Interviews: Ethics Questions and Responses

[cbrons]

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So now that some of us are gearing up for interviews in the next few months, I've been thinking a lot about the ethics question(s) that will invariably become a part of the discourse. I thought I would start this thread and pose a few ethics questions I found in the Interview Feedback portion of SDN to see if we can begin formulating some general ideas on how to answer such questions when they come up.

I'll number each question in this first post and if someone can come up with another possible question in later posts, I will add it up here. Try and keep your responses numbered and in a format that is understandable. Any pre-allo or pre-osteo students can answer these.

Questions from past interviews

1. What would you do if your friend's 15 year old daughter comes to you asking for birth control pills?

2. What would you do if your minor patient (under the age of 18) was dying from a curable illness but because of his parent's religious beliefs refused to authorize further treatment? [For a bonus, let's add the stipulation that there is not enough time for the hospital counsel to go in front of a judge and have a guardian ad-leiden appointed to make medical decisions for the child]

3. If a fellow MS3 showed up hungover/still drunk to rotations with you, how would you handle the situation? [For a bonus, you could answer this same question about an attending physician you are on rotations with who is obviously intoxicated]

4. You are the attending physician... you have 3 patients all enter at the same time. The first one returned because you prescribed them the wrong medication, the second is a drunk and disheveled homeless person, and the third is an eight month old infant. All have lethal conditions. Who do you treat first and why? [Maybe worded confusing but this was left in the interview feedback]

5. You have a homosexual patient whose partner wishes to see him (assume he is a minor). The family is disgusted by their relationship and refuses the partner's wish to visit the patient. The partner comes to you. What do you do?

Response template

1. I would do XXX. The reason is because XXX

2. I would do XXX. The reason is because XXX

3. etc.

 

[cbrons]

1. I would adhere to whatever state law is regarding parental notification/approval. The reason I would do so is because denying the girl a prescription for oral contraceptives would not place her in imminent danger and that’s where I would draw the line.

2. Assuming there was no time for legal recourse, I would make every physical attempt possible to still treat the patient. I recognize the obvious legal ramifications for taking such action and the liability issues it would raise not only for myself but for my employer. Having recognized the difficult position I would be putting myself and employer in legally, I would still make every attempt possible to treat the patient.

3. I would immediately report the individual in question to another superior. That is assuming I know for sure that they are intoxicated (i.e. you can literally smell in on their breath when they talk, they’re showing obvious signs of motor impairment consistent with acute alcohol intoxication [I only observed this in college for 4 years, I’m pretty sure I’d be able to tell].

4. I would treat the patient with the most severe case or rather the one that most imminently threatens their survival. I would also take into consideration the likelihood for survival. In other words, I would assess both severity and probability that my intervention would end up saving their lives. It would be a very difficult situation that would require making incredibly difficult decisions but the fact that you may have caused a patient’s suffering due to your own error wouldn’t necessarily mean that they should be the first one you attend to. All patients need to be triaged appropriately in order to ensure that the greatest number of them are stabilized.

5. I would first talk to the patient in private and see if he wanted to see his partner in the first place. You never know in these types of situations so it would be wrong to assume that the patient even wants to see him in the first place. If the patient was adamant about being allowed to see his partner, I would then approach the family (or who seemed to be the most reasonable member of the family) and encourage them to allow it. I would say that seeing the partner would possibly help to ease some of the anxiety/discomfort the patient is in. I would do my best to persuade them but if I had at my disposal another member of the hospital staff (say a psychologist/counselor) who I felt would have a greater chance of successfully persuading the family, I would ask them to do it in my place. If, however, the family still refused to allow visitation I would refuse the partners request.

 

[Avoidthetiger]

I agree with all the above except the last one. If the family still refused to allow the partner to visit the patient, I would suggest the partner come at a time when the family is not around OR knock on the door and enter regardless of the family. If the patient wants to see his partner, he should be able to. The patient comes first - not the family and their homophobia. If the patient has come out, than his family should respect this decision and allow his partner to enter -- whether a minor or not. (need to run though so this answer might not be as thought out as it could be)

 

[Sinfest]

Great idea 👍

 

[cbrons]

Bump...

 

[Lukat]

I agree with all your answers, only add for number one, I would give that little girl a lecture on having underage sex

 

[cbrons]

Okay will a mod please move to pre-allo so we can get some more responses. Apparently these pre-osteo kids don't think they'll be asked any ethics questions.

Sent on the Sprint® Now Network from my BlackBerry®

 

[cbrons]

Bump newbz

 

[Kalyx]

1. What would you do if your friend's 15 year old daughter comes to you asking for birth control pills?

Depending on when and where she approached me, I would give her either my office phone number or a cell number I used for work and have her contact me during official business hours. Next, I would discuss why she wants BCPs: is she sexually active or did she just hear they were good for your skin? Then I would ask her if she knew what the risks of sex are and figure out what she knows about STIs and barrier forms of protection. Next, I would encourage her to talk to her parents about sex, even though that may seem like an unappealing idea to her. Only if she's sure that her parents would not be responsive, or perhaps even unsafe, would I proceed. I'm not sure whether or not **I** would ultimately prescribe BCPs for her... as others have mentioned, it's important to take into account legal requirements for parental notification. But with my prescribing the pills, there may also be an issue of payment, anonymity, and sustainability. How will the girl pay for the bills? She might not be able to afford them out-of-pocket, and if she goes through her family plan's health insurance then her parents could easily discover that she's on BCPs. Thus I think I would refer her to somewhere like Planned Parenthood that has a "Take Charge" program, in which enrollees can receive free BCPs and STI testing for at least one year.

Gah, I don't have time at the moment to comment on the others, but I hope to soon! Great idea in starting this thread.

~Kalyx

 

[cbrons]

Would put you in a precarious position

 

[Kalyx]

Would put you in a precarious position

Care to elaborate?

 

[kevster2001]

I disagree with what you said about #2. It shows your naivete and overeagerness to impress ADCOMS. What you would be doing is illegal and puts your practice and your hospital at huge financial risk.

And for the medical student one. Always, always talk to the student first. Talk to him to make sure he is inebriated. Then ask him to go home. The worst interview answers are where people jump to conclusion and go full steam ahead.

 

[cbrons]

I disagree with what you said about #2. It shows your naivete and overeagerness to impress ADCOMS. What you would be doing is illegal and puts your practice and your hospital at huge financial risk.

And for the medical student one. Always, always talk to the student first. Talk to him to make sure he is inebriated. Then ask him to go home. The worst interview answers are where people jump to conclusion and go full steam ahead.

Mmk, little presumptuous as to my so-called eagerness to impress anyone but thanks for the fair assessment and response. Anyone have a unique one of their own?

 

[QuizzicalApe]

I disagree with what you said about #2. It shows your naivete and overeagerness to impress ADCOMS. What you would be doing is illegal and puts your practice and your hospital at huge financial risk.

It might vary by state, but we as a student body have been specifically instructed, in the case of situation #2, to save the child's life and let lawyers sort out the rest. You don't have time to prove that the parents are basically engaging in child abuse and negligence, someone else will.

 

[theWUbear]

I find these questions silly. When I go to my interviews I'll 'play the game' and give my responses, but what I really want to say is "I'll follow HIPPA and other legal aspects of the profession as you will teach me in ethics courses during MS1 and MS2" and I'll think in my head "I'm sorry I don't know all the legal ramifications involved with patient treatment but that's not really been my job as a pre-med, I expect this to be taught to me at your school"

 

[Myuu]

I find these questions silly. When I go to my interviews I'll 'play the game' and give my responses, but what I really want to say is "I'll follow HIPAA and other legal aspects of the profession as you will teach me in ethics courses during MS1 and MS2" and I'll think in my head "I'm sorry I don't know all the legal ramifications involved with patient treatment but that's not really been my job as a pre-med, I expect this to be taught to me at your school"

It hasn't been your job as a pre-med to learn about the issues associated with the profession you plan to take on? Interesting.

 

[theWUbear]

It hasn't been your job as a pre-med to learn about the issues associated with the profession you plan to take on? Interesting.

Very interesting 😛

Your point is well taken.

I suppose, if I can amend my above statement to reach a balance, I would claim ignorance to such specificities as what Quizzicalape posted, while showing a basic understanding of the need to maintain patient confidentiality, put the health of my patients above the any selfish need (in the case of Q#4), etc.

For instance, if I had to answer question number 1 right now in an interview, I might say something to the extent of:

If the girl has come to me in the hospital as a patient, I would make sure to treat her like any other patient - following all privacy laws as outlined in HIPPA and other hospital procedures. I would make sure to ask why she is requesting the pill, and illustrate to her the dangers of unprotected sex. As for the involvement of parents and the fact that she is a minor, I would follow the protocols mandated by the state with parental notification/permission. I do not know these protocols currently but I hope to gain a more thorough understanding of them during medical school

 

[wolverinepwns]

I disagree with what you said about #2. It shows your naivete and overeagerness to impress ADCOMS. What you would be doing is illegal and puts your practice and your hospital at huge financial risk.

And for the medical student one. Always, always talk to the student first. Talk to him to make sure he is inebriated. Then ask him to go home. The worst interview answers are where people jump to conclusion and go full steam ahead.

impressing ADCOMS or not, I can never picture my self letting a child die cuz of their parent's religious beliefs! NEVER!

 

[Myuu]

Very interesting 😛

Your point is well taken.

I suppose, if I can amend my above statement to reach a balance, I would claim ignorance to such specificities as what Quizzicalape posted, while showing a basic understanding of the need to maintain patient confidentiality, put the health of my patients above the any selfish need (in the case of Q#4), etc.

For instance, if I had to answer question number 1 right now in an interview, I might say something to the extent of:

If the girl has come to me in the hospital as a patient, I would make sure to treat her like any other patient - following all privacy laws as outlined in HIPAA and other hospital procedures. I would make sure to ask why she is requesting the pill, and illustrate to her the dangers of unprotected sex. As for the involvement of parents and the fact that she is a minor, I would follow the protocols mandated by the state with parental notification/permission. I do not know these protocols currently but I hope to gain a more thorough understanding of them during medical school

That is a much better answer.🙂 If I recall correctly, the University of Washington has a website with all sorts of medical ethical scenarios and write-ups about them that might be interesting to look at, if you get the time. You can find it here.

 

[metalgearHMN]

That is a much better answer.🙂 If I recall correctly, the University of Washington has a website with all sorts of medical ethical scenarios and write-ups about them that might be interesting to look at, if you get the time. You can find it here.

Wow thanks for the link, it'll be nice prep for my interviews. I have one at Case too maybe I'll run into you and not know it!

 

[theWUbear]

That is a much better answer.🙂 If I recall correctly, the University of Washington has a website with all sorts of medical ethical scenarios and write-ups about them that might be interesting to look at, if you get the time. You can find it here.

Thanks! Sick with a high fever right now 🙁 so this will provide some light reading

 

[AllDay24]

For #4, in a mass-casualty incident (MCI), you do triage patients according to severity. However, as an EMT/paramedic, you are simply transferring care to a hospital (i.e. other doctors), so time is not necessarily an issue because the time for each of the three patients in an MCI is the transport time. In this incident, though, I would be only physician for each of these patients, so I would treat the patients according to the time required to treat each patient.

 

[MB333999]

for #5 i agree with everything you said but by the end of it I would let the partner see the patient. I would ask the family to please step outside for a moment and explain to them that their son/daughter is insisting that he see's his partner.

After all were trying to take care of the patient not his family.

 

[barcoderider]

Myuu, that is an awesome link! 🙂

 

[MilkmanAl]

Are those really gray areas? It looks to me like the accepted response to each except #4 is very clear-cut and outlined in law (or school policy, for #3). 4 is just phrased terribly and is basically unanswerable without a hell of a lot of clarification.

 

[LizzyM]

The instructions for interviewers at my school discourage us from asking this type of question (except perhaps the impaired student question which is more common sense than anything else) because it is not common sense but does revolve around material that you will learn in medical school.

All the questions do require clarification, too.

I don't see where a physician would be involved in question 5... visitor issues are dictated by hospital policies and where a minor is involved the family may be able to specify that they wish to limit the visitor list. Would your answer be the same if the kid was a budding gang member and another member of the gang came to you asking you to intervene because the family had barred him as a visitor? Would your answer be different if the minor was 15 years old and the lover was 35? Would you have a different answer if the couple were heterosexual?

 

[theWUbear]

I find these questions silly. When I go to my interviews I'll 'play the game' and give my responses, but what I really want to say is "I'll follow HIPPA and other legal aspects of the profession as you will teach me in ethics courses during MS1 and MS2" and I'll think in my head "I'm sorry I don't know all the legal ramifications involved with patient treatment but that's not really been my job as a pre-med, I expect this to be taught to me at your school"

Not silly. They are given to see if you can logically answer them and take a stance and have an opinion of your own. They are also there to see if you've thought about the gray areas in medicine. And that attitude is a very poor one.

Do you like apples gujuDoc

The instructions for interviewers at my school discourage us from asking this type of question (except perhaps the impaired student question which is more common sense than anything else) because it is not common sense but does revolve around material that you will learn in medical school.

How do you like them apples

 

[IvyHopeful20]

What if a 15 year old girl came in and wanted an abortion and was afraid she will face consequences at home (e.g, disowned) if pregnancy and/or abortion were revealed to the parents?

 

[LizzyM]

What if a 15 year old girl came in and wanted an abortion and was afraid she will face consequences at home (e.g, disowned) if pregnancy and/or abortion were revealed to the parents?

Are they teaching the state laws regarding this issue in undergrad these days? If not, I don't know how a medical school applicant could answer this question correctly.


If the question is attempting to weed out pro-choice or pro-life applicants during the interview process then it is just wrong on the part of the school, IMO.

 

[cbrons]

The instructions for interviewers at my school discourage us from asking this type of question (except perhaps the impaired student question which is more common sense than anything else) because it is not common sense but does revolve around material that you will learn in medical school.

All the questions do require clarification, too.

I don't see where a physician would be involved in question 5... visitor issues are dictated by hospital policies and where a minor is involved the family may be able to specify that they wish to limit the visitor list. Would your answer be the same if the kid was a budding gang member and another member of the gang came to you asking you to intervene because the family had barred him as a visitor? Would your answer be different if the minor was 15 years old and the lover was 35? Would you have a different answer if the couple were heterosexual?

Those questions are all taken from the Interview Feedback section so apparently they do get asked at other schools. I would assume they ask these questions simply to gauge your thought process rather than to check whether or not you know specific laws or hospital protocol but maybe you could shed some light as to their purpose. Does your school not ask these sorts of questions?