Interview Prep Issues

[HughMyron]

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Going over the practice questions list...here are some issues I found:

What impact do you want to have on medicine?
Like hell if I know, it's not as if I'm going to find the cure for AIDS or save Namibia from tuberculosis or whatever. What are they even looking for with this question?


A patient who has been in an accident needs a blood transfusion. She states that her religion does not allow them. You are the physician in charge. What will you do? Will you override her strong objection? Why or why not?
I would say to NOT override the objection. I believe a Supreme Court case upheld the right of a patient to refuse treatment, but I'm not sure. Is this a question to test your legal knowledge or your ethics or what?


How would your plans differ if you knew that all physicians would be working in HMOs in the future?
From what I understand, it would make the more remunerative specialties less valuable because in groups such as Kaiser, they would have to share money with family practitioners and less-earning physicians. I am probably totally wrong tho. I don't know much about health policy.

I also don't really know what to say to the adcoms, since talking about money is taboo.


If there were an accident on the highway, would you stop and help the victims, knowing that doing so might lead to a malpractice claim?
Obviously the adcoms want you to say "yes," then give some cock and bull answer about your duty to help people, and how the omission of help is as good as killing them. How would you justify this so as not to appear naive?


Fix one thing about the United States healthcare system.
This is tricky. 🙁

 

[darkjedi]

Going over the practice questions list...here are some issues I found:

What impact do you want to have on medicine?
Like hell if I know, it's not as if I'm going to find the cure for AIDS or save Namibia from tuberculosis or whatever. What are they even looking for with this question?


A patient who has been in an accident needs a blood transfusion. She states that her religion does not allow them. You are the physician in charge. What will you do? Will you override her strong objection? Why or why not?
I would say to NOT override the objection. I believe a Supreme Court case upheld the right of a patient to refuse treatment, but I'm not sure. Is this a question to test your legal knowledge or your ethics or what?


How would your plans differ if you knew that all physicians would be working in HMOs in the future?
From what I understand, it would make the more remunerative specialties less valuable because in groups such as Kaiser, they would have to share money with family practitioners and less-earning physicians. I am probably totally wrong tho. I don't know much about health policy.

I also don't really know what to say to the adcoms, since talking about money is taboo.


If there were an accident on the highway, would you stop and help the victims, knowing that doing so might lead to a malpractice claim?
Obviously the adcoms want you to say "yes," then give some cock and bull answer about your duty to help people, and how the omission of help is as good as killing them. How would you justify this so as not to appear naive?


Fix one thing about the United States healthcare system.
This is tricky. 🙁

A critical things to know about some of these policy/healthcare questions is that even the experts on the matter disagree on what is the right thing to do. If you reply with a concrete answer there is always that chance that your interviewer may disagree with you. Additionally a concrete answer coming from a pre-med has the risk of coming off as presumptuous/know-it-all-y.

That said I was only asked a question similar to this once in my entire interview trail. Just make sure you come across as humble and give an answer that seems thought out and knowledgeable while admitting your lack of expertise on the matter.

 

[mimelim]

Going over the practice questions list...here are some issues I found:

These are relatively simple/easy questions. Just shooting from the hip...

Question: What impact do you want to have on medicine?
Purpose: Most doctors will not make a significant scientific contribution to the medical field. That having been said, medical schools and residencies are always looking for people who think they will or show the capacity to make an impact in one of many ways. There are tons of applicants every year. Many of them with similar backgrounds, extracurriculars and stats. What separates them is their attitude. Good students are a dime a dozen. Someone who wants to make an impact and demonstrates that they can impact an area of medicine or local is going to be productive. Medical schools and residencies want productive people.
What are they really asking and looking for: Are you a good student that can do what your told and nothing else? If you can't easily answer this question, either your drive or your motives are called into question. If you lack confidence yourself to make a difference, you won't. If you are going into medicine 'for the wrong reasons', you won't be able to answer this question without lying.


Question: A patient who has been in an accident needs a blood transfusion. She states that her religion does not allow them. You are the physician in charge. What will you do? Will you override her strong objection? Why or why not?
Purpose: Simple, straight forward ethics question. The reason it is simple and straight forward is because the way the question is asked, there is a fundamentally correct and a fundamentally wrong answer, which can NOT be said of all ethical questions.
What are they really asking and looking for: Can you identify the core construct of the practice of medicine in play here and present a logical explanation of the situation and possibly some exceptions or special situations. It NOT is okay to simply be humble and say, I don't know, I would get the opinion of a more experienced physician or ethics committee. That could be a part of the answer, but this situation is something that you have to think about, possibly discuss with people and understand. You can likewise discuss capacity, but the focus should be on the principle at play here, respect for patient autonomy. (simply: know and understand respect for autonomy, beneficence, non-maleficence, justice, respect for persons and truthfulness and honest. If you can't understand those or disagree with them, don't go into medicine.)

Question: How would your plans differ if you knew that all physicians would be working in HMOs in the future?
Purpose: Do you know what an HMO is and how it works?
What they are looking for and really asking: How much do you pay attention to the world around you? Similar questions are those about current events. Again, good students are a dime a dozen. They are trying to tease out how interested you are in the practice of medicine, the daily challenges and issues physicians face. The content is less important than understanding the question and then subsequently not coming across as being all about the money. Talking about money is not taboo. The people who are worried about talking about money are the ones that are libel to put their foot in their mouth.

Question: If there were an accident on the highway, would you stop and help the victims, knowing that doing so might lead to a malpractice claim?
Purpose: You can say 'yes' or you can say 'maybe'. Obviously you can't say 'no'. It is easy to justify 'yes' and 'maybe'. Good samaritan laws shield you from malpractice so the question is kind of silly. 'Yes' goes to the core principle of beneficence and general putting the needs of others before yourself. 'Maybe', you are under no ethical or legal pressure to help every person in need. I'm trying to explain this from the ground up, but honestly, if you aren't the kind of person that is helpful to people and at least somewhat put the needs of others in front of yourself, you will not survive residency.

Question: Fix one thing about the United States healthcare system.
Purpose: You seriously can't think of a single thing wrong with our healthcare system? Have you never been to a doctor, talked to one, watched the news or gone outside? If you seriously can't at least propose a single change to make, you are far too introverted or self-centered. This question is not asking for you to solve all the problems in the US or even to create a bullet proof plan. Simply identify a problem and give at least a thought out possible solution.

 

[TheMightySmiter]

Going over the practice questions list...here are some issues I found:

What impact do you want to have on medicine?
Like hell if I know, it's not as if I'm going to find the cure for AIDS or save Namibia from tuberculosis or whatever. What are they even looking for with this question?

I believe the answer they are looking for is more along the lines of, "Where do you generally see yourself in ten years?" As in, do you want to do research? Do you want to do only clinical practice? Do you think you have an interest in primary care? Do you see yourself being involved in hospital administration or the business of health care? Have you had any experiences that made you interested in a particular field? Etc. You don't have to say that you want to cure cancer, in fact that answer would probably be laughed at.

A patient who has been in an accident needs a blood transfusion. She states that her religion does not allow them. You are the physician in charge. What will you do? Will you override her strong objection? Why or why not?
I would say to NOT override the objection. I believe a Supreme Court case upheld the right of a patient to refuse treatment, but I'm not sure. Is this a question to test your legal knowledge or your ethics or what?

You don't have to know any legal history. The best way to approach this question is to discuss the pros and cons of each choice, and then say what choice you would make. There isn't necessarily a wrong answer, just a lot of factors to consider; some of them include the age of the patient, whether she is of sound mind, what other treatment options there may be, and of course her right to direct her own care.

How would your plans differ if you knew that all physicians would be working in HMOs in the future?
From what I understand, it would make the more remunerative specialties less valuable because in groups such as Kaiser, they would have to share money with family practitioners and less-earning physicians. I am probably totally wrong tho. I don't know much about health policy.

I also don't really know what to say to the adcoms, since talking about money is taboo.

Basically, physicians working for an HMO are salaried and do not privately bill patients. Instead, the HMO bills the patient and all the patient's care is coordinated through the same place. Kaiser is a great example to bring up. Money is not necessarily taboo, although I wouldn't make it the focus of your answer. The best thing to discuss might be how care would change from the patient's perspective, and whether you believe it is a good system.

If there were an accident on the highway, would you stop and help the victims, knowing that doing so might lead to a malpractice claim?
Obviously the adcoms want you to say "yes," then give some cock and bull answer about your duty to help people, and how the omission of help is as good as killing them. How would you justify this so as not to appear naive?

Ideally you would provide the maximum amount of care possible that you are trained to do, knowing that malpractice claims are a possibility when you are treating any patient.

Fix one thing about the United States healthcare system.
This is tricky. 🙁

I can think of dozens of ways to fix the US healthcare system! You only need ONE. 🙂 You could say something about access to care, or preventative health, or pay-per-procedure compensation, or malpractice suits, or defensive medicine, or contraceptive access, etc.

 

[ShenanigansMD]

I'm right with you man, I'm just about to start interviews and I'm about to... poop my pants. I think confidence is key in your answers, along with good reasons to back them up.

 

[Courtjester8]

These are relatively simple/easy questions. Just shooting from the hip...

Question: If there were an accident on the highway, would you stop and help the victims, knowing that doing so might lead to a malpractice claim?
Purpose: You can say 'yes' or you can say 'maybe'. Obviously you can't say 'no'. It is easy to justify 'yes' and 'maybe'. Good samaritan laws shield you from malpractice so the question is kind of silly. 'Yes' goes to the core principle of beneficence and general putting the needs of others before yourself. 'Maybe', you are under no ethical or legal pressure to help every person in need. I'm trying to explain this from the ground up, but honestly, if you aren't the kind of person that is helpful to people and at least somewhat put the needs of others in front of yourself, you will not survive residency.
.

I may be wrong about this but I don't believe good samaritan laws extend to trained healthcare professionals. The thinking is that if you are a certified healthcare professional, you shouldn't be messing up. So the question, if my information is correct, actually holds some merit. Regardless, I agree, you don't say no. I doubt that the adcom expects you to know this caveat of the legal system.

cj8

EDIT: Any i believe your malpractice insurance only extends to medical procedures done under the roof of the hospital you work at or your practice. In this case, I think the type of insurance you would need to properly CYA is professional liability insurance or something of that nature.

 

[mimelim]

I may be wrong about this but I don't believe good samaritan laws extend to trained healthcare professionals. The thinking is that if you are a certified healthcare professional, you shouldn't be messing up. So the question, if my information is correct, actually holds some merit. Regardless, I agree, you don't say no. I doubt that the adcom expects you to know this caveat of the legal system.

Good samaritan laws apply especially to healthcare workers, unless the action was performed as part of their job. ( There is some variation state to state)

 

[Bangersandmash]

I've been told by numerous advisers and students who do interviews and have been interviews that many questions don't have a right or wrong answer. They're asked to see your reasoning and thinking behind an answer. That said, you do have to be careful to not be too extreme and you must always be aware that interviewers can inject their bias into judging your answer, although you would hope an interview committee would be impartial.

For instance, in the case of the good samaritan question in stopping to help accident victims, I think it would be acceptable to say no with proper reasoning. What if the accident involved a danger to yourself when you stopped for help? As a trained medical professional, you have learned to treat people, but you also have a duty to yourself and your family. Pulling over on a local road to stop a bleed is different than diving into a canal to resuscitate a drowning victim or swerving over 4 lanes of traffic on a highway and rushing into a fiery car. You must also account for the situation, in that your duty is to treat patients in a managed care setting, not "heal the world" so to speak. Ethically speaking, you take an oath as a doctor to heal your patients. Does that make you ethically responsible to attempt to treat every sick person you come across in day to day life?

Just reason out a response. Show you can think critically and deeply about a subject, rather than spit out legal precedence and facts.

 

[LizzyM]

I may be wrong about this but I don't believe good samaritan laws extend to trained healthcare professionals. The thinking is that if you are a certified healthcare professional, you shouldn't be messing up. So the question, if my information is correct, actually holds some merit. Regardless, I agree, you don't say no. I doubt that the adcom expects you to know this caveat of the legal system.

cj8

EDIT: Any i believe your malpractice insurance only extends to medical procedures done under the roof of the hospital you work at or your practice. In this case, I think the type of insurance you would need to properly CYA is professional liability insurance or something of that nature.

See:

http://www.ama-assn.org/amednews/2007/06/11/prcb0611.htm

for a nice explanation of Good Samaritan laws. They do cover physicians but vary by state as to what activities are covered.

 

[HughMyron]

Thanks to everyone for all your help. 🙂

So for the impact question, I would answer that I am interested in clinical research, and would hope to make an impact on medicine by contributing to our knowledge of disease, physiology, and treatment blah blah blah.

But that might be a totally crappy answer. Do they want me to specifically say something about specialties?


For blood transfusion refusal question, I would answer that, as mimelim said, we need to weigh the principle of autonomy versus the principle of beneficience. Also, an issue of euthanasia (voluntary passive) comes up if the patient knows that she will die. Ultimately I would come down on the side of allowing the transfusion then.


HMOs Question:
I would say what an HMO is. It would not appreciably change what practice I choose to enter, tbh. That depends on what happens in Year 3 and on Match Day.


Car Question:
I would answer "maybe," it depends on too many things. For example, there's a difference between just driving along the road to the grocery store, and being on call and rushing to the hospital.


Fix One Thing:
Standarzie EMRs?

 

[UCFKnight]

See:

http://www.ama-assn.org/amednews/2007/06/11/prcb0611.htm

for a nice explanation of Good Samaritan laws. They do cover physicians but vary by state as to what activities are covered.

Thanks for the link, but wow...

Dr. Khokha gave a helping hand in an already life or death situation, and he becomes the one that is targeted in the suit? That is what I gathered from the article, and IMO that is not at all what should have happened. I will definitely be looking into Good Samaritan laws for FL if I am admitted this cycle.

 

[LizzyM]

Thanks for the link, but wow...

Dr. Khokha gave a helping hand in an already life or death situation, and he becomes the one that is targeted in the suit? That is what I gathered from the article, and IMO that is not at all what should have happened. I will definitely be looking into Good Samaritan laws for FL if I am admitted this cycle.

I do see a fundamental difference between stopping on the side of the road to help someone who has been in a crash and being called into the OR to assist in a surgical procedure for which one will bill the patient. In the second example, there is a clear physician/patient relationship and a fee for service arrangement. The same does not hold when one stops at the side of the road.

 

[Dmr6186]

Well, legally you don't have to stop to help the person on the side of the road. Ethically, it's probably a good idea, assuming the scene is safe. At least stop to see if 911 is called, comfort the family, and so on. If the victims' condition isn't so bad, just stay with them until an ambulance arrives. Sometimes that's all people need.
The question also said "might" lead to a malpractice claim. It'll only lead to one if you screw up. If you're generally a pretty capable person, chances are you're gonna be in a safe position and not get sued. If you feel that the situation is more than you can handle on your own, it's best to wait for help or else you will just do more harm than good.
And even if you do get sued, that doesn't mean that the patient will win. Overall, you did the right thing, and that's what matters the most 😉

 

[meix]

For blood transfusion refusal question, I would answer that, as mimelim said, we need to weigh the principle of autonomy versus the principle of beneficience. Also, an issue of euthanasia (voluntary passive) comes up if the patient knows that she will die. Ultimately I would come down on the side of allowing the transfusion then.

I don't know if I agree with this, but I'm only a fellow premed =P

What I think, though, is that your foremost duty is to do no harm. While giving the transfusion would save the patient's life, the patient would live in shame/self-hate/etc. because the transfusion is a violation of a strongly held religious belief. Essentially, from her perspective, what you have done to save her life has condemned her soul to rot in Hell (or her religion's equivalent). By doing so, you would have done (in her point of view) the worst harm you could have possibly done, despite having saved her life.

So if she strongly objects & is firm in that decision, I would not override her objection but instead do whatever I could to make her comfortable and/or increase her chance of survival (if there is such a chance). If her objection is weak/wavering/unsure, then I would attempt to change her mind, or go ahead and give the transfusion if I don't have the time to change her mind.

 

[HughMyron]

Well, legally you don't have to stop to help the person on the side of the road. Ethically, it's probably a good idea, assuming the scene is safe. At least stop to see if 911 is called, comfort the family, and so on. If the victims' condition isn't so bad, just stay with them until an ambulance arrives. Sometimes that's all people need.
The question also said "might" lead to a malpractice claim. It'll only lead to one if you screw up. If you're generally a pretty capable person, chances are you're gonna be in a safe position and not get sued. If you feel that the situation is more than you can handle on your own, it's best to wait for help or else you will just do more harm than good.
And even if you do get sued, that doesn't mean that the patient will win. Overall, you did the right thing, and that's what matters the most 😉

I wouldn't say that. An adcom would use it as an excuse to attack you for being naive and not recognizing how litigious Americans are. Americans are so lawsuit-obsessed that it's probably the main thing that bloats the cost of our medical care compared to every single other developed country.

 

[meix]

I wouldn't say that. An adcom would use it as an excuse to attack you for being naive and not recognizing how litigious Americans are. Americans are so lawsuit-obsessed that it's probably the main thing that bloats the cost of our medical care compared to every single other developed country.

There should seriously be fines in the US for frivolous lawsuits + have them strictly enforced. People and their putting blame on everyone else for their own mistakes.. hot coffee woman comes to mind. And more. But that's another discussion entirely, I guess.

 

[Dmr6186]

I wouldn't say that. An adcom would use it as an excuse to attack you for being naive and not recognizing how litigious Americans are. Americans are so lawsuit-obsessed that it's probably the main thing that bloats the cost of our medical care compared to every single other developed country.

That's why I think it's important to pick and choose your battles in terms of helping random people. Like I said, sometimes it's best just to call 911 and leave it at that. But you're right though.

As for the woman with the blood transfusion, you absolutely are supposed to respect the patient's decision if she refuses treatment. Unless it's an old confused person with no will and no family to speak for him/her, basically the patient is in control of their own fate. You're still required to give the warnings though about what could happen in terms of their health if treatment is refused.