NBME 2 ethics question

[osli]

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Had this question and wasn't sure what the correct answer was. The question described a woman with rheumatoid arthritis that called in to the doctor, very upset that she couldn't even turn on the faucet to take a bath and since her husband had left for work she would have to wait for him to get home to do most anything.

First 3 answer choices were bad, but D and E were hard for me to differentiate. Best I can remember, they were something like this:

D) Explain to her that many people with rheumatoid arthritis have difficulty turning on faucets. Ask her if she would be interested in joining a support group.

E) Explain to her that many people with rheumatoid arthritis feel like they have lost their independence because of their disease. Suggest that the use of a long handled tool might help with the faucet.


So this probably looks obvious, but I don't see it. I like the first part of E better since it seem to empathize with her situation better, instead of minimalizing it by saying "yeah, a lot of people with your condition have that problem". But the second half of those two choices really stumps me. It seems bizarre to suggest the use of a "long handled tool" (just looks too weird to be correct), but then asking if she would be interested in joining a support group seems to be pushing her problem to others instead of trying to help directly. And while the long handled tool seems very weird, it does directly address her frustration with a loss of independence. She's probably going to need a support group to help her make adjustments in lifestyle and attitude going forward, but would that really be the most helpful thing over the phone?


In short... can someone explain to me the "rule" that needs to be followed here to reach the correct answer, because my logic and morals don't lead me to one clearly correct one. And others that have taken NBME 2 and remember this question - check me on my recollection of the question and answers to make sure I'm representing it correctly.

 

[DwyaneWade]

Had this question and wasn't sure what the correct answer was. The question described a woman with rheumatoid arthritis that called in to the doctor, very upset that she couldn't even turn on the faucet to take a bath and since her husband had left for work she would have to wait for him to get home to do most anything.

First 3 answer choices were bad, but D and E were hard for me to differentiate. Best I can remember, they were something like this:

D) Explain to her that many people with rheumatoid arthritis have difficulty turning on faucets. Ask her if she would be interested in joining a support group.

E) Explain to her that many people with rheumatoid arthritis feel like they have lost their independence because of their disease. Suggest that the use of a long handled tool might help with the faucet.


So this probably looks obvious, but I don't see it. I like the first part of E better since it seem to empathize with her situation better, instead of minimalizing it by saying "yeah, a lot of people with your condition have that problem". But the second half of those two choices really stumps me. It seems bizarre to suggest the use of a "long handled tool" (just looks too weird to be correct), but then asking if she would be interested in joining a support group seems to be pushing her problem to others instead of trying to help directly. And while the long handled tool seems very weird, it does directly address her frustration with a loss of independence. She's probably going to need a support group to help her make adjustments in lifestyle and attitude going forward, but would that really be the most helpful thing over the phone?


In short... can someone explain to me the "rule" that needs to be followed here to reach the correct answer, because my logic and morals don't lead me to one clearly correct one. And others that have taken NBME 2 and remember this question - check me on my recollection of the question and answers to make sure I'm representing it correctly.

Weird question, I would say E because it addresses her problem right now.

 

[-Goose-]

Had this question and wasn't sure what the correct answer was. The question described a woman with rheumatoid arthritis that called in to the doctor, very upset that she couldn't even turn on the faucet to take a bath and since her husband had left for work she would have to wait for him to get home to do most anything.

First 3 answer choices were bad, but D and E were hard for me to differentiate. Best I can remember, they were something like this:

D) Explain to her that many people with rheumatoid arthritis have difficulty turning on faucets. Ask her if she would be interested in joining a support group.

E) Explain to her that many people with rheumatoid arthritis feel like they have lost their independence because of their disease. Suggest that the use of a long handled tool might help with the faucet.


So this probably looks obvious, but I don't see it. I like the first part of E better since it seem to empathize with her situation better, instead of minimalizing it by saying "yeah, a lot of people with your condition have that problem". But the second half of those two choices really stumps me. It seems bizarre to suggest the use of a "long handled tool" (just looks too weird to be correct), but then asking if she would be interested in joining a support group seems to be pushing her problem to others instead of trying to help directly. And while the long handled tool seems very weird, it does directly address her frustration with a loss of independence. She's probably going to need a support group to help her make adjustments in lifestyle and attitude going forward, but would that really be the most helpful thing over the phone?


In short... can someone explain to me the "rule" that needs to be followed here to reach the correct answer, because my logic and morals don't lead me to one clearly correct one. And others that have taken NBME 2 and remember this question - check me on my recollection of the question and answers to make sure I'm representing it correctly.

I took 2 yesterday and thought the answer was definitely E. You are offering empathy and a potential means of solving her problem. Longer tools offer mechanical leverage and are used often by people with RA. The support group answer wasn't bad, but I thought the other answer was the 'most correct'

 

[deuist]

I took 2 yesterday and thought the answer was definitely E. You are offering empathy and a potential means of solving her problem. Longer tools offer mechanical leverage and are used often by people with RA. The support group answer wasn't bad, but I thought the other answer was the 'most correct'

As I understand the ethics questions, the correct answer should involve you, and only you. Do not refer cases to hospital ethics committees, consultants, or anyone else.

 

[SOUNDMAN]

Support Group = Referral .... Cardinal Rule #2 violated "THOU SHALT NOT REFER ON STEP 1 USMLE"

 

[osli]

OK, thanks for the responses. I chose E because I liked the first half of the answer better, and thought the support group sounded like breaking the "no referral" rule. Good to know you all agree.

But that did sound like a weird answer choice! "Hey, here's what ya do lady, you get yourself a big-ass screwdriver and a roll of duct tape..."

 

[osli]

Support Group = Referral .... Cardinal Rule #2 violated "THOU SHALT NOT REFER ON STEP 1 USMLE"

BTW, do you have a handy list of these "cardinal rules"? Sounds like just what I've been looking for. 😎

 

[wonderboy00]

hmm, i remember this question and i chose the answer that said something like "tell her to come into the office so you can give her a corticosteroid shot..." i know it sounds like an insensitive reply, but i chose that because she was in severe pain and this would be the most direct solution to alleviate it. what do u guys think?

 

[-Goose-]

hmm, i remember this question and i chose the answer that said something like "tell her to come into the office so you can give her a corticosteroid shot..." i know it sounds like an insensitive reply, but i chose that because she was in severe pain and this would be the most direct solution to alleviate it. what do u guys think?

I thought about that one too, but chose the other because it offered more over the long term.