Pretend you are an ADCOM member interviewing an applicant. What bizarre question would you ask the interviewee to see how they react?

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DNAJB6 said:
You’re a physician and took an oath to do no harm. Your patient is a Jehovah’s Witness who refuses a blood transfusion. The patient is unconscious and rapidly bleeding out. In theory, the patient might not know if they ever received a transfusion. You also have reason to believe the patient was unduly influenced/coerced by family members into refusing blood. There isn’t time for a court order and guardian ad litem. The next of kin is unavailable. What would you do? Do you let the patient die? Do you violate patient autonomy? How would you decide?
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I was actually given this scenario during an MMI interview
I don’t think they liked my answer because I was rejected...
 
alm414 said:
Take it up with the FDA, or whoever else is in charge of making sure companies are accurately labeling their food products! Hot pockets are sandwiches!
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Having lived through the 1980's, when suburban housewives of American generally believed that Italian food consisted of pizza and spaghetti, I acknowledge this labeling inertia but I do not accept it. Food naming theory has moved on, and we should embrace the progress.
 
EdgeTrimmer said:
What was your answer?
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I said that I believe a physicians primary responsibility is to preserve health and save lives and that although I think that religion and politics are important considerations, my primary responsibility is to save the life of this patient regardless of what his family or religion might dictate.
 
RJ McReady said:
I said that I believe a physicians primary responsibility is to preserve health and save lives and that although I think that religion and politics are important considerations, my primary responsibility is to save the life of this patient regardless of what his family or religion might dictate.
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I would have selected you based on that answer 🙂
 
RJ McReady said:
I said that I believe a physicians primary responsibility is to preserve health and save lives and that although I think that religion and politics are important considerations, my primary responsibility is to save the life of this patient regardless of what his family or religion might dictate.
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Would your answer be the same if DNAJB6's question had the part about being "[potentially] unduly influenced" removed?
 
alm414 said:
Would your answer be the same if DNAJB6's question had the part about being "[potentially] unduly influenced" removed?
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Yes
Obviously in a real life situation you try your best to respect the patients wishes- use crystalloid, cell-saver during emergency surgery, etc., but if it comes down to transfusing or letting the patient die, I would choose transfusion every time.
 
RJ McReady said:
Yes
Obviously in a real life situation you try your best to respect the patients wishes- use crystalloid, cell-saver during emergency surgery, etc., but if it comes down to transfusing or letting the patient die, I would choose transfusion every time.
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It’s a noble answer, but I do see why adcoms might not like it. You’re openly admitting you would violate patient autonomy. Do you feel the same way about DNR’s?
 
DNAJB6 said:
You’re a physician and took an oath to do no harm. Your patient is a Jehovah’s Witness who refuses a blood transfusion. The patient is unconscious and rapidly bleeding out. In theory, the patient might not know if they ever received a transfusion. You also have reason to believe the patient was unduly influenced/coerced by family members into refusing blood. There isn’t time for a court order and guardian ad litem. The next of kin is unavailable. What would you do? Do you let the patient die? Do you violate patient autonomy? How would you decide?
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Did the patient refuse the transfusion and then become unconscious?
 
DNAJB6 said:
You’re a physician and took an oath to do no harm. Your patient is a Jehovah’s Witness who refuses a blood transfusion. The patient is unconscious and rapidly bleeding out. In theory, the patient might not know if they ever received a transfusion. You also have reason to believe the patient was unduly influenced/coerced by family members into refusing blood. There isn’t time for a court order and guardian ad litem. The next of kin is unavailable. What would you do? Do you let the patient die? Do you violate patient autonomy? How would you decide?
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anyone have advice on how to answer this one?
 
ThatSerb said:
anyone have advice on how to answer this one?
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While your answer is important, it's more important that you talk about how you arrive at your answer. For these MMI style questions, they're really looking to see that you're considering other perspectives and talking through the pros/cons of each side.

I think the argument for doing the transfusion is heavily dependent on if you can adequately make the case that you believed the patient was unduly influenced to refuse the transfusion. In that case, you would argue that the patient is NOT making an informed decision on their healthcare, and you would act in a way that assumes that if they were making an informed decision on their healthcare, they would choose the lifesaving treatment. Otherwise, in my opinion, I would not do the transfusion. The desire/responsibility to treat patients does not supersede their right to make informed decisions on their own healthcare. If you have no reason to suspect the patient was unduly influenced to refuse a transfusion, and no reason to suspect that they are unaware of the risks/benefits of refusing a transfusion, then you should respect their wishes. Patients have a right to make decisions on their healthcare, even if they are decisions that you don't agree with.
 
ThatSerb said:
anyone have advice on how to answer this one?
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This is a pretty classic ethical scenario.

If the patient is an adult and has the capacity to make his own decisions then you simply abide by those decisions, even if the patient dies.

If the patient is not an adult then you get a judge to order lifesaving treatment, even if it goes against the wishes of the parents.

The tricky part is what happens if the patient is an adult but does not have the capacity to make his own decisions, or if you are unsure whether or not he has capacity. In these instances, if lifesaving treatment is required acutely then you administer it. If you have the benefit of time, however, then you have several potential options, depending on circumstances: (1) obtain a psychiatry consult to determine the patient's capacity to make his own decisions, (2) locate next of kin and find out if the patient has designated anyone as medical power of attorney, and/or (3) obtain a clinical bioethics consult to help navigate any areas of ambiguity.
 
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Princeton Medical Student said:
That is honestly a very good question. Anyone answering zero is auto rejected as a liar.
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I feel like that question is different connotatively for females; I would suggest, perhaps, rephrasing the question. A female could answer once, but since climax can be reached many times successively in one session, they have an advantage over a male who may have to masturbate several more times per day to reach the same result, given that there's typically a recovery period necessary (however long or short) to achieve a new erection. This gives females a more modest answer, even if the action produces drastically different results.
 
Start throwing some zen koans at them until we get into some real weird territory

Show me your face before you were born
What is the sound of one hand clapping
 
gonnif said:
Over you legal obligations and possibly license? Any "belief" in the underlying influence, intent or motivation of the family would not overcome hard evidence of, say, finding a patient-signed Christian Scientist member card on their person. Your duty to save life does not overcome their constitutional right to freedom of religion, and your intervening in that scenario could cause your losing a license to practice medicine.
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With all due respect, your statement assumes a lot. My answer was my judgement based on the scenario. I had 5 minutes to come up with an answer and defend it, and I tried to do that based upon what I thought was ethically and morally right. I was not provided any other information about the patients’ family’s wishes and no there was not an “Christian scientist card” that I could look at. The patient was a Jehovah’s Witness who was bleeding out, and I chose to save his life.
 
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alm414 said:
It’s a noble answer, but I do see why adcoms might not like it. You’re openly admitting you would violate patient autonomy. Do you feel the same way about DNR’s?
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No, a DNR is a signed legal document. In this scenario there was no such document.
 
LunaOri said:
Tell me about something you've done that makes you cringe to remember it.
If you could have one superpower, what would it be, and why? (Answers related to medicine not allowed).
Are you still friends with all your exes? Why or why not?
If you could re-live one day in your life, without changing anything, what day would it be?
(Oh man, I could go on and on....)
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I liked these, so I'm going to answer them:

Something that made me cringe to look back on - my wedding vows. For the better part of my life I've been a writer and I've always been incredibly good at coming up with something to say on the spot. My husband challenged me to do that instead of practicing my vows for our wedding, and I completely choked, stuttering and stammering like an idiot in front of my friends and family. I wish I could go back and do it over.

I would have the power of teleportation (or apparation, as it's called in Harry Potter). The thing that I miss most in my life is seeing people I love because I'm too far away. One of the things I struggle with is not being there to help friends and family when they need me, and my kids growing up far away from our families and friends from home. I wish that weren't the case. If I could apparate, it wouldn't be.

I am only friends with one of my exes, and it's because we were always better as friends versus being in a relationship. The rest? I grew very much apart from them, and even if I wanted to we don't have enough common ground to sustain friendships. The one that I am friends with has been friends with me for so long that to not be friends seems weird. He's friends with my husband, and I'm friends with his wife. It just kind of happened that way and it works well for us.

I have control issues in my personal life. If I go back in time to re-live even one of my most favorite memories, I don't know that I could do it without fixing my mistakes. I have a deep-seated need to fix things. If I were guaranteed to be unable to change that day, I would want to relive the day that I went on my first date with my husband. I knew then he was the one, and I'd love to be able to relive those feelings; our love has changed and grown over the years, but there's nothing quite like that first rush of falling love.
 
RJ McReady said:
No, a DNR is a signed legal document. In this scenario there was no such document.
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So does your respect for a patients autonomy only extend so far as a signed legal document? Otherwise you’ll treat patients as you see fit, regardless of their wishes?

I’m being intentionally hyperbolic here to highlight the problems with that answer.
 
Not ****. I would recognize that this is an extremely stressful process for many young people and would try to make them more comfortable instead of less. My goal in and interview would be to have a conversation to assess someone’s personality and bedside manner. The interview for me would be an opportunity to make sure that in addition to the impressive resume, you are not a robot. If the person is able to communicate effectively, I’d be more supportive of accepting. Not to say that a good doctor can’t be awkward or shy, but I’d want to know that you are capable of holding a conversation, that you can talk in depth about your significant experiences, and that you have some humility. Being able to think on the fly is a skill that can be developed with training.
 
I would ask: How will being a doctor change the way you think of yourself and how others think of you? Why do you feel that way?
 
alm414 said:
So does your respect for a patients autonomy only extend so far as a signed legal document? Otherwise you’ll treat patients as you see fit, regardless of their wishes?

I’m being intentionally hyperbolic here to highlight the problems with that answer.
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Look, no matter what I said in my MMI or say here I’m sure you or someone else can find fault with it. That’s the whole point of the question. There is no obvious correct answer. Obviously my respect for a patient’s autonomy is not limited to a legal document and I’m not going to just go around treating people as I please. In the scenario given I was only told that he was a Jehovah’s Witness and their religious beliefs do not support transfusion. The patient in the scenario was unconscious and could not give consent.
 
gonnif said:
Over you legal obligations and possibly license? Any "belief" in the underlying influence, intent or motivation of the family would not overcome hard evidence of, say, finding a patient-signed Christian Scientist member card on their person. Your duty to save life does not overcome their constitutional right to freedom of religion, and your intervening in that scenario could cause your losing a license to practice medicine.
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While this is true, we don't expect interview candidates to have insider knowledge on the legal ramifications on the practice of Medicine. In fact, we avoid asking questions like that.

I don't ask the JW/blood transfusion question as was stated above, but in stead a use a variant to suss out the interviewee's ethical framework or world-view. It's kind of based upon a slippery slope argument.

No, I'm not not sharing!
 
DNAJB6 said:
How about both?
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the crux of it all is really just if they were competent when they refused, right? if they were, don't give the blood... if they weren't, give the blood?
 
ThatSerb said:
the crux of it all is really just if they were competent when they refused, right? if they were, don't give the blood... if they weren't, give the blood?
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Competency goes beyond whether the patient is demented or not. Was the patient coerced? That would seemingly be part of the calculus.
 
Well, they were unconscious so obviously couldn’t give consent.
but like I said, maybe they didn’t like my answer; they rejected me, but I wouldn’t change it just based on whether or not I thought it was what they wanted to hear.
 
Idk
I should preface this comment by stating I am not a religious person, and that I would do what my conscience dictates.
As a (future) physician, I can’t just let an otherwise healthy person die because their religion refuses to allow a transfusion when my oath is to protect life and do no harm. Is it not harming someone to let them die when you could have saved them?
 
Med Ed said:
I'm trying to understand the sequence of events. EMS bringing in an unconscious Jehovah's Witness is a very different scenario than a Jehovah's Witness who arrives conscious and interactive and then becomes unconscious.
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I had envisioned the latter but expanded the challenge of competency to go beyond AOx4 into whether the decision to refuse transfusion was done by pt's own free will and volition v. coerced by family members or members of his church. Think about refusal prior to THA followed by massive intraoperative hemorrhage in a geriatric patient...
 
RJ McReady said:
Idk
I should preface this comment by stating I am not a religious person, and that I would do what my conscience dictates.
As a (future) physician, I can’t just let an otherwise healthy person die because their religion refuses to allow a transfusion when my oath is to protect life and do no harm. Is it not harming someone to let them die when you could have saved them?
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Major red flag.

Although you yourself might not be religious, you still need the understanding and empathy to care for those who are. Despite what you might think is best, many patients would rather die than diverge from their beliefs. Not your or my job to play "god" just because we think we know what's best.
 
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RJ McReady said:
Idk
I should preface this comment by stating I am not a religious person, and that I would do what my conscience dictates.
As a (future) physician, I can’t just let an otherwise healthy person die because their religion refuses to allow a transfusion when my oath is to protect life and do no harm. Is it not harming someone to let them die when you could have saved them?
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This is a very good way to get sued. Successfully.
 
RJ McReady said:
Idk
I should preface this comment by stating I am not a religious person, and that I would do what my conscience dictates.
As a (future) physician, I can’t just let an otherwise healthy person die because their religion refuses to allow a transfusion when my oath is to protect life and do no harm. Is it not harming someone to let them die when you could have saved them?
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In the biz we call that thing you violated right here “patient autonomy”
 
clumsy.md said:
Major red flag.

Although you yourself might not be religious, you still need the understanding and empathy to care for those who are. Despite what you might think is best, many patients would rather die than diverge from their beliefs. Not your or my job to play "god" just because we think we know what's best.
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If a patient is part of a cult and wanted to die and had ingested toxic Koolaid (like the Jones Town Massacre except wittingly) would you accuse a doctor that resuscitates the patient against his will of lacking empathy?
One person’s cult is another person’s religion and vice versa.
 
GoPenguinsGo said:
In the biz we call that thing you violated right here “patient autonomy”
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If a patient has a serious disease but not terminal disease (and only the latter would allow physician assisted suicide in select states) and tries to hang himself, would you not violate pt autonomy to resuscitate him?
 
Emoryorbust said:
Well blended fruit salad
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But a salad is a medley or mix of things. What if it is only one fruit? Similarly a bowl of chicken wings is not a salad. Amalgamation of homogeneous substances does not equal salad... Breadless foods are not sandwiches; ergo, not all food is a salad or a sandwich.
 
DNAJB6 said:
If a patient has a serious disease but not terminal disease (and only the latter would allow physician assisted suicide in select states) and tries to hang himself, would you not violate pt autonomy to resuscitate him?
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Attempted suicide and refusing a treatment for religious reasons are WAY different. Sorry, try again.
 
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