How would you answer these interview Qs?

[Veilside]

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i had my stony brook interview yesterday, and here are some of the questions that were asked. i was just curious to know other people's answers to these questions:

1) you are an hmo doctor, and you see a patient. you do a complete physical exam and find three symptoms that suggests that she may have a serious illness. but hmo regulations specifically state that FOUR symptoms are necessary in order for you to refer the patient to a specialist that deals with that particular disease. what do you do?

2) you are a doctor, and the parents of an infant refuse to give the baby a blood transfusion due to their religious beliefs. what do you do?

3) you make a mistake and end up costing the life of a patient. do you tell the family members of that patient even if it means that it will end your career?

4) you find that a doctor is having a sexual relationship with a psychiatric patient. do you report that?

there were others, but can't remember too well thanks

 

[Dr JPH]

1. Consult with another PC doc in the office. Two people say it's there, it's there.

2. Give the transfusion. The baby didn't choose the religion, the parents did. Endangering a child.

3. This happens more than people want to know. Hard to tell what to do here. You tell the family, they sue you, you are out of a job, one less doctor out there, less faith in medical system. You don't tell, you live with that the rest of your life, patient is still gone, many unanswered questions, possible lawsuit and your apparent "coverup." Hope you have good malpractice.

4. Absolutely.

 

[Amy B]

1. Don't know, maybe have the patient return for a follow up in a few days and then maybe another symptom will appear.

2. respect their wishes however, strongly urge them to reconsider and make sure they KNOW ALL the consequences to their refusal. Then take it to the boss of wherever I practice or work to see if social services should be called. they do intervene in certain cases like this one mentioned.

3. Yes. If it is the first mistake, chances are that it won't end my career though.

4. Absolutely I would report it. To my immediate superior immediatly

 

[Amy B]

JP,
If you gave the transfusion, you would be in a huge pack of trouble. I know what the parents are doing is wrong but you are a doctor and unfortunetly can not save the world, no matter how much you want to.

 

[Veilside]

Originally posted by JPHazelton
1. Consult with another PC doc in the office. Two people say it's there, it's there.

i answered sort of along the same lines, but my interviewer was very specific about the choices, either i lie on the patient chart or i send her home.

 

[Veilside]

Originally posted by Amy B


3. Yes. If it is the first mistake, chances are that it won't end my career though.

my interviewer was very clear about the specifics of the question. he said that it WOULD end your career.

 

[skijag3]

These sound like hard questions. Did you find the entire interview stressful. I have an interview there next week. Do you have any advice ? Thanks so much !

 

[SolidGold]

Lie on the patient chart so that you could refer the patient to a specialist. First of all, most likely, the specialist will be able to help more than you could in that situation. Secondly, this is the most common way for doctors to get around strict HMO's in order to help their patients. Sending the patient home is the wrong thing to do because that person could become more sick. Besides, as a doctor, what did you do to help the patient when you send him home? Nothing at all.

 

[Amy B]

Originally posted by Veilside
my interviewer was very clear about the specifics of the question. he said that it WOULD end your career.

Oh, well, then I would still have to say yes, I would tell them. I'm just not the knid of person that could live with myself knowing this family had no idea why there loved one died. they deserve to know.

What did you say?

 

[Veilside]

i said that i would tell them. he wanted me to elaborate, and i said something along the lines of "if my action leads to the death of a patient, and if that warrants permanent dismissal from the medical profession, perhaps it is not the career for me" bleh....

 

[PrincessCKNY]

U of W has great stuff on medical ethics (thanks SMW!), where most of these topics are touched upon. Check those out, and you should be able to answer most of these questions. Here is what I would say after studying up:

1. This one is the toughest to me. If it is a serious illness and another physician is still only able to find 3 symptoms, I would just send them to a specialist and risk taking it out of pocket. But, I believe the seriousness of it depends on whether it is covered.

2. You must ALWAYS respect the patients' parents wishes. All you can do is counsel them on the pros and cons of not having (or having) a transfusion. If they still refuse, and the illness is not life threatening, then you must respect their wishes. If they refuse, and the illness is life threatening, I think you must obtain a court order for the child to have a transfusion.

3. Yes, tell them. Lying never gets you anywhere. Explain the situation.

4. There are 2 possible ways I would approach it, but I haven't figured out which one. 1) Report anonomously (most likely if I know the physician well) or 2) Tell the physician that they have a chance to end the relationship or leave his occupation...if not, then I would report him in XX days.

 

[Explosivo]

1. I agree with JP, consult with another physician and if the three symptoms are serious enough on their own a fourth one can be something generic that's common to a variety conditions and may or may not be involved in the patients medical problem, i.e. fatigue. This type of "fudging" is common place. In fact one doc did something like this for me once. Again, it depends on the specifics and severity of the situation. I have never been a fan of "one-size fits all" policies.

2. Strongly object to the parents' decision but my hands are tied. Unless I get a court order to do a transfusion I have no legal basis to take action. The U.K. has some legal precendence here when they ordered docs to separate conjoined twins despite the parents wishes when it was found that both would die w/o the procedure. I'm not sure what the legal responsiblities of a physician in the U.S. would be on this issue. Whatever it is, I would play it safe and follow the law.

3. Hard question to answer. If it was due to an honest mistake I would and my career would probably remain intact. Allow the insurance company to deal with it. Again, usually losing one's license results from a consistent track record of screw ups not one mistake unless it was something done maliciously with the intention of hurting the patient--something I would never do.

4. I would report it. No question.

 

[Veilside]

Originally posted by skijag3
These sound like hard questions. Did you find the entire interview stressful. I have an interview there next week. Do you have any advice ? Thanks so much !

the questions themselves were very hard and thought-provoking, my first interview of the sort actually. but the interviewer was a pretty cool guy i thought. the interview lasted about an hour and he asked me pretty much everything that was on my application, especially the research that i was involved in, and wanted details details details. he also asked about what i wrote on one of the secondary essays. basically, he asked me about anything and everything...except primary care. i read somewhere that stony brook is big on primary care so i was prepared on that subject but he didn't ask me anything related to that. we talked about it at the end when i had the time to ask questions. so overall, it was a pretty tough interview!!! 😡

 

[agent]

Wow these are hard questions!! Good prep for us though. I'll tell you how I'd answer.


1) you are an hmo doctor, and you see a patient. you do a complete physical exam and find three symptoms that suggests that she may have a serious illness. but hmo regulations specifically state that FOUR symptoms are necessary in order for you to refer the patient to a specialist that deals with that particular disease. what do you do?

If I was absolutely sure that it appeared they had this disease I would lie. IMO not all patients that have a illness present with all symtoms. The specialist will be able to best help them.


2) you are a doctor, and the parents of an infant refuse to give the baby a blood transfusion due to their religious beliefs. what do you do?

I agree with Amy B. Respect the parents wishes but inform them of the consequences. Then see if you can get social services involved.

3) you make a mistake and end up costing the life of a patient. do you tell the family members of that patient even if it means that it will end your career?

Doctors make mistakes as well. I guess it depends on the severity of what I did. If I it was a blatent mistake then I guess I'd probably have to own up to it. If it could have happened to anyone I'd probably not tell, and assume it was just bad luck. I know that might sound bad but there's a margin of error in everything. Some things are beyond human control.


4) you find that a doctor is having a sexual relationship with a psychiatric patient. do you report that?


Definitely. Thats abuse.

 

[Street Philosopher]

Originally posted by Veilside
i said that i would tell them. he wanted me to elaborate, and i said something along the lines of "if my action leads to the death of a patient, and if that warrants permanent dismissal from the medical profession, perhaps it is not the career for me" bleh....

lol yeah right buddy

 

[agent]

Originally posted by Street Philosopher
lol yeah right buddy

agreed, no offense but that just wouldnt work in our med system. see my explanation.

 

[Veilside]

Originally posted by Street Philosopher
lol yeah right buddy

i know it's bs 😀
but here's how it happend. he first asked me whether or not i would tell the family of my mistake, and of course my response is yes. but i was not expecting him to respond " even if it meant it would end my career?". so that was the best response that i could come up with arrrgh.

EDIT: he made very clear that it was a definitve mistake that i made that led to the patient's death

 

[Joe Bradley]

With regards to the blood transfusion point:

The first thing that you should do is try to convince the parents that it is in the best interest of the child to receive the transfusion. However, if they still decline the transfusion, but you as the physician absolutely believes that the child needs it in order to survive, you may speak to the hospital social worker and bring up a court order. The Supreme Court ruled in Jehovah's Witnesses v. King County Hospital Unit No. 1 (390 U.S. 598) that a hospital may seek and obtain a court order requiring the blood transfusion against the religious wishes of the parent in the event of an emergency.

 

[Veilside]

it's funny b/c i actually told my interviewer that i would give the blood transfusion even against the wishes of the parents if it came to that. and then he started talking about how there were some doctors who call hospital security to restrain the parents so that they could give the blood transfusion to the infant.
i honestly don't think i can stand and watch a helpless baby die b/c of his or her parent's beliefs. as much as i don't have the legal right to do that, my moral views would override it in this case. then i'll see the parents in court if need be. the interviwer was also saying that almost all cases against doctors who perform such acts do not lose. so go figure.

 

[Amy B]

As crazy as it sounds, there are people who believe that if they get donated blood they will not be allowed to go to Heaven. Why? I have no idea, but that is why they fight it so severely. I can only imagine hospitals and doctors hate when these cases come up and I guess I'll be honest and say I hope I never have to face a case like this when I am a doctor.

 

[Street Philosopher]

hmmm i would answer that mistakes happen, everything in life has risks. but then again if it's so bad that they would end my career, well... that must REALLY be bad, like if i walked to the 7-11 during surgery or something. hmmm

at that point it wouldn't really be a mistake, like "oops" but like "i regret having sexual relations with that woman, ms lewinsky" so i mean i would answer that the phrasing of the question is misleading and ask him to rephrase. haha

if he pushes then i'll just point out that this mistake can't be a mistake at all (if the punishment is losing my career) and it would be more like a crime. and like that's like manslaughter so of course i would confess to something like that.

if it's just a mistake or "complication" then i wouldn't say anything because like i said risks are part of the deal and telling the family won't bring back the dead.

 

[Veilside]

Originally posted by Amy B
I hope I never have to face a case like this when I am a doctor.

chances are you will come across such a case. i think what my interviewer was trying to do was emphasize the tremendous amount of responsbilities you take on as a doctor. he only kept saying that every other sentence

 

[mvervaine]

Originally posted by Joe Bradley
With regards to the blood transfusion point:

The first thing that you should do is try to convince the parents that it is in the best interest of the child to receive the transfusion. However, if they still decline the transfusion, but you as the physician absolutely believes that the child needs it in order to survive, you may speak to the hospital social worker and bring up a court order. The Supreme Court ruled in Jehovah's Witnesses v. King County Hospital Unit No. 1 (390 U.S. 598) that a hospital may seek and obtain a court order requiring the blood transfusion against the religious wishes of the parent in the event of an emergency.

it's true. i asked a lawyer and she says the doctor WILL NOT be penalized for overriding the wishes of the parents AS LONG AS the case goes to court. judges balance conflicting interpretations of the constitution, and yes, while the parents 1) have freedom of religion and 2) have freedom to rear (their kids as they wish), these two rights do NOT override the child's right to life. parents CANNOT 1) abuse their kids, and 2) kill their kids, and the jehovah w parents would be breaking these two laws if they were to prevent the child from getting a transfusion. therefore, if it were me i'd give the transfusion then take it to court.

 

[agent]

Originally posted by Street Philosopher
hmmm i would answer that mistakes happen, everything in life has risks. but then again if it's so bad that they would end my career, well... that must REALLY be bad, like if i walked to the 7-11 during surgery or something. hmmm

at that point it wouldn't really be a mistake, like "oops" but like "i regret having sexual relations with that woman, ms lewinsky" so i mean i would answer that the phrasing of the question is misleading and ask him to rephrase. haha

if he pushes then i'll just point out that this mistake can't be a mistake at all (if the punishment is losing my career) and it would be more like a crime. and like that's like manslaughter so of course i would confess to something like that.

if it's just a mistake or "complication" then i wouldn't say anything because like i said risks are part of the deal and telling the family won't bring back the dead.

you are so right. thats what i meant when i answered mine

 

[Dr JPH]

Originally posted by Amy B
JP,
If you gave the transfusion, you would be in a huge pack of trouble. I know what the parents are doing is wrong but you are a doctor and unfortunetly can not save the world, no matter how much you want to.

I had a friend who interviewed and got this question. When he said he would NOT give the transfusion, the interviewer told him of a court case where the hospital was held responsible for the baby's death.

The world is screwy.

I would rather have a healthy baby and a lawsuit than a dead baby and a guilty conscience.

 

[Dr. Wall$treet]

man tough questions, really a no win situation, like wahts the odds ur gonna have the same view as the interivwer on all of those toughies.. good job to get through that one, every interivew after that wills eem like cake

 

[woolie]

I wonder if there was the option to confer with social services, attendings, senior specialists, etc. so that other people were actively involved in the process.

I don't mean, foist the decision off onto them, but in my working world experience I have found that very delicate and dificult situations call for the opinions of lots of different people. Especially considering these people will be impacted down the line anyway. And, to be honest, as a doctor that IS what I would do.

I woud not decide these issues by myself, but would want the support and censensus of other trained professionals (except the sleeping with your patient, which is actually AGAINST the law; and I would definitely fudge the HMO 3 - 4 issues and find something extra).

 

[DALABROKA]

Even though I would want to fudge the rules that the HMO has given or give the sick infant a transfusion against the parent's wishes, I would not.
The rules given by the HMO may be ridiculous, but the rules are still the rules. If I didn't like the HMO, I would move on to a different place. Bending of the rules one day can lead to some very serious problems in the future. For instance, if a phantom symptom can be manufactured one day, why not two the next. Changing a diagnosis all together can increase the tests available for further diagnosis, this would be even better yet. Hell, after the diagnosis is changed we can just code the case into a higher DRG and increase the compensation to the hospital and to the physician. These types of things can, will, and do get out of hand very quickly. While I don't agree with the rules set out by HMOs and insurance companies, I would be obliged to work within them. These are issues that need to be addressed at a higher level; circumventing the rules by lies and deceit will never get to the heart of the problem.
As far as the issue with the baby goes, once again the laws are there for a reason. One should go through the proper channels prior to doing anything that would violate an individuals' religious beliefs. While it seems ludicrous to prevent ones' own child from having a transfusion that would save his or her life, a physician is not the one to make that type of decision for a parent. This is line that should not be crossed and stems from past abuse facilitated on unwitting and unwilling people that have been involved in medical abuses and research that was based on racial, ethnic, and religious grounds and done in the name of science. Some of these issues cross into the Nuremberg code and informed consent laws. I am certainly not advocating that it is acceptable to withhold medical treatment based on a religious belief, I am simply saying that the decision to override a parents wishes, in the interest of all, should be left to the courts and social services. Mixing medicine with religion can be a very dangerous path to travel down.

DALA

 

[shanet74]

A phone call to the insurance company explaining the symptoms, reason for diagnosis, and need for a specialist would suffice. Often times it is just a matter of communicating effectively with the insurance company. The insurance company would rather pay for the specialist visit, then be sued later for not allowing the patient to be seen by the specialist. If the insurance company still denies, then this should be explained to the patient, but as someone mentioned earlier, lying simply leads to problems later on. Have the patient follow up shortly to monitor the progress of the illness.

Interesting set of questions, but more then likely each of us will see one of these four cases in the future, or very much similar to these cases.

good post Veilside, especially as many of us begin the interviewing process.

 

[monklands monk]

Originally posted by PrincessCKNY
Report anonomously (most likely if I know the physician well)

Be very very careful about doing this - we have a member of staff on suspension who found some info about a colleague on a dodgey internet site. (S)he sent it anomomously to the colleague, the trade union rep and a local news paper. This act has been interpreted as being maliscious and it is believed that it is unlikely that the person will remain in employment in this hospital.

 

[PrincessCKNY]

Originally posted by monklands monk
Be very very careful about doing this - we have a member of staff on suspension who found some info about a colleague on a dodgey internet site. (S)he sent it anomomously to the colleague, the trade union rep and a local news paper. This act has been interpreted as being maliscious and it is believed that it is unlikely that the person will remain in employment in this hospital.

hmm...well, I didn't mean report it to the tabloids and such. I meant report anonomously to the proper authorities (i.e. department manager, etc). However, if it is still a bad idea to you, then I guess go w/ the second option of giving a guy a chance to redeem himself. I dunno...maybe it's that childhood fear of being a nark.

 

[Veilside]

Originally posted by shanet74
A phone call to the insurance company explaining the symptoms, reason for diagnosis, and need for a specialist would suffice. Often times it is just a matter of communicating effectively with the insurance company. The insurance company would rather pay for the specialist visit, then be sued later for not allowing the patient to be seen by the specialist. If the insurance company still denies, then this should be explained to the patient, but as someone mentioned earlier, lying simply leads to problems later on. Have the patient follow up shortly to monitor the progress of the illness.

i actually answered along the same lines. i said that probably i will make an appeal to the hmo. what i was not expecting was his response. he was very unflexible in terms of how i can answer the question. he said that i cannot make an appeal to the hmo, or anything like that. it's just me and the patient. do i send her home or do i lie on the patient chart??? needless to say, a very tough interview

 

[Veilside]

oh and also to clear up a little confusion for question #4
the doctor was having a sexual relationship with A psychiatric patient, not HIS patient.

best,
veilside

 

[Andrew_Doan]

Originally posted by Veilside
i had my stony brook interview yesterday, and here are some of the questions that were asked. i was just curious to know other people's answers to these questions:

1) you are an hmo doctor, and you see a patient. you do a complete physical exam and find three symptoms that suggests that she may have a serious illness. but hmo regulations specifically state that FOUR symptoms are necessary in order for you to refer the patient to a specialist that deals with that particular disease. what do you do?

2) you are a doctor, and the parents of an infant refuse to give the baby a blood transfusion due to their religious beliefs. what do you do?

3) you make a mistake and end up costing the life of a patient. do you tell the family members of that patient even if it means that it will end your career?

4) you find that a doctor is having a sexual relationship with a psychiatric patient. do you report that?

1. In the situation of the HMO doctor, I wouldn't advise lying on the chart. This will come back and haunt you later. If you're concerned about the patient having a serious illness, then order the tests, e.g. MRI, CT, blood test, ect..., that will make the diagnosis. After making the diagnosis, then refer them to the specialist. One good example is SLE (Lupus). If the patient has a malar rash, joint pain, and pericarditis, then you can order a ANA and DS-DNA test. With three symptoms and supportive data, then you can make the diagnosis yourself and then refer.

2. This is a USMLE boards question. In a life threatening event, the physician has the right to make decisions that will protect children. Parents cannot enforce their religious beliefs onto children who cannot make decisions for themselves. If needed, you can involve the hospital's legal services. First, I'd recommend talking to the parents and try to convince them to do what's best for the child. Second, I'd then involve the legal services at the hospital. Third, if it's an emergency, I'd transfuse.

3. If a complication occured that resulted in death, then you are obligated to inform the family. I have found that many people sue because they were left out of the loop and decision making process, only to find out the truth at a later time. The best policy is keeping your patients and their family informed of the truth at all times. Most often, families understand that medicine is not an exact science and if they see that their physicians care about them and the patient, they will not sue even if a mistake was done.

4. This last one was a boards question for me too. You report your colleague to the Department Supervisor/Head. This also includes physicians who are intoxicated during work.

 

[Smoke This]

Originally posted by Amy B
JP,
If you gave the transfusion, you would be in a huge pack of trouble. I know what the parents are doing is wrong but you are a doctor and unfortunetly can not save the world, no matter how much you want to.

That's actually incorrect. It is perfectly allowable legally to transfuse the kid. If there is time to go to court to get it court-ordered, the hospital should do that; otherwise, the justification to give the transfusion can be assumed from innumerable precedents.

If the child were at an age where she could consent herself, that would be a different story. However, it is obligatory in this situation to act in the child's best interests.