Do you agree with this sample MMI question and answer?

[Lost in Translation]

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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.

There was a patient that was "going for the shakes" and they were 24 years old. Granted, they likely weren't in a college or university, but still. It hit really hard... we had to turn them away because we had no detox beds. I can only hope they at least found a place to go that day.

 

[Lucca]

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

In regular conversation or non-philosophy paper arguments I try to borrow the logic and reasoning from philosophers and theories rather than naming them outright. Just saying one word is much more efficient than 50 but it turns people off and it could just lead to more confusion than it's worth. It's the same as explaining your scientific research to someone. Sure you could say "we did a mini prep to isolate the plasmid and transformed some XL-1 Blue cells which grew overnight in some 20% glyc Tb." Or you could just explain what that means, briefly. Theories and names are identical to jargon; they serve to obfuscate rather than clarify in most cases (especially if you yourself don't have a very strong grasp on a certain concept, which in philosophy is a very easy trap to fall into given how much disagreement abounds)

 

[banthapug]

I agree that this specific response is too much... however, I do agree with the general sentiment that it should be about patient's potential clinical outcome, not their social status, for the purpose of medical school interview. I was told the answer to these ethics questions should always be about the patient, not your own personal belief, finances, etc.

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?"

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?

 

[Favour517]

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?

because some alcoholics dont want to be helped.

 

[NotAProgDirector]

I can't get over how painfully bad the question is.

Both patients would be put on dialysis. Kidney transplant is never an emergency from the recipient end. Both would need to be fully evaluated prior to considering transplant to determine their suitability.

Alcohol abuse causes lots of problems, but renal failure isn't one of them (unless the patient develops hepatorenal syndrome, but then they need a liver transplant, not a kidney transplant) (or unless they start drinking ethlyene glycol instead) (or, if they do have kidney failure at 20, you've missed the real cause). It's very unlikely the 20 year old has permanent kidney failure, hydrating them might make them much better.

If the 20 yo is currently intoxicated and might go through withdrawal, that would be an absolute contraindication to transplant until resolved.

If you're working at an ED where there is only one doctor on, your hospital doesn't do transplants.

80 is over the age of any transplant center to consider for kidney transplant.

I'm all for some sort of ethical dilemma to discuss. They happen all the time in medicine. But can't we at least make it somewhat realistic?

 

[ZAC.RAZ]

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.

Exactly!

 

[VegasPreMed]

Frankly, the sample answer contains waaaaaay too much clinical knowledge for a premed in my opinion. And the question was never actually answered. As was stated before, these questions are a way to get at your logic skills. It doesn't matter which patient you pick.

But can you back it up with a reason?

 

[mistafab]

I think the sample answer totally blows.

Too much jargon and objectivity to the point of self-righteousness. If I was a med student rating this one I'd give it a mediocre score - answer tells me I don't want this person to be my classmate.

 

[Cytarabine]

I'm all for some sort of ethical dilemma to discuss. They happen all the time in medicine. But can't we at least make it somewhat realistic?

This is my big problem with the question. Good ethical problems abound. I took care of a young IVDUer with a repeat episode of tricuspid endocarditis s/p surgeries x2 and continued IVDU. Super high mortality without another operation. Ethics was consulted to determine possibility of pursuing conservative therapy instead of surgical, with the idea it would be a waste of resources to continue surgical intervention. Not sure how this situation wouldn't accomplish similar goals as the original question posed

 

[studentdoctorpremed]

That's a tough question! and yes their response is long but they mentioned that it was long for instructional purposes in the document they provide with the answer to the follow up question. I think it's possible to make this super concise but yet again what would you do with the rest of your 8 minutes in an mmi lol

 

[LizzyM]

What if one person on the transplant list is the childless President of the United States and the only person ahead of him on the transplant list is a younger man with kids?
😉

 

[minor.groove]

What if one person on the transplant list is the childless President of the United States and the only person ahead of him on the transplant list is a younger man with kids?
😉

You get the secratery of hhs to alter the reciepent list...

 

[LizzyM]

You get the secratery of hhs to alter the reciepent list...

Is that ethical? Should a doctor do that?? Let's not talk about that here so as not to spoil things for others

 

[PreMedicalStudent89]

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.

Dude it says on the thing this is for learning purposes hence why its longer and more detailed. And of course MMI questions have multiple different answers

 

[studentdoctorpremed]

Anyone found some more tough questions like this one anywhere for practicing?

 

[ChrisMack390]

Pro tip: If asked a rhetorical question, don't respond by completely under-minding it or by saying "that would never happen".

This is a tip for both interview scenarios and also for not being a really annoying person.

 

[JJRousseau]

What if one person on the transplant list is the childless President of the United States and the only person ahead of him on the transplant list is a younger man with kids?
😉

Is the vice-president of the United States fit to be president? Does a physician have the moral license to make such a call? If not, then who will, shouldn't the call be made if the vice-president would bring disaster?

I like your twist. I think I would enjoy an MMI with you at the helm.

 

[To be MD]

I can't get over how painfully bad the question is.

Both patients would be put on dialysis. Kidney transplant is never an emergency from the recipient end. Both would need to be fully evaluated prior to considering transplant to determine their suitability.

Alcohol abuse causes lots of problems, but renal failure isn't one of them (unless the patient develops hepatorenal syndrome, but then they need a liver transplant, not a kidney transplant) (or unless they start drinking ethlyene glycol instead) (or, if they do have kidney failure at 20, you've missed the real cause). It's very unlikely the 20 year old has permanent kidney failure, hydrating them might make them much better.

If the 20 yo is currently intoxicated and might go through withdrawal, that would be an absolute contraindication to transplant until resolved.

If you're working at an ED where there is only one doctor on, your hospital doesn't do transplants.

80 is over the age of any transplant center to consider for kidney transplant.

I'm all for some sort of ethical dilemma to discuss. They happen all the time in medicine. But can't we at least make it somewhat realistic?

Thank you for your insight!
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Let's pretend that this MMI is a reasonable/realistic scenario... in such a case: would a medical school candidate be torn apart by admissions for choosing the younger patient based on age alone?

If I had to choose, an 80 year old patient may be the nicest person, most noble person on earth, but he or she has still had 80 years to experience the world. The younger 20 year old, "drinking problems" aside, has the best chance to benefit long-term from the organ.
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If there are two people dying in front of me, one 5 years old and the other 120, I'm going to go for the 5 year old first. Call me crazy.

I don't believe this is ageist or morally questionable. I believe that all human life is of equal value; however, as a part of this, one life coming to a close is less valuable than one that is beginning.

This is reflected in your answer as far as healthcare policy is concerned: an 80 y.o. isn't even allowed to be on the transplant list!
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I'm sure things get more nuanced if the situation is: 1 person gets the vital organ / person 1 is 40 y.o., a(n otherwise) healthy father and schoolteacher, and person 2 is a 30 y.o. unemployed, single recently-released-from-prison pedophile / who gets the organ? In such a scenario, the age argument isn't so easy and things get more complicated.

 

[wizzed101]

^
Idk mane. If it were me who interviewed you, the moment you told me about one life more valuable than the other, to the wait list you go, regardless of your reasoning.

 

[To be MD]

^
Idk mane. If it were me who interviewed you, the moment you told me about one life more valuable than the other, to the wait list you go, regardless of your reasoning.

Really? Why?

I said all life, starting at birth, is of equal value. That being said, someone who has already been able to live their life is not as high a priority, to me, as someone who has not yet had that chance.

Again, take the answer to an even easier-to-decide scenario: 5 y.o. vs. 120 y.o. patient. You can only save one. Who do you save?

A 120 y.o. patient has had a full life. A 5 y.o. has not. Both, from birth, have equal value... yet the older patient has already had the chance to live that equally valuable life out. The young one has not. By and large, I'm going to save the young one first.

 

[ChrisMack390]

^
Idk mane. If it were me who interviewed you, the moment you told me about one life more valuable than the other, to the wait list you go, regardless of your reasoning.

Good thing you aren't an MMI interviewer, because that is not how it works. The person who refuses to answer the question is much more likely to be rejected than one who picks a side and backs it up with some form of reasoning.

 

[JJRousseau]

^
Idk mane. If it were me who interviewed you, the moment you told me about one life more valuable than the other, to the wait list you go, regardless of your reasoning.

And I would likely respond to your refusal to make a value judgement with: "Well, as a result of your inaction due to your principled belief that all lives are equally valuable, the kidney has gone to waste and both patients are dead. But it's a relief to know that you felt that both of their lives mattered equally."

But maybe that would be unfair...

 

[JJRousseau]

Thank you for your insight!
---
Let's pretend that this MMI is a reasonable/realistic scenario... in such a case: would a medical school candidate be torn apart by admissions for choosing the younger patient based on age alone?

If I had to choose, an 80 year old patient may be the nicest person, most noble person on earth, but he or she has still had 80 years to experience the world. The younger 20 year old, "drinking problems" aside, has the best chance to benefit long-term from the organ.
----
If there are two people dying in front of me, one 5 years old and the other 120, I'm going to go for the 5 year old first. Call me crazy.

I don't believe this is ageist or morally questionable. I believe that all human life is of equal value; however, as a part of this, one life coming to a close is less valuable than one that is beginning.

This is reflected in your answer as far as healthcare policy is concerned: an 80 y.o. isn't even allowed to be on the transplant list!
----
I'm sure things get more nuanced if the situation is: 1 person gets the vital organ / person 1 is 40 y.o., a(n otherwise) healthy father and schoolteacher, and person 2 is a 30 y.o. unemployed, single recently-released-from-prison pedophile / who gets the organ? In such a scenario, the age argument isn't so easy and things get more complicated.

For the record, I would not respond to an MMI question like this the following way, but it's a good bit of fun to point out why your response is particularly sound from a purely analytical perspective.

Let's suppose an individual claims 10 years of prospective life is equally valuable to 70 years of prospective life, because they believe all life is equally valuable. Since all life is equally valuable and life exists on a finite scale operationalised by time. Then, one second of life is equivalently valuable to any other second of life. If each second of life is equivalently valuable, then two seconds of life must be more valuable than one second of life. This implies that 70 years of prospective life must be more valuable than 10 years of prospective life, a contradiction. Therefore, the claims that both patients's lives have equal value and that life is equally valuable are logically inconsistent. In actuality, it's tougher than this because clinical outcomes are not determinative so you have to consider the probabilities associated with prospective life-years to form a space of likely-life-years.

 

[To be MD]

For the record, I would not respond to an MMI question like this the following way, but it's a good bit of fun to point out why your response is particularly sound from a purely analytical perspective.

Let's suppose an individual claims 10 years of prospective life is equally valuable to 70 years of prospective life, because they believe all life is equally valuable. Since all life is equally valuable and life exists on a finite scale operationalised by time. Then, one second of life is equivalently valuable to any other second of life. If each second of life is equivalently valuable, then two seconds of life must be more valuable than one second of life. This implies that 70 years of prospective life must be more valuable than 10 years of prospective life, a contradiction. Therefore, the claims that both patients's lives have equal value and that life is equally valuable are logically inconsistent. In actuality, it's tougher than this because clinical outcomes are not determinative so you have to consider the probabilities associated with prospective life-years to form a space of likely-life-years.

Yes, it implies that 70 years of perspective life is more valuable than 10. That is exactly what I am saying. There's no contradiction.

Let's put numbers on it for simplicity's sake.

Based solely on age, each individual, equally valuable, has--let's say--100 years of value ('life years') that each person deserves to be able to live out.

- A newborn starts at 100 and goes down to 0.
- An 80 y.o. also started at 100. However, he has already lived out 80 of them and is at 20 right now (i.e., 100-80)--and is approaching 0.

Each individual's life has the same value. The 80 y.o. has had the chance to live out 80 of his 100 'life years', whereas the newborn has not yet had the chance. He's already lived out 80 life value points, whereas the newborn has had no chance to. It is unjust to save the 80 y.o. over the newborn, from my perspective.

If you try saying that both patients are have a value of 100 because all lives are of equal value, I'm going to fire back and again say, "Of course they're of equal value originally, but only one of these patients (i.e., the elderly man) has had the chance to exist and enjoy 80 years of life... the other has not and is, thus, more deserving of having the chance to do so."
---

Again, this is an argument based on age alone, and it does not take into account other factors. I think a better, more difficult to answer, question is (again): would you save X person who is 40 and of great benefit to society and his/her family or would you save Y person who is a bit, but not significantly so, younger but is of no benefit to society. Seems to me that this scenario is when the "all lives have equal value" position is much easier to argue. I don't believe doctors in emergency scenarios should have a quick mental calculation of how much X person recycles vs. Y, etc... I think it is more fair to approach it from an age approach.

 

[bc65]

You guys are missing the point. This type of question has NO correct answer. The correct response is to acknowledge that it's a difficult choice, to present BOTH sides of the argument, and finally to indicate which decision you made and why. Then you have to be prepared to defend your position if and when it's challenged with variations on the scenario.

There is often no correct answer, with the exception of certain situational scenarios ( e.g. you ran over your neighbor's cat, but no one saw you; or, the fax machine broke after you used it and they blamed you ) where the correct answer is always to take responsibility and accept blame, because as a med student and resident you will get blamed a lot even when it's not really your fault ( but often it really is ).

 

[JJRousseau]

Yes, it implies that 70 years of perspective life is more valuable than 10. That is exactly what I am saying. There's no contradiction.

Let's put numbers on it for simplicity's sake.

Based solely on age, each individual, equally valuable, has--let's say--100 years of value ('life years') that each person deserves to be able to live out.

- A newborn starts at 100 and goes down to 0.
- An 80 y.o. also started at 100. However, he has already lived out 80 of them and is at 20 right now (i.e., 100-80)--and is approaching 0.

Each individual's life has the same value. The 80 y.o. has had the chance to live out 80 of his 100 'life years', whereas the newborn has not yet had the chance. He's already lived out 80 life value points, whereas the newborn has had no chance to. It is unjust to save the 80 y.o. over the newborn, from my perspective.

If you try saying that both patients are have a value of 100 because all lives are of equal value, I'm going to fire back and again say, "Of course they're of equal value originally, but only one of these patients (i.e., the elderly man) has had the chance to exist and enjoy 80 years of life... the other has not and is, thus, more deserving of having the chance to do so."
---

Again, this is an argument based on age alone, and it does not take into account other factors. I think a better, more difficult to answer, question is (again): would you save X person who is 40 and of great benefit to society and his/her family or would you save Y person who is a bit, but not significantly so, younger but is of no benefit to society. Seems to me that this scenario is when the "all lives have equal value" position is much easier to argue. I don't believe doctors in emergency scenarios should have a quick mental calculation of how much X person recycles vs. Y, etc... I think it is more fair to approach it from an age approach.

I meant a contradiction with the claim that both patient's lives had equal value. It is my understanding that we are in agreement.

 

[To be MD]

I meant a contradiction with the claim that both patient's lives had equal value. It is my understanding that we are in agreement.

Understood, my Solitary Walker friend 😀. Sorry if I was obtuse.

 

[wizzed101]

Good thing you aren't an MMI interviewer, because that is not how it works. The person who refuses to answer the question is much more likely to be rejected than one who picks a side and backs it up with some form of reasoning.

If this "I can spout anything as long as I defend my position" were true, the dude playing the banjo on his front porch in Alabama will be like the best interviewee in the whole world. There is nothing you can say to stop him from defending his position!

And I would likely respond to your refusal to make a value judgement with: "Well, as a result of your inaction due to your principled belief that all lives are equally valuable, the kidney has gone to waste and both patients are dead. But it's a relief to know that you felt that both of their lives mattered equally."

But maybe that would be unfair...

False dichotomy. To the wait list you go!!!

I thought the purpose of MMIs is to see if we can become decent doctors, not to see if we can handle MMIs.

 

[ChrisMack390]

If this "I can spout anything as long as I defend my position" were true, the dude playing the banjo on his front porch in Alabama will be like the best interviewee in the whole world. There is nothing you can say to stop him from defending his position!


False dichotomy. To the wait list you go!!!

I thought the purpose of MMIs is to see if we can become decent doctors, not to see if we can handle MMIs.

I'm going to repeat this:

Pro tip: If asked a rhetorical question, don't respond by completely under-minding it or by saying "that would never happen".

This is a tip for both interview scenarios and also for not being a really annoying person.



Furthermore, do you actually think a "good doctor" is one who when faced with a tough decision just refuses to make one on some philosophical grounds?

 

[wizzed101]

I'm going to repeat this:

Pro tip: If asked a rhetorical question, don't respond by completely under-minding it or by saying "that would never happen".

This is a tip for both interview scenarios and also for not being a really annoying person.



Furthermore, do you actually think a "good doctor" is one who when faced with a tough decision just refuses to make one on some philosophical grounds?

Why do you assume that I will not make a decision simply because I don't make a value judgment on the worthiness of patients? That is what a false dichotomy is.

You are giving tips for handling MMIs: your advice can be used for any type of application, not just medical school. And that is what I object to. Let's examine another scenario to see how the ludicrous notion that you can pick any answers as long as you can provide an explanation.

Q: Should we allow harvesting organs of death row convicts?

To some, anything but a irrevocable no will be the end of your application. But hey, do whatever you want it's your interview.

 

[JJRousseau]

Why do you assume that I will not make a decision simply because I don't make a value judgment on the worthiness of patients? That is what a false dichotomy is.

Let's explore your assertion that this is a false dichotomy. So, what is your basis of decision, if not a value judgement? You claim you would make a decision and that you can deny the dichotomy presented by one kidney and two patients thereby avoiding value judgement of patient's lives. If I were the unchosen patient, could you tell me why? Did you flip a coin to overcome this 'false' dichotomy that is beneath your moral wisdom to accept both lives are completely equally valuable?

I'm extremely confused as to how a decision does not imply value judgement barring a completely unbiased stochastic basis for the decision.

 

[bc65]

Q: Should we allow harvesting organs of death row convicts?

To some, anything but a irrevocable no will be the end of your application. But hey, do whatever you want it's your interview.

Not if I were asking the question. Because if you give me an irrevocable "no", I will torment you for giving that answer, too. Again, the correct answer is to explain why it's a good idea ( organs are otherwise going to waste ) and why it's a bad idea ( various moral and ethical questions ) and then explain why you come down on one side or another. Most interviewers will expect you to explain both sides, and explain why you chose your response, and defend your position against a whole variety of objections. If the interviewer can't think of questions to ask you, their interviewer's instructions for that question will give them extra material to work with.

If you just sit there and give an irrevocable "no" or an irrevocable "yes" without explaining and considering both sides you will fail that question. With prejudice.

 

[wizzed101]

Let's explore your assertion that this is a false dichotomy. So, what is your basis of decision, if not a value judgement? You claim you would make a decision and that you can deny the dichotomy presented by one kidney and two patients thereby avoiding value judgement of patient's lives. If I were the unchosen patient, could you tell me why? Did you flip a coin to overcome this 'false' dichotomy that is beneath your moral wisdom to accept both lives are completely equally valuable?

I'm extremely confused as to how a decision does not imply value judgement barring a completely unbiased stochastic basis for the decision.

Why don't you read the first post? It's an excellent answer. If you object to that answer because the scenario "wasn't realistic." Well!!!! Thanks for making my job easy!

Not if I were asking the question. Because if you give me an irrevocable "no", I will torment you for giving that answer, too. Again, the correct answer is to explain why it's a good idea ( organs are otherwise going to waste ) and why it's a bad idea ( various moral and ethical questions ) and then explain why you come down on one side or another. Most interviewers will expect you to explain both sides, and explain why you chose your response, and defend your position against a whole variety of objections. If the interviewer can't think of questions to ask you, their interviewer's instructions for that question will give them extra material to work with.

If you just sit there and give an irrevocable "no" or an irrevocable "yes" without explaining and considering both sides you will fail that question. With prejudice.

I will give explanations. I mean, that's question is so easy; the puny obstacle is to consider the extremely obvious rationales of those saying "yes."

 

[JJRousseau]

Why don't you read the first post? It's an excellent answer.

Other than it's inevitable rehearsed and inorganic tone, I don't have a problem with the initial answer. However, I do think there is a fine line between allowing your perception of the person's personal history to distort your clinical decisions and the fact that personal history contains important clinical information in terms of outcomes and ethics.

Would you say this surgeon's article exploring the ethics of performing a liver transplant disqualifies them from being objective doctors, because they explored the clinical options considering the patient's personal history of psychiatric illness: http://bulletin.facs.org/2014/11/tr...orbid-psychiatric-illness-an-ethical-dilemma/

I suppose my point is that I agree with you insofar as we should not choose the 20 year old over the 80 year old merely on the basis that one patient is older and we should not choose the 80 year old over the 20 year old on the basis that we are averse to excessive drinking habits - however, either of these choices could be justified by the co-morbidities associated with those personal histories and the risks would have to balanced and weighed to maximise "distributive justice".

 

[LizzyM]

I might say that neither is a good candidate at this time. The 20 year old might become a good candidate sometime down the line and in the mean time, dialysis can keep him alive. The 80 year old might be a candidate for dialysis but is not likely to be a good candidate for surgery and immunosupression. If this were acute liver failure, then it would be a harder call given that there is nothing equivalent to dialysis for liver failure. Not every kidney must be transplanted. Better to waste it pre-transplant than to put someone at risk through surgery and immunosuppression only to have the transplant fail.

And that's why I'll never be admitted to medical school. The End.

 

[Goro]

This is exactly what I would do as well as an interviewer.

Not if I were asking the question. Because if you give me an irrevocable "no", I will torment you for giving that answer, too. Again, the correct answer is to explain why it's a good idea ( organs are otherwise going to waste ) and why it's a bad idea ( various moral and ethical questions ) and then explain why you come down on one side or another. Most interviewers will expect you to explain both sides, and explain why you chose your response, and defend your position against a whole variety of objections. If the interviewer can't think of questions to ask you, their interviewer's instructions for that question will give them extra material to work with.

If you just sit there and give an irrevocable "no" or an irrevocable "yes" without explaining and considering both sides you will fail that question. With prejudice.

 

[wizzed101]

Other than it's inevitable rehearsed and inorganic tone, I don't have a problem with the initial answer. However, I do think there is a fine line between allowing your perception of the person's personal history to distort your clinical decisions and the fact that personal history contains important clinical information in terms of outcomes and ethics.

Would you say this surgeon's article exploring the ethics of performing a liver transplant disqualifies them from being objective doctors, because they explored the clinical options considering the patient's personal history of psychiatric illness: http://bulletin.facs.org/2014/11/tr...orbid-psychiatric-illness-an-ethical-dilemma/

I suppose my point is that I agree with you insofar as we should not choose the 20 year old over the 80 year old merely on the basis that one patient is older and we should not choose the 80 year old over the 20 year old on the basis that we are averse to excessive drinking habits - however, either of these choices could be justified by the co-morbidities associated with those personal histories and the risks would have to balanced and weighed to maximise "distributive justice".

I don't object that. It is approach is more or less similar to that of the OP and LizzyM. However, you should read the post that I objected to

I don't believe this is ageist or morally questionable. I believe that all human life is of equal value; however, as a part of this, one life coming to a close is less valuable than one that is beginning.

I will keep my original opinion: the moment I hear that, to the wait list the app goes.

 

[mangomaniac]

This is exactly what I would do as well as an interviewer.

@Goro I know this have been discussed multiple times by people in this thread but can you please re-iterate your opinion? I'm getting the impression that in this particular scenario, or in similar scenarios, you (and other interviewers) would rather have the applicant pick a side and defend his/her opinion rather than argue it is unethical to say one life is more valuable than another, given that all else - lab and radiology results, risks, prognosis, etc. - are equal? I feel like picking a side and defending yourself will show that you would make a considerate, compassionate physician that is not a robot. But it still feels wrong to subjectively argue one life is worth more than another. What would medical schools look for in their applicant? Signs of compassion, as shown by the applicant demonstrating he/she is able to consider other factors such as if the 20 year old had a son, or the ability to remain I suppose objective and not let subjective factors deter you from your ethics?

 

[Goro]

bc65 perfectly explained what would be my logic. You need to be able to hold both ideas in your head, and explain the pros and cons of each. We need you to be able to think on your feet.

@Goro I know this have been discussed multiple times by people in this thread but can you please re-iterate your opinion? I'm getting the impression that in this particular scenario, or in similar scenarios, you (and other interviewers) would rather have the applicant pick a side and defend his/her opinion rather than argue it is unethical to say one life is more valuable than another, given that all else - lab and radiology results, risks, prognosis, etc. - are equal? I feel like picking a side and defending yourself will show that you would make a considerate, compassionate physician that is not a robot. But it still feels wrong to subjectively argue one life is worth more than another. What would medical schools look for in their applicant? Signs of compassion, as shown by the applicant demonstrating he/she is able to consider other factors such as if the 20 year old had a son, or the ability to remain I suppose objective and not let subjective factors deter you from your ethics?[/QUOTE]

 

[mangomaniac]

bc65 perfectly explained what would be my logic. You need to be able to hold both ideas in your head, and explain the pros and cons of each. We need you to be able to think on your feet.

If you were able to thoroughly explain both sides but end with it would nonetheless be unethical of me to choose one over the other, id flip a coin so the organ doesn't go to waste... would that be okay? Or would you recommend we just pick a side..

 

[Goro]

It's OK to have an opinion! Just be able to explain your rationale. This holds true for any medical ethics question.

If you were able to thoroughly explain both sides but end with it would nonetheless be unethical of me to choose one over the other, id flip a coin so the organ doesn't go to waste... would that be okay? Or would you recommend we just pick a side..

 

[Endoxifen]

This is basically the kobayashi maru.

I think the only honorable answer is to say "I don't deal in hypotheticals" and walk out of the room, eating an apple.

 

[SquigglyQ]

Not if I were asking the question. Because if you give me an irrevocable "no", I will torment you for giving that answer, too. Again, the correct answer is to explain why it's a good idea ( organs are otherwise going to waste ) and why it's a bad idea ( various moral and ethical questions ) and then explain why you come down on one side or another. Most interviewers will expect you to explain both sides, and explain why you chose your response, and defend your position against a whole variety of objections. If the interviewer can't think of questions to ask you, their interviewer's instructions for that question will give them extra material to work with.

If you just sit there and give an irrevocable "no" or an irrevocable "yes" without explaining and considering both sides you will fail that question. With prejudice.

I am very sorry to bring this thread back to life. I have an MMI tomorrow and wanted clarification. Are we supposed to defend our position through every possible scenario, or, if the interviewer brings up a valid point, can we switch sides? Does that come off as indecisive or willing to compromise?

 

[aldol16]

I am very sorry to bring this thread back to life. I have an MMI tomorrow and wanted clarification. Are we supposed to defend our position through every possible scenario, or, if the interviewer brings up a valid point, can we switch sides? Does that come off as indecisive or willing to compromise?

You are supposed to have a thoughtful answer that is defensible. If you switch sides just because there's a difficult challenge, that just means that you haven't thought it completely through yet. Don't open your mouth unless you know what you're going to say and why you're saying it.

If the interviewer does bring up a valid point that you haven't thought about, you can say that you hadn't thought about that and if it really is substantial enough to change your opinion, then you can change it at that point. But your initial answer should have been very well thought through. Don't be dogmatic about your answer when valid points are raised.

 

[Tenk]

I would have put a trialysis catheter in each of them and gotten them both dialysis. I win.

 

[HomeSkool]

I'd respond that both patients are in acute renal failure, not end-stage renal disease, and are inappropriate candidates for transplant. And then my application would be trashed for being a smartass.

Sent from my Pixel 2 using SDN mobile

 

[Goro]

I am very sorry to bring this thread back to life. I have an MMI tomorrow and wanted clarification. Are we supposed to defend our position through every possible scenario, or, if the interviewer brings up a valid point, can we switch sides? Does that come off as indecisive or willing to compromise?

Just answer the question as it's asked. If you're not asked for a "give a for and against", then don't give what you're not asked for.
If the interviewer brings up a valid point, doesn't that me you simply abandon your reasoning? Don't appear wishy-washy...think things through, and be able to justify your logic.

 

[liquidcrawler]

I'm assuming, if we're given a scenario such as this, the point is to make a decision one way or the other and not teeter on bs like "I'd put both on dialysis" or "these are non-emergency situations so I'd review their charts and consult the literature for who has the best chance of survival" type of answers.

If I had to respond in the heat of the moment I would say: The objective would be to produce the most good possible given a poor situation. If I give the professor the kidney, he may have ~1-5 good years left given his age, but given his occupation and talent (being a prof) he may have yet a lot of good left to produce in the world. The student has a long life ahead of him, but his potential to lead a good life or produce good in the world is uncertain due to alcohol related acute kidney failure. However, the professor has been given the chance to live out his potential, while the student has not. I therefore give the kidney to the student, and it is his/her own prerogative now to turn their life around or squander the second chance they have been given.

Would this be an appropriate response? I entertain both options while pointing out the pros and cons of each and then make a decision based on valuing potential to produce good. I've often hear this is the format you should approach these scenarios with - discuss both sides' pros and cons then make a decision.

 

[HomeSkool]

If the interviewer brings up a valid point, doesn't that me you simply abandon your reasoning? Don't appear wishy-washy...think things through, and be able to justify your logic.

Yep. Taking a couple moments to think through follow-up questions is perfectly fine, as long as it doesn't become excessive or seem like a smokescreen for indecision. If the interviewer brings up a good point, acknowledge it and think about how it fits into your previous answer. Your interviewer may be testing your resolve, but they might also be giving you a way out of a weak answer. So there's a little gamesmanship involved: you want to avoid being wishy-washy without becoming inflexible. Think about it: you wouldn't want a doctor who couldn't take a position and stick with it, but you also wouldn't want one who refused to adjust when presented with additional data. Both extremes are bad.

As trite as this advice may sound, just try to relax. We all know interview days are stressful - we've been through several of them ourselves at various points in our careers. We don't expect perfect applicants and perfect answers, we expect excellent applicants and honest answers.

 

[Rooster Booster]

I hate MMI. Dumbest interview style ever.

Agree so much with this. lol