interview question?!

[shch0730]

Hi everyone,

I need some help on this interview question, how would you guys answer it? Thanks a lot.

"You have two patients who have been admitted after a serious accident. Both require immediate attention in order to survive. One patient is 20 years old; the other is 60 years old. Which life would you save?"

I guess we can't say "save both".

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[Asyouwereatrio]

Hi everyone,

I need some help on this interview question, how would you guys answer it? Thanks a lot.

"You have two patients who have been admitted after a serious accident. Both require immediate attention in order to survive. One patient is 20 years old; the other is 60 years old. Which life would you save?"

I guess we can't say "save both".

I'd first ask about the condition of the patient--which one has the greatest likelihood of survival? If it's the same, then I'd think of which one has the greatest contribution to society in the future. If they're both in the same profession or whatever, I'd likely then save whichever one will have LEAST complications being alive in the future--like chronic illness, recovery issues in old age, etc. Bottom line, I think it boils down to me saving the 20 year old, assuming he's not like a drunkard who gambles away all his money every hour of his living life.

 

[metalgearHMN]

I'd first ask about the condition of the patient--which one has the greatest likelihood of survival? If it's the same, then I'd think of which one has the greatest contribution to society in the future. If they're both in the same profession or whatever, I'd likely then save whichever one will have LEAST complications being alive in the future--like chronic illness, recovery issues in old age, etc. Bottom line, I think it boils down to me saving the 20 year old, assuming he's not like a drunkard who gambles away all his money every hour of his living life.

I don't think physicians are supposed to be making judgment calls about who is contributing most to society. I'd answer this question by saying that I would use the triage and management skills I'll learn in medical school to decide who needs my help the most. As I understand it, you can try and save both by focusing on the more injured person first. Then again I haven't gone through the training yet.

 

[shch0730]

I'd first ask about the condition of the patient--which one has the greatest likelihood of survival? If it's the same, then I'd think of which one has the greatest contribution to society in the future. If they're both in the same profession or whatever, I'd likely then save whichever one will have LEAST complications being alive in the future--like chronic illness, recovery issues in old age, etc. Bottom line, I think it boils down to me saving the 20 year old, assuming he's not like a drunkard who gambles away all his money every hour of his living life.

thank you Asyou, that;s a very good comment. What if I say "I'd treat whoever comes in first" would that be a good answer? If yes, what if they came in the same time?😕

 

[TriagePreMed]

I would be honest. If they both came to me in an emergency, I don't know anything about what's in their heart, and even if I knew, my job as a physician wouldn't be to be judge and jury of anyone. I'd save the patient that I believe I can save. If they are both in equally sick, equally treatable, etc., I would just toss a coin because it makes no difference who I save. I'm not going to use ageism as a source of defining who deserves to live and who deserves to die.

 

[Disinence2]

Bring some key ethical concepts into this discussion.

1) Beneficence- Do whats best for the patient. Talk about that for a while in this context.

2) Nonmaleficence - Do no harm. Talk about that for a while in context.

Bring up some ethical terms, say something intelligent about how they apply to this situation and your set. No matter who you choose to "save" first.

Chances are you won't be given more info to help make this choice easier. If forced to make a choice, I'd consider helping the younger patient because of a statistically better chance at recovery, and higher quality of life.

Saying you would help both at the same time probably won't go over well with the interviewer.

Have a good reason for whoever you would pick and your set.

 

[addo]

With this type of question, I think equality/justice of treatment is very relevant. The tricky thing about this question is that they tell you one is younger than the other, one is richer than the other, one is a criminal and the other is not....all of this info should be irrelevant given the principle of equality/justice.

I dont know if this is the "right" answer, but I would say I would save the one with the higher likelihood of surviving, whomever of the two that is, as others have already stated. I dont think theyll go on to say that both have an equal chance.
And like Disience2 said, also try to explicitly talk about the basics of ethics- justice and beneficence are two of them.

 

[Tabicakes]

I would be honest. If they both came to me in an emergency, I don't know anything about what's in their heart, and even if I knew, my job as a physician wouldn't be to be judge and jury of anyone. I'd save the patient that I believe I can save. If they are both in equally sick, equally treatable, etc., I would just toss a coin because it makes no difference who I save. I'm not going to use ageism as a source of defining who deserves to live and who deserves to die.

really liked your answer👍

 

[BearDownAZ]

I'd try to save the younger person because I believe they would have a better chance of survival (older person might have more complications). If more info is given, I'd still save the person who has the best chance for survival.

 

[LizzyM]

Does any school actually use a question like this?

My own answer would be "I don't know, I'm hoping that I'll learn that here."

What if you say, "the younger one" but one is the Vice President and the other is a kid who tried to kill him. Are you going to change your answer? Why? You need to stick to your principles but at the same time you have to be willing to adjust your thinking. So if there isn't enough of a rare blood type to make it likely that you'll be able to save the young guy if you take him to the OR but resources to save the older one, would you change your mind? What if the old guy is your dad?

 

[wanderer]

This question has no utility. A doctor is supposed to be nonjudgmental, whether in regard to only being able to treat one person, or if treating a criminal serving a life-term or whatever.

 

[OtoHNS]

This question is pretty stupid and does not have a right answer. I think as long as you avoid becoming flustered or giving some crazy answer like "I would let the old guy die because old people suck" you will be fine. This advice goes for any of the weird ethical questions. The interviewer doesn't care about your answer, he/she cares about how you respond to a difficult question and how you think.

 

[LizzyM]

In thinking about how to allocate scarce resources to patients, take a look at

This won a pulitzer:

http://www.propublica.org/article/the-deadly-choices-at-memorial-826

Its really long, but it is a good ethics dilemma.

While some of the focus of the article is on the decision to administer drugs to some of the patients, some of the decisions about how to allocate staff energy, spots on rescue helicopters, etc was made on the basis of DNR orders (which are not equivalent to being terminally ill or near death) and body weight. How might these decisions have been made differently in those extreme circumstances (post-Katrina New Orleans).

 

[nabeel76]

I know this an older thread but this is an intresting question to be asking at an interview. As mentioned already, it probably just serves for the purpose of analyzing your thought process at the interview and there is no correct answer.

To entertain the question however, I would have to question whether I am going to be the only source of medical staff at this facility? Are there any other doctors, nurses, etc. on staff? If so, then I would allocate the staff as appropriate to manage the situation and try and keep both patients alive. If not, then I would route the latter call to another facility prior to arrival at my facility to insure that both patients have the best chance at survival.

 

[kevster2001]

I know this an older thread but this is an intresting question to be asking at an interview. As mentioned already, it probably just serves for the purpose of analyzing your thought process at the interview and there is no correct answer.

To entertain the question however, I would have to question whether I am going to be the only source of medical staff at this facility? Are there any other doctors, nurses, etc. on staff? If so, then I would allocate the staff as appropriate to manage the situation and try and keep both patients alive. If not, then I would route the latter call to another facility prior to arrival at my facility to insure that both patients have the best chance at survival.

That's not the purpose of the question. You're suppose vocalize your thought process about how you would ration care and justify why you would save one patient over another. Of course you can say all the stuff you just said but you wouldn't be answering what the interviewers really want to know

 

[byurazorhog]

Reminds me of one Grey's Anatomy episode in which a number of trauma patients was brought into the ER after a major train collision. There were two people-one young woman and a middle-aged man-who had been tragically connected/skewered by a metal beam that went straight though their backs! The docs after much painful deliberations decided to save the older guy because he would sustain less damage to vital organs and less blood loss when the beam were removed.

Anyway, keep these ethical questions coming. I enjoy thinking about them and reading all of your thoughtful responses.