How would you answer these interview questions?

I don't feel like thinking about answering number 1, but I'll answer number 2.

Don't let this question fool you. If you have been interviewing for 1 hour and that interviewer has asked you tons of questions about your app, it's not uncommon if you don't have anything else to say. It's okay to say no, and to thank them for their time. That being said, it would be nice if you could think of something not in your application that you could tell them...but definitely not required.

 

1. Something to the effect of "whoever's higher on the list," i.e., the transplant list, which is how this would probably work out in real life. Doctors can't make these kinds of decisions ethically.

2. I usually just took this time to talk about my intangible characteristics (compassion, commitment, etc).

 

I was asked something similar to the first question at one interview. I made a decision and explained my reasoning and answered the follow-up questions that the interviewer had for me. Accepted.

I was asked the second one by 4 separate interviewers at 3 different schools, and each time I responded with "uhh...not that I can think of, no." Accepted at all 3.


Interviews are important, but I really don't think your application will be made or broken by your answer to one question, unless your response to "why medicine?" is "uhh...that's a good question. I've never thought about that before."

 

I usually like to use the last item to update schools about stuff that I've been doing since I submitted my application that I usually don't get around to discussing during the interview. Saves me an update letter up front and it usually stimulates a few more minutes of conversation.

 

I would make a reality television show like Survivor where that patients would have to best each other at eating bugs and whacking each other over the head with giant foam q-tips in order to win the cure.

 

On saving the patient:

Appoint a three person panel to communicate with the patients. One of the patients will die. Ask if they will be willing to fight to the death, then save the survivor. If they don't agree, then pick a number between 1 and 69 to be chosen by the panel. The closest will get the cure.

 

I am going to disagree with Spurs here. In a hospital setting, yes, there will be an order/list - but this question is a hypothetical with two theoretical equivalents. I think a proper answer would be something along the lines of use of a placebo:

Make a syringe of the drug and one of saline, or a pill and an sugar pill, or whatever form the drug/cure is in. Mix the two of them up so even you don't know which is which. Administer one to each patient, and "[FONT=Arial, Helvetica, Geneva]remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.."

 

1. Flip a coin- best way to be non-biased and it's not the doctor's job to assign value to someone's life. (actually, I'd try to make more of this super cure, but hey... stupid scenario)

2. My first car was a 93 VW Fox. <- there is plenty of info about you that isn't in your app. You can mention it just for the sake of conversation. Bring up something new, it doesn't have to be related to medicine.

 

The only fair way:

 

I'd propose that the cure be distributed evenly amongst the two patients, not necessarily to save both of their lives, but rather to prolong both of them until more of the cure could be obtained to fully save them both.

(This may be prohibited due to the theoretical nature of the question, but it's another "fair" approach that is worth mentioning).

 

I suspect the "correct" answer is to give the cure to whoever is otherwise healthier and thus can benefit most from having this disease cured. Talk about the Seattle God Commission and the problems that occured when doctors first tried to distribute uneven dialysis resources.

http://www.aei.org/publications/filter.all,pubID.28156/pub_detail.asp

 

I've got a good one

If your 3 year old child smashed his finger with a hammer and began to cry, what would you do?

I couldn't believe they asked me this...

 

If i were interviewing you I'd totally accept you on the basis of that alone. I f'ing love that car.

VW!

 

poor man's porche.

 

From a pharmacological standpoint, you would kill both patients by not giving the proper dose

I think they really just want to see how you think about these kinds of situations and ultimately they will force you to choose one patient or the other. There is no wrong answer.

 

For #1. You can't play God. Therefore, you can't choose one person over the other. "I understand the difficulty of this situtation, but I would consult a committee so that I did not have to bear the weight of this decision alone. By consulting my colleagues for their opinions, I will be able to make a decision free of personal bias."

 

A committee would also involve bias in the final decision. It's true that no one person alone should be empowered to judge the worth of someone's life over another's...but neither should a committee of people who potentially have biased opinions of their own. I assume that's why there is first-come-first-serve transplant list instead of a transplant committee that judges each individual case to determine who "deserves" the organ more.

 

2 - working on a comic book. I mean, really. As depakote pointed out..it's not too difficult.

Also, for 1, i'd just dilute it 1:2 and give them both the cure and then, if they want, let them drink each others blood for hte other half if they can get to it before the liver processes it.

But honestly, we all know the answer to number 1

"We're going to play a little game, and oh yes, there will be blood. Both of you have this disease. I have insert half of the required amount of the cure into seperate capsules and surgically placed them inside your body. How you get them is up to you...."

 

There is definitely a time component to the list, but other factors affect it as well. A committee oversees this list (UNOS).

 

Yes there is a transplant list committee but I'm saying that those people aren't making opinion-based judgment calls on whose life is more worthy of saving. The other factors that you speak of are objective, not subjective (i.e. who is in imminent medical danger). So in terms of the OP's original question, I don't think a committee of physicians that you suggested would make a sound decision on which patient to give the drug to, since it would undoubtedly be tainted by personal opinion (since there are no objective "rules" like there are for transplants).

 

1. Ask for a volunteer to accept his fate. Some people are more ready for death than others.

 

It's entirely possible that if someone knows that they can voluntarily save the life of someone else by sacrificing their own, they would do it. So the first step would be to let both patients know the situation and see if either one is forthcoming.

But setting this aside, if you've got two people who are completely equal in every respect - neither one more deserving than the other - then I guess you would give it to whoever came through the door first. The alternative is that if they were both very old, you don't give this miracle treatment to either one, and instead reserve it for someone much younger. But otherwise: first come, first served.

 

I don't know about this...how old is too old?

 

I agree. It'd be impossible to determine a definite age past which someone shouldn't get the drug. Also, it's unethical to deem an older person undeserving of a life saving treatment over a younger person simply based on age.

 

That's how organ transplants work. 70 year olds don't get livers, people in their 50's do. If you're a fan of Phil Lesh/Evel Knievel/Linda Lovelace, no doubt you would agree that age is a germane factor.

 

It's directly based on age but indirectly based on a lot of other things like the number of years of life that younger patient still potentially has and what he could do with those years.

Of course, if these patients are exactly the same in every way like some people have suggested, just flip a coin. There's no way to come to the best conclusion if they are both exactly the same.

 

Definitely speaking for myself here, but it seems extremely callous to let a simple heads/tails decide someone's fate. If my doc came up to me and said, "we sat down and talked about it, and we've decided to flip a coin" my response would be, "you're not taking this very seriously, are you?"

Honestly, we can pinpoint a nascent tumor with PET scans and do brain surgery with a catheter, but you're going to let a coin decide a pressing ethical issue? Anything is better than a coin flip.

 

...pretty sure he meant it as a joke.

 

I'm pretty sure that organ transplants are determined by a list, regardless of age. A healthy 70 year old can get a liver if he's further up on the lsit than a 50 year old. Maybe older people are more likely to have medical issues that make them ineligible for transplants, but age alone is not what determines priority for transplant. Someone correct me if I'm wrong here as I'm no expert on transplant ethics.

 

A young person may have more years to live, but you cannot fairly and objectively assume that that person is going to do something productive with them. If you use this "who has more potential" logic then there would be a lot of prejudice in the organ transplant system. For example, by that logic, you'd give an organ sooner to a 30 yr old Ivy-grad lawyer with a wife and a kid than to a 55 year old single homeless person. You can't just assume that the latter is less deserving of life simply because he/she has less "potential".

 

Hahahahaha. Hilarious... Or you could just have them do rock, paper, sissors. Best two out of three, of course.


AtG

 

scissors*


AtG

 

I agree, the error in a single coin flip is too great for it to be a good basis for decision making. Best of three should be made the standard.

 

Phil Lesh

I was serious. I mean an intern and I could break out the Rock 'em Sock 'em Robots, draw the name from a digitally calibrated science hat or play Rock Paper Scissors for it but this should be a non-biased decision given the scenario presented.

 

Heh, it was a joke, BUT this is still assuming the patients are EXACTLY the same. What's there to analyze? How do you determine which one should receive the cure when they're the SAME?

When I'm a doctor, of course there will be no coin flipping, but the point of this question is that there's virtually no wrong answer.

 

But we're not talking about organ transplant lists. We're talking about this hypothetical scenario. Plus, I was just giving one factor; I didn't bother to list many other potential factors. That's why we have lists, so we can follow the "first-come, first-serve" idea, rather than choose who gets to live and who gets to die.

 

That's generally the way it's going to go anyway, if only because the 55 year old homeless guy is probably on drugs, has a laundry list of other problems, or is too poor/disinterested to keep up his immunosupressants. Because organs are in short supply relative to the demand, they have to be rationed, and how much mileage you're going to get out of your new organ is important in making that decision.

First off, I'm not surprised that you're a Phil Lesh fan. I'm guessing if Jerry had lived a little longer, he would have needed an organ transplant too, but that's neither here nor there.

It's true that you want a non-biased decision, or as close to one as you can get. But bias is a question of introducing conflicting values, and you can make decisions that don't break too hard with respect to ideology. If we assume that both people have the same degree of need, then there's other valid considerations: who got there first? Who will get better use of it? I don't think you're removing bias by drawing names out of your calibrated science hat; you're surrendering the ability to make the decision.

 

Well it's a lifesaving "cure". One will live one will die, so someone's going to get good use out of it. Beyond that your definition of "best use" becomes subjective. You start assigning value to someone's life b/c you find x or y aspects important... bias has entered the decision making process.

And who got there first? So I give it to someone b/c they had the before lunch appointment instead of the afternoon when the other dude did? Talk about bad timing. Mine seems a bit more fair in the distribution, everyone gets a fair crack at it.

You're absolutely surrendering the ability to make a decision in this situation because it's a situation where human bias (conscious or otherwise) should not be allowed to have an impact.

 

I agree with you somewhat. Except I do think someone who is well educated, younger, and has a family should be the first choice as to who gets the cure. Look at it this way, sure a homeless 50 year old would be a tragic loss, but if the 30 year old lawyer/doctor/engineer lives, he can benefits hundreds of lives in the long run. Therefore saving that person....you are technically saving hundreds of other people in the future. If you do the math thats 1000..... vs. 1? I know this sounds terrible, but honestly speaking I would go for that one....

 

1. Have a committee figure it out, that's there job.

2. Nope

 

Sure it's a hypothetical situation but I don't know why it wouldn't follow the exact same standards with which we treat organ transplant. In both scenarios, there is a shortage of life-saving treatment (i.e. transplant or drug) and there are too many potential recipients. I'm guessing that this interviewer was simply disguising the somewhat expected "who gets the organ transplant?" question.

 

This might be your (and many others) instinct but it's still not ethical to make that kind of judgment call on who should live and who should die. While physicians should be moral individuals, they cannot fairly make that kind of decision as it would be based on personal opinion. I don't think an official "ethics committee" can make that decision either. It needs to be objectively driven, whether that be through a list or a random process.

 

The interviewer still wouldn't be impressed with the answer, "Whoever got there first." The organ-transplant list standards are still subjective because they don't just depend on whoever got there first (the objective part). Doctors also take into consideration how they live (bad habits, etc.) and what they plan to do. Like you said, "there is a shortage of life-saving treatment," and doctors HAVE to reason where organs and in this case a cure will be used the best. The organ transplant list is not purely objective.

Which is, once again, why some of us have mentioned flipping a coin (within the hypothetical scenario, not reality ) because each person has a 50% chance which is FAIR and OBJECTIVE. On the other hand, whoever got there first has 100% chance of getting the cure, and the other has 0% chance. Lists work in real life because eventually there are more organs, but in the hypothetical scenario, there is only one cure so there is no hope for whoever gets there second.

 

Some posters on this thread seem to be conflating age and social status. The issue of a 30 year old lawyer (let's say doctor, to make it clear that it's positive ) vs a 50 year old homeless man can be reframed as a 30 year old otherwise healthy individual vs a 50 year old individual with multiple comorbidities. It is unethical for me to judge what they are going to to do with their life, but it is not unethical for me to judge HOW MUCH life I can save. Even if they could both be expected to have a normal life expectancy when given the treatment, it makes sense to treat the 30 year old, because that way I am maximizing the effectiveness of the treatment.

The question is simply a metaphor for public health policy; replace "single dose of cure for some rare disease" with "limited resources for health care". It seems to me that no wise policy would spend $100,000 on chemotherapy to extend an 80-year-old's life by 6 months if that same $100,000 could extend a sick child's life by 60 years.

 

I think this is a great idea if you are confident talking about yourself in this abstract kind of way. Confidence is everything, really.

Btw, just my take, but I think its kind of awkward to say "no" to this question. There should be more to you as a person that qualifies you for medical school than they can possibly learn in less than an hour.

 

The "list" is not first-come first-served. I've sat in on a transplant committee meeting and factors from age and lab values to a social work evaluation all come into play.

I think a "healthy" (obviously he's not healthy if he needs a transplant) 70 year old would have a very hard time getting a transplant.

 

General rule is to stay away from sensitive subjects if you can. Unless there's a specific reason why you would want to bring up universal health care, I would leave it alone.

Of course, it is fair game for questions. Be prepared to explain your stance and your reasons.