Practice MMI Questions

[tofuuu]

So I thought it would be good idea to have a thread where people can discuss different ethical issues with each other, as well as provide feedback on each others' answers. Great practice for those who have MMI interviews coming up!

I will be posting some practice MMI prompts that I found online. I do NOT own any of these prompts.

This should me fun! 😛

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PROMPT #1:

Autonomy
Autonomy essentially means "self rule," and it is a patient's most basic right. As such, it is a health care worker's responsibility to respect the autonomy of her patients. However, at times this can be difficult because it can conflict with the paternalistic attitude of many health care professionals. The following two cases address patient autonomy. The first involves the rights of an individual to decide her own fate, even against her physicians' judgments. The second case involves the rights of a parent to care for her child in the manner that she sees fit.

Case 1:
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter's death). The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an erotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars.

Questions for Case 1:

• Do you believe that the physician's actions can be justified in any way?
  
  
• Is there anything else that they could have done?
  
  
• Is it ever right to take away someone's autonomy? (Would a court order make the physicians' decisions ethical?)
  
  
• What would you do if you were one of the health care workers?

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[tofuuu]

Alright, I'll go ahead and answer the first prompt. Feedbacks appreciated!

Case 1:
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter's death). The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an erotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars.

Do you believe that the physician's actions can be justified in any way?

I think that the physician's action can be justified if the patient's mental status appears to be altered (poor judgement, poor insight, lack decision-making skills, etc.)
In this case, the physician did not believe that the patient could reasonably make a decision on her own at the moment and was acting what he believed was best for the patient, resulting in saving her life.

Is there anything else that could have been done?

The physician could have attempted to get consent from family members. Doing so could have prevented the suing incident from happening.

Is it ever right to take away someone's autonomy? Would a court order make the physician's decisions ethical?

It depends. If an individual does not have decision-making skills (Example: Patients with dementia, mental ******ation, etc.), it is reasonable to have someone else make decisions for them. However, if the individual is capable of fully understanding the situation and making decisions for themselves, I don't think it would be ethical to take away their autonomy. In the end, everyone has the right to live their lives the way they want to. As a physician, your responsibility is to provide patients with the information necessary to make informed decisions. While it is appropriate to make suggestions and present your perspective, forcing one's opinion on another is not the duty of a physician.

What would you do if you were one of the health care workers?
I would talk to the patient. I would try to convince her to agree to the procedure by explaining to her that this is a serious life-threatening situation and how essential it is for her to get the surgery. If she dies, she wouldn't be able to continue dancing either way. But if she lives, we can worry about how to cover up the scar or something later. If the patient does appear to not be at her baseline mental status, I would attempt to reach a family member and discuss with them about the case. Hopefully they would consent to the surgery.
If I can't reach a family member and seriously think the patient is not in her right mind, I would do the surgery without consent.

 

[ATPsynthase87]

Love doing these! I probably shouldn't have read the prior answer as I feel like I may piggy back too much on it but here goes!

From my understanding, a patient has an abdominal aortic aneurysm that if not treated has a 50% chance of causing her death. The patient decides not to undergo surgery because she is worried about the scar from the surgery affecting her livelihood. Regardless, the physician continues to operate and treat her abdominal aortic aneurysm and is sued. Is this correct?
Well two things come to mind when I read this scenario, beneficence and patient autonomy. As a future physician, I am my patient's biggest advocate and so I will give and do everything I can to allow my patient to make an informed decision with their best interest at heart. At the same time, if they are competent enough to make such decisions I will respect said decisions.

• Do you believe that the physician's actions can be justified in any way?
• The physicians actions can be justified if the patient is not competent enough to make an informed decision. If she has dementia, or has limited mental acuity and judgement, I would understand why the physician took such action.

• Is there anything else that they could have done?
• What could be done is talking to the patient and giving her all necessary information to make an informed decision. For instance, explaining to her that an AAA can cause death and not be treated and therefore she would never be able to dance is more of a loss than the scar. Similarly there exists laser treatments, and other ways to minimize scarring. I will help her come up with solutions to address her concern about the scar. I may also contact her family to talk to her.

• Is it ever right to take away someone's autonomy? (Would a court order make the physicians' decisions ethical?)
• Only in circumstances where the patients has poor judgement, poor insight, lack decision-making skills - IN OTHER WORDS - I would assess for patient decision making capacity - Does the patient have decision making capacity?
  
  
• What would you do if you were one of the health care workers?
• If I was one of the healthcare workers I would give the patient all the tools to make an informed decision and then after they have that information, get family, and then I would respect their wishes.