How would you respond to this interview question?

[TheMightyAngus]

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Ok so here's the thing. I reread the situation presented in the original post and there are a few things to take into account:

This situation is kind of vague for the following reasons...

1. Do we define outside of the hospital as being right outside of the hospital literally??? Or does it mean somewhere far away from the hospital??

2. If they guy is profusely bleeding to death and some random person you've never seen the patient history of, then how do you know they are even HIV/AIDS positive??? I'm sure AIDS or HIV is not the first thing that is going to pop out of their mouth, for you to know that they are of such status.

3. Do we know if it is something like a bullet through the gut or a gash on the arm that caused the bleeding???

Also, someone mentioned that we see him when we are driving. If we encountered him, that would probably be different then seeing him through a car window. So this all leaves some major questions, because if we are in the car we will probably have more materials to help them (i.e. first aid kit which will have gloves for our own safety).

I think, the person that said it is a way to see how you react under pressure was probably on target. I'd probably call 9-11 and have them apply pressure if possible, where the bleeding is occuring. I doubt if it were someone random, though, that we'd even know the status of the patient as an HIV patient.

1) Within the context of the question, "outside the hospital" means: a) you're not on duty to care for this patient; b) you cannot leave the patient to call for help.

2) Concerning the HIV-positive status of the patient: you are supposed to treat all bleeding patients using the same precautions as though they have HIV, Hep, or any other scary infectious agent.

3) Bleeding profusely means a serious episode that needs to be stopped immediately.

4) Calling for 911 dodges the question because it absolves you from responsibility. The real question is: would you risk contracting HIV in order to help a patient.

Altruism aside, you do not risk contracting a disease that has no cure.
Using clothes to apply pressure to the wound and yelling for help seemed to satisfy the interviewer. I also added that if the blood started to soak through the clothes, I'd stop even if it would risk losing the patient.

 

[gujuDoc]

1) Within the context of the question, "outside the hospital" means: a) you're not on duty to care for this patient; b) you cannot leave the patient to call for help.

2) Concerning the HIV-positive status of the patient: you are supposed to treat all bleeding patients using the same precautions as though they have HIV, Hep, or any other scary infectious agent.

3) Bleeding profusely means a serious episode that needs to be stopped immediately.

4) Calling for 911 dodges the question because it absolves you from responsibility. The real question is: would you risk contracting HIV in order to help a patient.

Altruism aside, you do not risk contracting a disease that has no cure.
Using clothes to apply pressure to the wound and yelling for help seemed to satisfy the interviewer. I also added that if the blood started to soak through the clothes, I'd stop even if it would risk losing the patient.

Ok, so those things had confused me before because of what other posters were saying. But now that you've cleared that up. I don't think that calling 911 absolves you of any responsibility. I'd make the call, and then try to apply the pressure to them by use of clothes or shoes as Suppuration suggested. But I doubt that calling 911 absolves the issue of responsibility, because it shows that you are able to maintain calm and still do whatever possible to get further assistance while trying to deal with the situation in the meantime. I just think that is the most appropriate way of dealing with the situation.

Its like saying someone had a car accident and you see it. Do you just sit there and try to act like your status as MD means you don't need other means to help a person? No, you would still call 911 first and foremost, and then deal with the situation in the meanwhile to help and save the patient if possible.

 

[TheMightyAngus]

Ok, so those things had confused me before because of what other posters were saying. But now that you've cleared that up. I don't think that calling 911 absolves you of any responsibility. I'd make the call, and then try to apply the pressure to them by use of clothes or shoes as Suppuration suggested. But I doubt that calling 911 absolves the issue of responsibility, because it shows that you are able to maintain calm and still do whatever possible to get further assistance while trying to deal with the situation in the meantime. I just think that is the most appropriate way of dealing with the situation.

Its like saying someone had a car accident and you see it. Do you just sit there and try to act like your status as MD means you don't need other means to help a person? No, you would still call 911 first and foremost, and then deal with the situation in the meanwhile to help and save the patient if possible.

I meant the interviewer was more interested in my ethical rationale than the practicalities of the situation.

 

[gujuDoc]

I meant the interviewer was more interested in my ethical rationale than the practicalities of the situation.

I understand that. And I have taken that into account in my response. However, I interpret unethical as leaving the scene and ignoring it, while I consider the ethical and practical thing to do as calling 911 and doing what you can with the rest of the situation by applying the pressure to the blood. Most likely, you won't have a first aid kit, but you will have your cell phone to call 911 and you will have a jacket or some sort of something that you can use to apply pressure to the wound. At least that's my take.

 

[gujuDoc]

Oh and I should also mention that something similar to this happened to us once, when my brother was taking me to get my license. We were outside of the DMV office and this guy had an epileptic attack right before us. So it was a bit different in that there was no bleeding or AIDS, but it was still and urgent matter. I think again, if you see someone in a situation like this, you would call 911 and then use your basic skills to the best you can do in the situation. Its really what it comes down to.

In the AIDS situation, the other thing to take into account is the risk of the bleeding and contracting AIDS, but I think ethically speaking that if you are involved in the scene and have to wait around there for 911 anyways, you should use your own skills as a professional to apply whatever basics you can to stopping the bleeding because, as someone else already rightly pointed out, unless you have a gash........ it is somewhat unlikely you will contract the disease.

 

[TheMightyAngus]

Transfer the situation to an AIDS-stricken developing country where the nearest urgent care center is a half-a-day trek away, then what do you do?

 

[gujuDoc]

Transfer the situation to an AIDS-stricken developing country where the nearest urgent care center is a half-a-day trek away, then what do you do?

In my opinion, you still try to stop the bleeding and try to get anyone around you to go get some more help. But that's just my opinion.

 

[WholeLottaGame7]

I understand that. And I have taken that into account in my response. However, I interpret unethical as leaving the scene and ignoring it, while I consider the ethical and practical thing to do as calling 911 and doing what you can with the rest of the situation by applying the pressure to the blood. Most likely, you won't have a first aid kit, but you will have your cell phone to call 911 and you will have a jacket or some sort of something that you can use to apply pressure to the wound. At least that's my take.

Just so we don't get confused here:
3. ethics (used with a sing. or pl. verb) The rules or standards governing the conduct of a person or the members of a profession: medical ethics.

ETHICALLY, you have no responsibility to help anybody. If you're off-duty, and you don't want to get involved in something, no one is forcing you. You can't be sued for not calling 911 or for not stopping their bleeding. The MORAL thing to do is to call 911 and try to help them anyway you can.

 

[Omicron]

This question is somewhat ambigous. First what is the HIV patient doing outside the hospital. Doesnt he/she have any sense to go into the hospital and ask for help? If he/she made it thus far they might as well push to go in.
Secondly since its just outside the hospital there will be other people around and most likely someone will alert the Emergency department before you have time to think about a glove.
Thirdly responding to the more ethical side of the question, consider a person drowning in quick sand that asks for your help since you are on dry land. It would be foolish to jump into the quick sand in an attempt to help the person because both of you would probably sink and drown. This is a similar situation. You will be much more helpfull to a patient when you maintain your own safety.

First of all, I wonder how someone knows this patient to be HIV+ unless he/she is a regular at the hospital. But that's a side point.

I'd gauge the severity of the situation and--since I'm outside the hospital--I'd run in and grab a pair of gloves and then come out. Alternatively, it may be possible to get the patient on a gurney without bathing in his/her blood. If I deem this possible, I would do this first. If not, I'd either run into the hospital for a pair of gloves or grab someone who's already wearing a pair of gloves.

 

[Suppuration]

That type of reasoning used all the time. Its called triage. If you wanna be a doc, you have to be prepared to make life and death decisions. Practicing medicine isnt all roses.

Gee thanks, Buck-O, but I have my MD, so I possess some slight awareness of the realities of medicine.

That quote was totally taken out of context. Read the entire post. Name one person who has recovered from full blown AIDS. Either he dies from the wounds or dies later on due to AIDS. Even if he did receive a huge amount of blood transfusion, he would die soon due to a now a greatly diminished immune system.

Context or not, I'm just saying that using your rationale in an interview is like stepping on a mine. The doc across the desk could tie you into a pretzel and dip you in mustard with that one.

Anyhoo, we're not talking about full blown AIDS, we're talking about HIV positivity. Go back and read the original post. An HIV positive status used to be a veritable death sentence, but with modern drug regiments the lives of HIV+ patients have been (in general) greatly extended. Better drugs, therapeutic vaccines, etc. may be on the horizon, so it's conceivable that someone who contracted HIV last night could ride the luck train into old age. Who are we to say?

What if the patient's HIV positivity is a lab error? That's happened once or twice (cough). Or how about those pesky long-term non-progressors? You know, those folks who have been HIV+ for 7-12 years with stable CD4 counts >600 and no immunodeficiency symptoms despite an utter lack of anti-viral therapy?

How can you extend life threatening blood loss of an AIDS patient to cystic fibrosis?

Again, this is HIV, not AIDS. BIG difference. Anyways, there is a very strong parallel between an HIV+ patient and a CF patient, because both of them are generally considered terminal conditions. If somebody pulled the whole "he's going to die anyways" routine in an interview with me, I'd toss this one out:

You're a pediatrician who has to break the news to a set of young parents that their kid has CF. He's 8, and his life expectancy is 25. He's hacking up in your office and spraying Pseudomonas everywhere. Do you tell the parents:

A. Excuse me while I get some antibiotics.
B. Sorry, but junior probably doesn't have any more than 17 years ahead of him, so I'd load him up on brandy and break out the velvet pillow.

The bottom line is that yes, we have to make life and death decisions, but we're not inherently entitled to decide who lives and who dies based on our own presumptions about their length/quality of life. Not in emergency situations, anyways. You'll put yourself at risk every day in medicine, so not wanting to treat someone for the sole reason that it presents risk is horse****.

 

[Suppuration]

I might look back and think wtf was I saying?

I'm way ahead of you.

 

[WhatUpDoc!]

Gee thanks, Buck-O, but I have my MD, so I possess some slight awareness of the realities of medicine.



Context or not, I'm just saying that using your rationale in an interview is like stepping on a mine. The doc across the desk could tie you into a pretzel and dip you in mustard with that one.

Anyhoo, we're not talking about full blown AIDS, we're talking about HIV positivity. Go back and read the original post. An HIV positive status used to be a veritable death sentence, but with modern drug regiments the lives of HIV+ patients have been (in general) greatly extended. Better drugs, therapeutic vaccines, etc. may be on the horizon, so it's conceivable that someone who contracted HIV last night could ride the luck train into old age. Who are we to say?

What if the patient's HIV positivity is a lab error? That's happened once or twice (cough). Or how about those pesky long-term non-progressors? You know, those folks who have been HIV+ for 7-12 years with stable CD4 counts >600 and no immunodeficiency symptoms despite an utter lack of anti-viral therapy?



Again, this is HIV, not AIDS. BIG difference. Anyways, there is a very strong parallel between an HIV+ patient and a CF patient, because both of them are generally considered terminal conditions. If somebody pulled the whole "he's going to die anyways" routine in an interview with me, I'd toss this one out:

You're a pediatrician who has to break the news to a set of young parents that their kid has CF. He's 8, and his life expectancy is 25. He's hacking up in your office and spraying Pseudomonas everywhere. Do you tell the parents:

A. Excuse me while I get some antibiotics.
B. Sorry, but junior probably doesn't have any more than 17 years ahead of him, so I'd load him up on brandy and break out the velvet pillow.

The bottom line is that yes, we have to make life and death decisions, but we're not inherently entitled to decide who lives and who dies based on our own presumptions about their length/quality of life. Not in emergency situations, anyways. You'll put yourself at risk every day in medicine, so not wanting to treat someone for the sole reason that it presents risk is horse****.

Wow!!!!! Spoken like a true Doc... Get em

 

[Law2Doc]

Altruism aside, you do not risk contracting a disease that has no cure.
Using clothes to apply pressure to the wound and yelling for help seemed to satisfy the interviewer. I also added that if the blood started to soak through the clothes, I'd stop even if it would risk losing the patient.

I guess the real question is did this interviewer give you a good recomendation -- i.e. did you get in? I suspect that if you said - I'm not going to risk getting exposed to HIV blood, so I will do whatever I can without actually coming in contact with his blood, that might not necessarilly be positively received by every interviewer.
But to keep this thread interesting, what if the interviewer didn't tell you this person was HIV+ (actually a better question) -- and was just someone you saw bleeding on the street (and let's assume that you are not particularly close to the hospital) -- would that change your answer? (i.e. the risk is the same, but your knowledge is not).

 

[WhatUpDoc!]

I guess the real question is did this interviewer give you a good recomendation -- i.e. did you get in? I suspect that if you said - I'm not going to risk getting exposed to HIV blood, so I will do whatever I can without actually coming in contact with his blood, that might not necessarilly be positively received by every interviewer.
But to keep this thread interesting, what if the interviewer didn't tell you this person was HIV+ (actually a better question) -- and was just someone you saw bleeding on the street (and let's assume that you are not particularly close to the hospital) -- would that change your answer? (i.e. the risk is the same, but your knowledge is not).

Nawww... not a better question, an easier question that wouldn't let the interviewer know anything about your moral or ethical standpoints (Save that you're an dingus for just leaving the dude ). If this were the question then a right and wrong answer is blaringly apparent.

 

[Suppuration]

But to keep this thread interesting, what if the interviewer didn't tell you this person was HIV+ (actually a better question) -- and was just someone you saw bleeding on the street (and let's assume that you are not particularly close to the hospital) -- would that change your answer? (i.e. the risk is the same, but your knowledge is not).

As someone mentioned earlier, you are supposed to presume that everything that squirts out of a person is infectious and act accordingly. The person's HIV status is therefore technically irrelevant to how you should handle the case.

 

[Suppuration]

why are you more concerned of his HCV status???

HCV is more easily transmissible (by needlestick, at least). Then, 20-30 years later you have a 60-70% chance of getting chronic hepatitis, 10-20% chance of cirrhosis, and a 1-5% chance of good old HCC.

 

[eccles1214]

I was asked this question at my last interview, and it left me like a deer in the headlights:

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

First, I would quickly assess the situation. The fact that you know the patient is HIV+ is a bit hint. Let's pretend that you don't know the patient is HIV+ but is still bleeding. Given this, this patient could be anybody. After all someone can be HIV+ and not know it (maybe they just became seropostive but haven't had a recent HIV test).

What would I do sans gloves? I would do what I would for any patient whose medical history is unknown. I would try to stem the bleeding by applying pressure with some sort of barrier to prevent contact with the blood: a shirt, piece of plastic, etc. And I would make sure that more advanced care i.e. was summoned. Even though we are outside the hospital, where outside the hospital are we? in the back alley, on a side street? Medical complexes are huge and where you are may be blocks from the hospital or ER entrance.

 

[Psycho Doctor]

First of all, I wonder how someone knows this patient to be HIV+ unless he/she is a regular at the hospital. But that's a side point.

I'd gauge the severity of the situation and--since I'm outside the hospital--I'd run in and grab a pair of gloves and then come out. Alternatively, it may be possible to get the patient on a gurney without bathing in his/her blood. If I deem this possible, I would do this first. If not, I'd either run into the hospital for a pair of gloves or grab someone who's already wearing a pair of gloves.

i said the same thing. i guess he's wearing a sign saying "I'm HIV+ but please help me!"

 

[Psycho Doctor]

HCV is more easily transmissible (by needlestick, at least). Then, 20-30 years later you have a 60-70% chance of getting chronic hepatitis, 10-20% chance of cirrhosis, and a 1-5% chance of good old HCC.

tell me about it....not even 20-30 years later

 

[WhatUpDoc!]

i said the same thing. i guess he's wearing a sign saying "I'm HIV+ but please help me!"

Geez... just take all the fun out of hypothetical situations 😛 . I'm still trying to figure out how why the chicken crossed the road, when there was an overpass 2 miles down yonder Damn those stupid chickens and HIV advertising bleeders!!!

 

[SteelEyes]

It's quite simple. Rescuer safety comes first. Period.

 

[Law2Doc]

It's quite simple. Rescuer safety comes first. Period.

Well, you could be perfectly safe (and within your legal rights) staying clear across the street -- but I suspect that isn't a good answer if you hope to go to med school. Medicine is a messy business, and you will at some level be exposed to various diseases - you take whatever precautions you can, but you cannot eliminate all risks, or opt to not examine or help someone because they might have some illness you can catch. When someone on a plane, at the beach, or at the theatre asks "is there a doctor in the house" you are supposed to present yourself, not stay quiet because you don't have gloves handy. I would guess that the "right" answer is that you take whatever precautions you reasonably can, but still try to provide some degree of help. (Most important for the interview though would be to see this person as a person and not a disease.)

 

[SteelEyes]

I never said I would do nothing. I simply said rescuer safety comes first. "First, do no harm" applies to ourselves too. We have to be smart and recognize our own weaknesses and vulnerabilities. We owe it to ourselves and our families to be smart about it.

And as a sidebar, as far as me getting into medical school, been there done that bought the T shirt. I'm an MD now. I've never shyed away from a situation, but you protect yourself as much as possible. I don't neglect the TB patient I have now, I wear my respirator. I don't avoid my many HIV patients, I wear gloves.

As physicians, unless you're a radiologist, you're being exposed to disease and risks daily. It is imperative to be diligent about personal safety as well.

 

[dbhvt]

unless you're a radiologist, you're being exposed to disease and risks daily. It is imperative to be diligent about personal safety as well.

I seem to recall a study about the incidence of cancer and radiologists.

Where is it, mr. pubmed...?

Maybe this is it:

Richard DOLL: “Mortality of British Radiologists: A Lecture Note”. Journal of Radiation Research, Vol. 46, 123-129 (2005) .


Wait, that might not be the one I was thinking of, but the abstract seems to come to the same conclusion.

Anyhow, radiologists have risks too.

 

[gujuDoc]

I seem to recall a study about the incidence of cancer and radiologists.

Where is it, mr. pubmed...?

Maybe this is it:

Richard DOLL: “Mortality of British Radiologists: A Lecture Note”. Journal of Radiation Research, Vol. 46, 123-129 (2005) .


Wait, that might not be the one I was thinking of, but the abstract seems to come to the same conclusion.

Anyhow, radiologists have risks too.

👍

That's all.

*EDIT*
Actually, I take that back. There's something I'd like to add.

If you work in a hospital you are at risk all the time, because the hospital is one of the places where people are most at risk of contracting diseases.

Hence, the term NOSOCOMIAL INFECTIONS!!!!!!!!!!! So in theory, everyone's at risk if they are working around the sick, granted that not all docs work in hospitals.

 

[SteelEyes]

Well it's only a matter of time before all radiologists read from their homes. With computer imaging, there will be less and less reason to be in the hospital at all. PACS is awesome!

 

[Jon Davis]

Well it's only a matter of time before all radiologists read from their homes. With computer imaging, there will be less and less reason to be in the hospital at all. PACS is awesome!

On the flip side, some hospitals are outsourcing their work since you can send it over the internet (ex: send the info to india at night while it is daytime there). I haven't kept up with the situation with the rads. Will it still be a strong specialty in the future?

 

[45408]

For those of you who are so concerned about contracting a life-threatening virus that you neglect your responsibilities as a health care provider, maybe you should pick a profession that limits your exposure to such dangers. Try medical transcriptionist.

🙄 Please. My responsibilities as a health care provider don't extend to helping every injured person I see. If there's an MVA with FD on scene, I don't jump out of my car and say "Everybody freeze! I'm an EMT, and I know what to do!"

You're exaggerating the situation to a painful degree. If I was in the OR, and my patient was bleeding to death, and I refused to do anything, that would be neglect.

Let me reiterate: my safety > patient safety. I highly doubt that adcoms or physicians are going to disagree at all. Plunging your unprotected hands into the blood of a person with a fatal, incurable disease is absurd.

But you make a good point. I'll withdraw all my applications now and apply for a medical transcriptionist program. 🙄

 

[Suppuration]

🙄 Please. My responsibilities as a health care provider don't extend to helping every injured person I see. If there's an MVA with FD on scene, I don't jump out of my car and say "Everybody freeze! I'm an EMT, and I know what to do!"

You're exaggerating the situation to a painful degree. If I was in the OR, and my patient was bleeding to death, and I refused to do anything, that would be neglect.

Let me reiterate: my safety > patient safety. I highly doubt that adcoms or physicians are going to disagree at all. Plunging your unprotected hands into the blood of a person with a fatal, incurable disease is absurd.

But you make a good point. I'll withdraw all my applications now and apply for a medical transcriptionist program. 🙄

Dude, you're totally overreacting to a perfectly valid point.

 

[jebus]

Well it's only a matter of time before all radiologists read from their homes. With computer imaging, there will be less and less reason to be in the hospital at all. PACS is awesome!

Ha ha! Why pay an American radiologist when you can get an Indian or Chinese radiologist who will do the same job for one fifth of the price? It's already happening. They're called "nighthawks". At home? I assume you mean the American radiologist will be unemployed.

 

[Law2Doc]

Ha ha! Why pay an American radiologist when you can get an Indian or Chinese radiologist who will do the same job for one fifth of the price? It's already happening. They're called "nighthawks". At home? I assume you mean the American radiologist will be unemployed.

The nighthawk system has yet to damage radiology practices, and probably won't for a while. For hospital liability reasons, the persons reading the radiology films definitively will likely need to have US licensure -- which means either the US trains and exports those willing to work from India (which may defeat the savings), or just uses this kind of system as a "first draft" review of films, which the licensed radiologists can review when they come in in the morning.
But FYI radiologists do a lot more than just read films, and many are greatly expanding the scope of their practice into the more interventional (hands on) areas thanks to the evolution of real time diagnostic technology. Not the kind of stuff you can do from home. (And will result in increased exposures to infectious people for this specialty -- to stay on point with this thread)

 

[Medic_9]

I'm surprised no one has thought of asking the patient to hold pressure on the wound himself.. Also what about indirect pressure if you are that worried about infection.

--My take--
Call 9111 (no matter what your training you are nothing but a textbook of knowledge without the tools you normally use. ie. tests, EKG, monitor) You can't not call 911. What are you going to do, sit applying pressure to this known/unknown patient forever? The patient needs higher care, the ambulance will take them there.. (hey..I made a rhyme!)

Don't strip! Use the patients clothes, hand, go back to wherever and get gloves and bandages.

Remember, it's not your emergency, don't treat it as such.

 

[45408]

Dude, you're totally overreacting to a perfectly valid point.

Not in the least. WhatUpDoc! committed the common fallacy of taking an argument to an extreme - suggesting that my (and others) lack of desire to plunge my hands into a geyser of blood (that I know to be contaminated with a fatal virus) is equivalent to being unwilling to treat any patients with infectious diseases at all.

 

[it.]

i'd laugh at the guy's misfortune




j/k i'd open a fire hydrant and hose the guy down. that oughta clean up the guy's mess

 

[Philo Beddo]

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

I still don't know what the proper answer is, any suggestions?

They just want to see some sort of inner debate. They want to know you care about others, but make rational decisions.

hippocritis.com <---medical satire for students and residents.

 

[riceman04]

Here's one tack. Assume you have a family. You have more responsibility to your family than to this patient. Dying for the patient and leaving your kids without a parent is not ethical.

or would that be immoral!????

So you say unethical....but I am not sure if it would be based on ethics or morality...

What's the diff btwn ethics and morals?

 

[WhatUpDoc!]

Not in the least. WhatUpDoc! committed the common fallacy of taking an argument to an extreme - suggesting that my (and others) lack of desire to plunge my hands into a geyser of blood (that I know to be contaminated with a fatal virus) is equivalent to being unwilling to treat any patients with infectious diseases at all.

Damn, if I implicitly suggested all that, I must be good 😎 Damn good. But to clarify (because I hate committing fallacies, my philosophy teachers would be shamed), I don't think anyone in their right mind would DESIRE to plunge their hands into a geyser of HIV infected blood (and I'm being accused of exaggerating 😕 ). Before I make my next clarification, I think an example is in order. A fire-fighter rushes into a burning building knowing that his life is in just as much jeopardy as the rescuee's. Does he say, "well damn, let me wait until the fire is out, and then I'll get to that poor old lady on the 3rd floor." Or does he say "this is my job, and I'm going to bust my ass in there and save that woman like the ass-kickin fireman that I am." I think he chooses the latter my friend. This is all I'm trying to say with helping out the bleeding HIV+ dude. If you're a physician, do your job. You got gloves with you... GREAT!!! If you don't, oh freakin well, who's to say the gloves you retrieve won't have a microscopic tear in them anyways. Did I take it to the extreme again, or wait, maybe my argument by analogy is invalid too. I'll never get my point across 🙁

 

[Suppuration]

Not in the least. WhatUpDoc! committed the common fallacy of taking an argument to an extreme - suggesting that my (and others) lack of desire to plunge my hands into a geyser of blood (that I know to be contaminated with a fatal virus) is equivalent to being unwilling to treat any patients with infectious diseases at all.

Interesting. All I heard him say was: "For those of you who are so concerned about contracting a life-threatening virus that you neglect your responsibilities as a health care provider, maybe you should pick a profession that limits your exposure to such dangers."

The first mention of hand plunging was yours. I reckon we're just interpreting the statement "responsibilites of a health care provider" differently. I read that to mean an inherently reasonable approach to minimizing one's own risk while still trying to help the patient. You read it and saw hand plunging. I'd say that if anyone is making the fallacy of taking something to an extreme, it's you.

 

[dragonmate]

I don't think anyone with EMS experience would touch that person, or honestly say they would. Doctors seem much more cavalier about these things for some reason, so maybe some physicians would see that as a "wrong" answer.

Most of the time, interview questions like that are designed to see how you handle pressure and how you think about the problem. Don't get rattled; do think about your response and explain your thinking clearly, and then try to stay with your position. You will probably come off well if you can articulate your reasoning and not change your answer under pressure.

Or not.

You're right. An EMT would never touch that person. It's a safety hazard. As altruistic as we would all like to think we are, we must take care of ourselves first and foremost. And from a more logistic pov, it still makes sense not to touch him because if we save him, we save one person. If we die, that trickles down to all the other possibly 100's of lives that we could've saved in the future. Either way you look at it, I would not touch that person, but definetely call 911.

 

[dbhvt]

What's the diff btwn ethics and morals?

The way I use the words:
Choosing "moral" puts the emphasis on an individuals ideas about right and wrong.

Choosing "ethical" puts the emphasis on societies ideas of what a person ought to do.

 

[Suppuration]

You're right. An EMT would never touch that person. It's a safety hazard. As altruistic as we would all like to think we are, we must take care of ourselves first and foremost. And from a more logistic pov, it still makes sense not to touch him because if we save him, we save one person. If we die, that trickles down to all the other possibly 100's of lives that we could've saved in the future. Either way you look at it, I would not touch that person, but definetely call 911.

So in other words, you would sit in front of an interviewer and, with a straight face, state that you would watch someone bleed out in front of you rather than expose yourself to a *miniscule* chance of contacting HIV (as in less dangerous than my morning commute). I'm not talking about hand plunging, either, I'm talking about finding a way to apply some pressure. You would rather do NOTHING and watch somebody expire on the pavement. Oh, wait, you're off calling 911 so you won't actually get to see the moment of death. If that's the result of your personal decision tree analysis, that's fine. As someone who has been coughed on, bled on, and hooked once or twice in the OR (skin didn't break, but thanks for asking), I'd say that your decision sucks.

 

[WhatUpDoc!]

So in other words, you would sit in front of an interviewer and, with a straight face, state that you would watch someone bleed out in front of you rather than expose yourself to a *miniscule* chance of contacting HIV (as in less dangerous than my morning commute). I'm not talking about hand plunging, either, I'm talking about finding a way to apply some pressure. You would rather do NOTHING and watch somebody expire on the pavement. Oh, wait, you're off calling 911 so you won't actually get to see the moment of death. If that's the result of your personal decision tree analysis, that's fine. As someone who has been coughed on, bled on, and hooked once or twice in the OR (skin didn't break, but thanks for asking), I'd say that your decision sucks.

I second, triple, and quadruple that 👍

 

[45408]

You would rather do NOTHING and watch somebody expire on the pavement.

Well, glad to see that while I was away, someone else was busy taking arguments to the extreme. 👍

 

[45408]

Does he say, "well damn, let me wait until the fire is out, and then I'll get to that poor old lady on the 3rd floor." Or does he say "this is my job, and I'm going to bust my ass in there and save that woman like the ass-kickin fireman that I am." I think he chooses the latter my friend. This is all I'm trying to say with helping out the bleeding HIV+ dude. If you're a physician, do your job. You got gloves with you... GREAT!!! If you don't, oh freakin well, who's to say the gloves you retrieve won't have a microscopic tear in them anyways. Did I take it to the extreme again, or wait, maybe my argument by analogy is invalid too. I'll never get my point across 🙁

Yeah, your analogy is pretty invalid. The firefighter is wearing as much protection as possible, and by analogy, so do surgeons/physicians, by wearing gloves and masks and such.

 

[WhatUpDoc!]

Yeah, your analogy is pretty invalid. The firefighter is wearing as much protection as possible, and by analogy, so do surgeons/physicians, by wearing gloves and masks and such.

Lost cause 😴

 

[45408]

Lost cause 😴

Pot? Kettle. Black.

 

[Suppuration]

Well, glad to see that while I was away, someone else was busy taking arguments to the extreme. 👍

In the context of "I would not touch that person" = certain death, it was a little difficult to water it down.

 

[DeterminedMD]

There is no right answer......it is meant to see how you react. But honestly who here can say they would actually take the risk of contracting the disease. Not many. It is a tough dilemma though. Before i started med school I became certified as an EMT and the first rule was ALWAYS make sure the scene is safe and you have proper personal protective gear. Otherwise you do not go in. So it is fine to not treat the person. What you should do however is make sure help is on the way.

 

[gujuDoc]

There is no right answer......it is meant to see how you react. But honestly who here can say they would actually take the risk of contracting the disease. Not many. It is a tough dilemma though. Before i started med school I became certified as an EMT and the first rule was ALWAYS make sure the scene is safe and you have proper personal protective gear. Otherwise you do not go in. So it is fine to not treat the person. What you should do however is make sure help is on the way.

The above bolded is exactly why I said call 911, and the OP said that it would make the answer too easy and then tried to spin it around like what if it weren't in a country with 911. But I still think that's the best thing to do, and then if there is protective gear nearby like if you are directly outside of the hospital, then get the protective gear and do what you can, and have the patient apply pressure if possible.

 

[Flopotomist]

As long as I have intact skin, my understanding is that the transmission rate approaches (if not equals) zero. Therefore, I would check myself for open cuts or sores, and if I had none, I would treat the patient the same way I would treat any patient. Also, because I assume that ANY bodily fluid I encounter is potentially infectious, this would not change if I "knew" that the patient was HIV negative.

I have to ask though, what on Earth caused this patient to be so bloody in the first place? Is there a knife-wielding mad-man running lose? That would pose more of a threat than HIV. Is the patient not able to apply pressure to him/herself?

I would use a shirt or some other available material to apply pressure and do my best to control bleeding while coordinating to get the patient to a higher level of care. I don't think this is being a "hero" or acting recklessly, so the quicksand analogy does not apply.