And then a follow-up prompt to flip the script. Beyond that, my research is in the logistics of kidney transplantation, so I might be taking chagrin with the vast oversimplification of a very complex process.

 

[Goro]

We ask questions about clinical decision making all thaw time... the goal is not to assess your insider knowledge, but to see the moral choices you would make, and, even more importantly, that you can back that choice up from a moral basis. Some people just have better wisdom, insight and clarity than others. These types of questions can also sometimes help weed out people who are too rigid in their thinking.

Oh I definitely agree, being from the great white north I've had the merits of MMI lectured into me by the very people who developed it, and I agree with it being superior to the 1 on 1.

But a crux of the MMI (as far as I've been taught it) is the avoidance of forcing students to make clinical decisions in almost any capacity. This question would be better phrased as "You are a 4th year medical student (in this same situation), your attending believes the 80 year old deserves the kidney more, you disagree, how do you approach him/her to make your case?" And then a follow-up prompt to flip the script. Beyond that, my research is in the logistics of kidney transplantation, so I might be taking chagrin with the vast oversimplification of a very complex process.

 

[philosonista]

We ask questions about clinical decision making all thaw time... the goal is not to assess your insider knowledge, but to see the moral choices you would make, and, even more importantly, that you can back that choice up from a moral basis. Some people just have better wisdom, insight and clarity than others. These types of questions can also sometimes help weed out people who are too rigid in their thinking.

As a philosophy major I have to ask, would you be deterred if someone you were interviewing referred to ethical theories (ex. utilitarianism, kantianism, etc)? As long as it's not done pompously, is it okay to show you are well versed in ethics?

 

[ImmunoLove]

As a philosophy major I have to ask, would you be deterred if someone you were interviewing referred to ethical theories (ex. utilitarianism, kantianism, etc)? As long as it's not done pompously, is it okay to show you are well versed in ethics?

I referred to theories in my MMI, not to be an arse or show off, but merely to frame the dilemma in a different light. It was successful...

 

[Goro]

If they were trying to BS their way through an answer and didn't actually answer the question, I'd think very poorly about them. One doesn't have to go into the nature of the human soul to answer why you'd treat patient A vs Patient B.

As a philosophy major I have to ask, would you be deterred if someone you were interviewing referred to ethical theories (ex. utilitarianism, kantianism, etc)? As long as it's not done pompously, is it okay to show you are well versed in ethics?

 

[Doug Underhill]

The OP has provided an archetypical overprepared answer. The goal of the MMI is not to test your ability to study, it's supposed to be impromptu.

 

[Lost in Translation]

The toughest MMI station I've ever had was one where if I moved to a new country and I had children, would I let them assimilate or try to instill as much of my old heritage in them as I possibly could. The rater grilled me hard and I really struggled with that question.

 

[Hitmann]

Just say give it to the patient who came in first. An alcoholic's life isnt any less worth than an old man and vice versa.

 

[philosonista]

If they were trying to BS their way through an answer and didn't actually answer the question, I'd think very poorly about them. One doesn't have to go into the nature of the human soul to answer why you'd treat patient A vs Patient B.

I can definitely express my thoughts without waving around philosophy terminology -- and good God I would never go into the "human soul" (Not all of us are continental philosophers, you know...). So I'll take you're answer to mean if I can do the same thing without invoking formal philosophy, then it is preferable.

 

[DokterMom]

The student's drinking behavior CAN be improved.
The elderly professor's AGE problem can't.

As a philosophy major I have to ask, would you be deterred if someone you were interviewing referred to ethical theories (ex. utilitarianism, kantianism, etc)? As long as it's not done pompously, is it okay to show you are well versed in ethics?

If you referred to the theories by name "Kantianism", I'd find it near-impossible to avoid pompousness. If you phrased the theory into plain English "Using the logic that the best solution is one that saves the greater number of lives" it would be fine. But if you were hiding behind the theories without stating which rationale you personally feel is the more important, I'd just be annoyed. Juggling theories is one skill; making a hard decision is another.

 

[Lost in Translation]

The student's drinking behavior CAN be improved.

The more I volunteer at my hospital the more I lose faith in this belief. I've seen so many repeat detox patients... it sucks.

 

[Cotterpin]

Yeah, but 20 year-olds who binge drink in college are a dime a dozen and they don't all go on to become life-long alcoholics with wrecked kidneys. There's a decent chance he'll grow out of it . . . if he doesn't die in your ER first.

 

[bc65]

As a philosophy major I have to ask, would you be deterred if someone you were interviewing referred to ethical theories (ex. utilitarianism, kantianism, etc)? As long as it's not done pompously, is it okay to show you are well versed in ethics?

I have had several applicants talk about "autonomy", "utility", etc. It was extremely painful to listen to. I couldn't find it in my heart to ding them since the question asked for an ethical evaluation and I couldn't blame them for regurgitating what they learned in an ethics course, but I found it obnoxious and annoying and it didn't help them any. Personally, I would suggest telling the interviewer that you can offer either a lay analysis or a technical analysis, and let them decide.

 

[CaliforniaDreamer]

You know what he meant. Maybe poorly worded, so replace ER doc with "transplant coordinator". The scenario is a standard question and a good one at that.

I would agree with this, but I did read an MMI question about" a patient with brain cancer who read about a therapy where you listen to an ipod in an MRI. It is a very expensive therapy and it isn't covered by insurance." And it asked about how you would respond to their request for referral. One of the sample answers said that you must do no harm to the patient and that taking an iPod into an MRI would harm them as the magnet would cause the iPod to fly out and hit them. I thought that was so stupid and irrelevant to the intent of the question.

 

[Goro]

That's an OK answer. My take on the prompt is that it's asking about the financial considerations of medical decision making. Did you see it that as well?

I would agree with this, but I did read an MMI question about" a patient with brain cancer who read about a therapy where you listen to an ipod in an MRI. It is a very expensive therapy and it isn't covered by insurance." And it asked about how you would respond to their request for referral. One of the sample answers said that you must do no harm to the patient and that taking an iPod into an MRI would harm them as the magnet would cause the iPod to fly out and hit them. I thought that was so stupid and irrelevant to the intent of the question.

 

[Lawpy]

As a philosophy major I have to ask, would you be deterred if someone you were interviewing referred to ethical theories (ex. utilitarianism, kantianism, etc)? As long as it's not done pompously, is it okay to show you are well versed in ethics?

I can definitely express my thoughts without waving around philosophy terminology -- and good God I would never go into the "human soul" (Not all of us are continental philosophers, you know...). So I'll take you're answer to mean if I can do the same thing without invoking formal philosophy, then it is preferable.

I hear @efle and @Lucca may be interested to hear about your philosophy skills

 

[CaliforniaDreamer]

That's an OK answer. My take on the prompt is that it's asking about the financial considerations of medical decision making. Did you see it that as well?

I thought the financial aspect was an important point because it could cause financial harm to the patient and their family, the only other harm I saw was diversion of time/funds from more effective treatments. I also saw it as a question about unproven therapies and about patient autonomy. I guess I wasn't thinking specifically about the "iPod."