How to answer this tricky interview question?

[texas aggie]

A patient comes to you and will die if you don't operate on him. He has no insurance and cannot afford the operation. What do you do?

This question is often asked in many ways, but that is usually the most dramatic. Basically, what are you supposed to do if a patient comes to you and can't afford to pay?

---

Members don't see this ad.

 

[BABSstudent]

A patient comes to you and will die if you don't operate on him. He has no insurance and cannot afford the operation. What do you do?

This question is often asked in many ways, but that is usually the most dramatic. Basically, what are you supposed to do if a patient comes to you and can't afford to pay?

If it is a necessary procedure and the patient will die if you don't do anything, then you do the procedure. Worry about the payment later (or not at all depending on who handles billing). Of course, I am assuming something like an emergency situation. I am not sure how it would be handled differently if it was a foreseeable problem that will arise in the future. However, a person without health insurance is probably not going to know about this because they would have to see a doctor in the first place.

Now if the person came in with something not severe, like acne, then you don't have to do anything.

 

[Chillbo Baggins]

Yeah, it's pretty straightforward: you're a doctor, save him.

 

[Mr Avante]

A patient comes to you and will die if you don't operate on him. He has no insurance and cannot afford the operation. What do you do?

This question is often asked in many ways, but that is usually the most dramatic. Basically, what are you supposed to do if a patient comes to you and can't afford to pay?

Is this the kind of questions interviewers ask all the time???!

 

[circulus vitios]

How is this a difficult question? Tell them what they want to hear: you'll do the procedure for free.

 

[whatever5]

I don't think it's as simple as saying you'll do the procedure for free - there are a lot more resources at stake than a surgeon donating his time. You might want to look up how hospitals go about approving pro-bono work, it will probably give you insight on how to answer the question and will make you sound more educated on the matter.

 

[Redpancreas]

I think this question is not as straight forward as some of the responses have suggested. Yes, a physician's job is to better the lives of their patients but physician's, on the clock, are not necessarily responsible for making the policy decisions. That is what administrators do. Part of the reason why this question is hard to answer is because it is a general hypothetical and I guarantee you won't ever be given this exact prompt. Anyways, if you saved the guy that's good but assuming you are in an Emergency Dpt. won't there be others with similar urgent matters that need to be attended to? Your time, as a physician, is valuable. If you do one thing, you're likely giving up on another. Given this limited prompt here is what I think I would say:


As a physician, I would ultimately abide by the policies of the hospital I am employed under. If I am not aware of the policies, I would do the best I could to save the patient and take the blame later if what I did what unethical due to my value for human life. I do recognize, though, that my time as a physician is a useful commodity. Every task that I do is a trade-off and I would carefully weigh my options before performing a life saving procedure, for example.

Does that sound too general?

If it does, it's because the question you posed is a pretty generalized one too that would not be asked, as is.

 

[sh0rtstop34]

A patient comes to you and will die if you don't operate on him. He has no insurance and cannot afford the operation. What do you do?

This question is often asked in many ways, but that is usually the most dramatic. Basically, what are you supposed to do if a patient comes to you and can't afford to pay?

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

If you are working in a hospital, it is the law. you have to treat the patient. very few hospitals in the US are exempt from this

 

[487806]

A patient comes to you and will die if you don't operate on him. He has no insurance and cannot afford the operation. What do you do?

This question is often asked in many ways, but that is usually the most dramatic. Basically, what are you supposed to do if a patient comes to you and can't afford to pay?

This is where Obamacare comes to the rescue.

The answer is simple: carry out the operation.

 

[Slowpoke]

primum non nocere

 

[Redpancreas]

This is where Obamacare comes to the rescue.

The answer is simple: carry out the operation.

I was wondering about this. How do you think we, as medical applicants in this transition phase, should approach health policy questions. The consequences of Obamacare are unclear and the bill itself is indecipherable. Should we read up on the various technicalities of the laws? That would seem like the right thing to do but in the subjective context of an interview it would seem like the best thing to do would be sincere and put your best foot forward. Also, most traditional physicians from the baby-boomer generation are against Obamacare but still, many physicians support it. Should we look to see if what expansions the state in question has passed?


---------

Also, my previous answer accounts for that policy law. Basically, you would have to be wary of the policy in place at the hospital you work at. Maybe at the beginning of your answer or as a transition you could say "I think this prompts underscores the importance of knowing the rules of the hospital I am in employment under". Also, regardless of what the policy is, you should never say you will consciously disobey them. Sure, we're all opinionated and saving lives is always a good thing. The thing though is that on the clock, doctors are meant to follow policy, not dictate it. A doctor who commits insurance fraud will not keep his license for long.

 

[Radon XP]

There's nothing tricky about this question. It's your moral obligation to help the man if you are immediately able.

 

[sh0rtstop34]

I was wondering about this. How do you think we, as medical applicants in this transition phase, should approach health policy questions. The consequences of Obamacare are unclear and the bill itself is indecipherable. Should we read up on the various technicalities of the laws? That would seem like the right thing to do but in the subjective context of an interview it would seem like the best thing to do would be sincere and put your best foot forward. Also, most traditional physicians from the baby-boomer generation are against Obamacare but still, many physicians support it. Should we look to see if what expansions the state in question has passed?


---------

Also, my previous answer accounts for that policy law. Basically, you would have to be wary of the policy in place at the hospital you work at. Maybe at the beginning of your answer or as a transition you could say "I think this prompts underscores the importance of knowing the rules of the hospital I am in employment under". Also, regardless of what the policy is, you should never say you will consciously disobey them. Sure, we're all opinionated and saving lives is always a good thing. The thing though is that on the clock, doctors are meant to follow policy, not dictate it. A doctor who commits insurance fraud will not keep his license for long.

I would say to stick to the facts. Change is usually difficult at the national level and all change comes with pros and cons. examples: pro - greater patient outreach by extending insurance to more citizens; cons - not enough doctors to sufficiently cover this new influx of patients, and it is expensive so we have to find an efficient way to fund it.

It is still new, and there will be changes and provisions made to the health care reform so it is hard to tell exactly how it will effect everyone, just try to stick to the facts and try not to bring too much opinion into play. Thats just my opinion, you do not want to get in some big debate with your interviewer.

 

[TooMuchResearch]

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

If you are working in a hospital, it is the law. you have to treat the patient. very few hospitals in the US are exempt from this

If you aren't actually an EM doc, you can avoid emergent patients. Join a group that doesn't take ED call, and then it isn't your problem. But pts will suffer if no one takes ED call. Your choice.

 

[Ismet]

Is this the kind of questions interviewers ask all the time???!

No. I got a question similar to this in the MMI at Cincinnati, but MMI's are usually scenario/ethics-based questions so that was expected. I was never asked anything like this at any of my other interviews, nor do I try to ask anything like this when I interview.

 

[Goro]

Not all the time. Scroll through the Interview Feedback section of SDN. I mine it constantly for my own questions. I hate the "Why Medicine?" "Why our school?" etc standard crap.

Is this the kind of questions interviewers ask all the time???!

 

[yehhhboiii]

Not all the time. Scroll through the Interview Feedback section of SDN. I mine it constantly for my own questions. I hate the "Why Medicine?" "Why our school?" etc standard crap.

Had those at every single one. Still not sure what to say

 

[Mr Avante]

Not all the time. Scroll through the Interview Feedback section of SDN. I mine it constantly for my own questions. I hate the "Why Medicine?" "Why our school?" etc standard crap.

Nice move, although you might now be predictable

 

[GoPelicans]

"I would do the operation for free of course because this is a hypothetical situation, so I can give you a hypothetical answer"

 

[Barcu]

As a physician, I would ultimately abide by the policies of the hospital I am employed under. If I am not aware of the policies, I would do the best I could to save the patient and take the blame later if what I did what unethical due to my value for human life. I do recognize, though, that my time as a physician is a useful commodity. Every task that I do is a trade-off and I would carefully weigh my options before performing a life saving procedure, for example.

Don't say this. You are completely over-thinking the question. This is not an actual, realistic question. It is an ethical question. Don't get into policies of the hospital or bring in circumstances that are not given to you. This question is about YOU.

 

[Redpancreas]

Don't say this. You are completely over-thinking the question. This is not an actual, realistic question. It is an ethical question. Don't get into policies of the hospital or bring in circumstances that are not given to you. This question is about YOU.

Haha, I keep mixing up in my head whether this is a secondary prompt or interview question. If it was a secondary prompt, that's what I would say, though. Never brought up any unique circumstances and is agree that that's the absolute wrong thing to do. All it shows it that you're hiding behind facts like a robot instead of having an opinion. In a secondary though, if this was asked I don't think it would be the straight forward answer. Anyways, that wasn't the question. If in an interview, I would probably say that I would save the person and just keep my mouth shut about the rest. That's the funny thing about talking. Either you can say something with conviction or you can say something with technical accuracy. As a scientist, I usually think with the latter and thus try to communicate in that way. The more I go through life, though, the more I realize how short statements with conviction (that are often technically incorrect) are the way to go in oral situations.

 

[JohnQuincyAdams]

Haha, I keep mixing up in my head whether this is a secondary prompt or interview question. If it was a secondary prompt, that's what I would say, though. Never brought up any unique circumstances and is agree that that's the absolute wrong thing to do. All it shows it that you're hiding behind facts like a robot instead of having an opinion. In a secondary though, if this was asked I don't think it would be the straight forward answer. Anyways, that wasn't the question. If in an interview, I would probably say that I would save the person and just keep my mouth shut about the rest. That's the funny thing about talking. Either you can say something with conviction or you can say something with technical accuracy. As a scientist, I usually think with the latter and thus try to communicate in that way. The more I go through life, though, the more I realize how short statements with conviction (that are often technically incorrect) are the way to go in oral situations.

Jesus Christ, you sound like a wordy robot.

 

[BABSstudent]

The more I go through life, though, the more I realize how short statements with conviction ... are the way to go

It seems like you still have a little ways to go.

 

[Thespunger]

Seriously bro, you think this question is "tricky"? Come on.. You going to make an argument about how you let him die because he could not afford it and he deserved to die, or you really needed to money or some crap. You got to be a ***** if you think there is more than one right answer to this question.

 

[OCDOCDOCD]

If you think that's a tricky question, just withdraw all your apps now. You'll never make it through even the easiest interview. All that question does is test to see if you're a psychopath. It's essentially asking "What's more important to you? A person's life or money?"

 

[DoktorO]

Easy question. You save his life. Someone else deals with the billing, its not the doctors job to deal with the billing.

 

[Redpancreas]

Easy question. You save his life. Someone else deals with the billing, its not the doctors job to deal with the billing.

Alright fine, maybe I'm wrong.
Of course I would save the life if it actually came down
to a situation like that.
I was just confused because in Wayne's prompt
something similar was asked but now I realize that
situation actually required the physician to
cheat the system. Sorry, med students would
know I guess...Ill take the advice if the prompt comes up and use
my common sense. Wish it was said in a nicer
way, though. Treat the patient, let others worry about
the legal ramifications, got it.

 

[circulus vitios]

Easy question. You save his life. Someone else deals with the billing, its not the doctors job to deal with the billing.

I wouldn't mention billings at all. Either you go full-on rose tinted glasses, or you go full-on beancounter. Anything in between is going to be a mess

 

[Redpancreas]

I wouldn't mention billings at all. Either you go full-on rose tinted glasses, or you go full-on beancounter. Anything in between is going to be a mess

Yes, this is what I was trying to say.

 

[deleted458807]

I would say I would do the procedure pro-bono and try to find others who will donate their services too (anesthesiologist and other physicians involved)

 

[cincincyreds]

Just say you will do everything in your power to help that patient out.

That is a nice quick answer that covers all bases.

 

[muddyduck7]

The problem with these type of scenarios is that you need to balance brevity with acknowledgment of the complexities. A doctor cannot unilaterally decide that a surgery is going to be pro bono - the entire surgical team, and administration needs to be involved. Not only does it require the skills of the surgeon / anesthetist etc, but it requires the OR space and equipment.

But it is difficult to address such complexities in a one liner, especially if the interviewer is be pressed for time / disinterested but required to ask an ethical dilemma question (as in CCLCM). In some instances, the interviewer may play devil's advocate and challenge your assertions - especially if they are not nuanced. In other circumstances, the interviewer may be put off if you try to discuss the nuances ("You would clearly have to perform the surgery). I have had interviews go both ways.

 

[mimelim]

If you think that's a tricky question, just withdraw all your apps now.

This was my first thought as well. If you find this challenging, you are not going to make it through interviews, much less the 7+ years of further schooling.

 

[KindofBlue]

Alright fine, maybe I'm wrong.
Of course I would save the life if it actually came down
to a situation like that.
I was just confused because in Wayne's prompt
something similar was asked but now I realize that
situation actually required the physician to
cheat the system. Sorry, med students would
know I guess...Ill take the advice if the prompt comes up and use
my common sense. Wish it was said in a nicer
way, though. Treat the patient, let others worry about
the legal ramifications, got it.

Can't see how there is any cheating involved at all.
These kind of patients pop up every day, and that's why there's a law that requires doctors to treat patients who will die if not treated immediately.

Yes the patients are going to be stuck with a huge bill, but there are always payment arrangements and deals that can be made with the hospital, like how insurance companies pay just a portion of the amount they're billed for.

I agree with the poster above, this question is probably asked to see if you're not a psychopath of some sort. I really don't know any other way it can be answered.

 

[Redpancreas]

This was my first thought as well. If you find this challenging, you are not going to make it through interviews, much less the 7+ years of further schooling.

Kindofblue, I was talking about last year's Wayne prompt. If your interested, go read it. It is an instance of insurance fraud. In that case, I would do my best to make ends meet by sacrificing all my resources that do not inflict harm on other patients. I might end up treating the patient for free but I would not accept the SO's insurance card. Again, this is for the Wayne prompt.


As for a few others, the bread and butter of my desire to attend medical school is service-oriented. Therefore, I would appreciate a little civility as opposed making quick judgments of my character and capability as an applicant.
People on SDN have feelings too.

 

[Ismet]

Kindofblue, I was talking about last year's Wayne prompt. If your interested, go read it. It is an instance of insurance fraud. In that case, I would do my best to make ends meet by sacrificing all my resources that do not inflict harm on other patients. I might end up treating the patient for free but I would not accept the SO's insurance card. Again, this is for the Wayne prompt.


As for a few others, the bread and butter of my desire to attend medical school is service-oriented. Therefore, I would appreciate a little civility as opposed making quick judgments of my character and capability as an applicant.
People on SDN have feelings too.

You're taking this a little too personally. No one is being uncivil or saying you would be a bad applicant. Most people, unless directly quoting you, are responding to the OP. Also, this is SDN. Not that I condone rudeness, but with being here since 2010, you should know by now that not everyone on this site is as nice on the internet as they probably would be in person. Just take everything with a grain of salt and move on with your day.

 

[Bacchus]

Do the procedure. The hospital has a budget for charity care. A patient has the full right to declare him or herself self-pay and receive a bill in the mail. The patient either pays or not, leading to collection possibly. But, you don't filter who gets a procedure or not based on self-pay status, at least in the emergent setting.

Scenarios:
Man living under the bridge is brought in extremely sick. CT abdomen shows a dissecting aneurysm. He goes to surgery, the hospital attempts to bill him (maybe he has a PO box? ). If they can't it will be written off/taken as a loss.

You're a private practice hemeonc who has a patient come in for initial consultation. The patient pays the consultation fee OOP and gets a plan of chemotherapy/radiation. Patient can't afford this. They can apply for state emergency medicaid to have expenses covered. Inversely, you could deny even taking the patient for the consultation if you know they don't have insurance/can't pay up front.

Remember, you can't deny a medicare/caid patient or you risk not being reimbursed in the future if you typically see patients with this payer.

Open to being corrected if any of this is wrong.

 

[gimghoul]

Analyze and discuss the relevant ethical dilemmas, demonstrate an understanding of charity care options and hospital resources, and ultimately indicate that you will do everything in your power to make the procedure happen.

You can also take this opportunity to demonstrate that it takes more than a willing physician to make a procedure happen. There are facilities costs, and your willingness to work for free doesn't cover the cost of OR time, nurses, techs, etc., so there will invariably be wrangling with the hospital and the consideration of options mentioned above like self-pay.

Self-pay raises its own set of ethical dilemmas. In the event of a life-saving procedure, it's fairly simple - bankruptcy is probably better than death. What if they tweak it and say the procedure is to significantly improve their quality of life? How do we weight the medical improvement in quality of life against the harm of long-term financial damage?

I think it's an interesting question.

 

[neurodoc]

I don't think it's as simple as saying you'll do the procedure for free - there are a lot more resources at stake than a surgeon donating his time. You might want to look up how hospitals go about approving pro-bono work, it will probably give you insight on how to answer the question and will make you sound more educated on the matter.

Right. The question asks if you would do the operation for free given the stated facts. I would (if I were a surgeon, which I'm not), but just how do you go about getting the guy into the OR. If you also own the hospital, you could probably get the guy into the OR, arrange for all the staff and equipment for the operation and then the post-op hospital care. But most likely you're just a staff physician.

Yes, you could give up your personal reimbursement for the surgery, but it's not that simple. As stated, it's a dumb question from med school interviewers, who ought to be fairly knowledgeable about how hospitals operate (pun intended).

 

[BioBeaver]

Tougher one:

A family friend's 13 year old daughter comes to you saying she is pregnant, and asks you to help her get an abortion. Do you help her? Do you tell her parents?

 

[crowgwu]

it will probably give you insight on how to answer the question and will make you sound more educated on the matter.

 

[Beargryllz]

A patient comes to you and will die if you don't operate on him. He has no insurance and cannot afford the operation. What do you do?

This question is often asked in many ways, but that is usually the most dramatic. Basically, what are you supposed to do if a patient comes to you and can't afford to pay?

Billing is what somebody else gets paid to bother with

Why would it matter to a physician, who practices medicine?

Counting dollars and cents is someone else's game

 

[TooMuchResearch]

Billing is what somebody else gets paid to bother with

Why would it matter to a physician, who practices medicine?

Counting dollars and cents is someone else's game

Not universally true.

 

[Ismet]

Tougher one:

A family friend's 13 year old daughter comes to you saying she is pregnant, and asks you to help her get an abortion. Do you help her? Do you tell her parents?

That's not tough.

First of all, this is assuming you are even trained and qualified to perform the procedure (very few are). Personally, I would not be willing to perform the procedure. I would direct her to someone who I know is willing and capable, but I would offer my support along the way. I cannot tell her parents, as she is covered under HIPAA.

 

[mimelim]

Tougher one:

A family friend's 13 year old daughter comes to you saying she is pregnant, and asks you to help her get an abortion. Do you help her? Do you tell her parents?

http://hipaa.bsd.uchicago.edu/minors.html

It is a direct HIPAA violation if you tell her parents. Varies from state to state somewhat.

 

[circulus vitios]

Billing is what somebody else gets paid to bother with

Why would it matter to a physician, who practices medicine?

Counting dollars and cents is someone else's game

Not really. I've seen residents get chewed out for screwing up billings or not explaining something about Medicare/Medicaid correctly to the patient.

 

[Status Sciaticus]

http://hipaa.bsd.uchicago.edu/minors.html

It is a direct HIPAA violation if you tell her parents. Varies from state to state somewhat.

But then how does she consent if she is not of legal age to do so?
Simple assent isnt enough...


New ethical question:

two kidney transplant patients are presented.
Patient 1 is a rich donor who has agreed (contractual agreement) to donate an entire dialysis wing if he is given the kidney.
Patient 2 is a poor woman working two jobs and a single mother.

Both patients present at the same time and have the same lab values (and thus everything else is held equal)

Who do you decide to treat?

 

[Redpancreas]

But then how does she consent if she is not of legal age to do so?
Simple assent isnt enough...


New ethical question:

two kidney transplant patients are presented.
Patient 1 is a rich donor who has agreed (contractual agreement) to donate an entire dialysis wing if he is given the kidney.
Patient 2 is a poor woman working two jobs and a single mother.

Both patients present at the same time and have the same lab values (and thus everything else is held equal)

Who do you decide to treat?

Healthcare is a right for all citizens
All men and women are created equal
Disregard the donation.
Decide by a random process (assuming all else is equal)
or better yet, use the rich donor's money if he or she would be willing
to help the poor woman out and pay for her kidney procedure
if he or she is given treatment.

 

[mimelim]

But then how does she consent if she is not of legal age to do so?
Simple assent isnt enough...

She can consent. She is considered an adult in the eyes of the law.

New ethical question:

two kidney transplant patients are presented.
Patient 1 is a rich donor who has agreed (contractual agreement) to donate an entire dialysis wing if he is given the kidney.
Patient 2 is a poor woman working two jobs and a single mother.

Both patients present at the same time and have the same lab values (and thus everything else is held equal)

Who do you decide to treat?

Organ donation does not look at any of the factors you listed for a reason. Beyond that, the fundamental ethical issue at hand if you make two patients "equal" medically (which you can't) is very trivially easy to understand and explain to an interviewer.

 

[Status Sciaticus]

Healthcare is a right for all citizens
All men and women are created equal
Disregard the donation.
Decide by a random process (assuming all else is equal)
or better yet, use the rich donor's money if he or she would be willing
to help the poor woman out and pay for her kidney procedure
if he or she is given treatment.

There is only one kidney to give.. so you must pick one.

She can consent. She is considered an adult in the eyes of the law.



Organ donation does not look at any of the factors you listed for a reason. Beyond that, the fundamental ethical issue at hand if you make two patients "equal" medically (which you can't) is very trivially easy to understand and explain to an interviewer.

I agree that organ donation is usually objective, but there are always instances where rich donors to a hospital are afforded priority and certain priveleges.

The question was a hypothetical, which is why I said all else held equal. If they are both about to die in the next hour without the transplant and you have one kidney, how do you decide who to give it to?