Very hard interview question(s)...

[SBuck53]

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I really didn't mean to start any debates, but thank you everyone for all of your responses. They helped me more than I ever thought possible.

A special thanks to: drkennyj, SBuck53, LizzyM, mimelim, greatnt249, and SrootsWwings. (Sorry if I am leaving anyone out and hurting feelings, but the responses by these people seemed to be the most constructive/helpful for me.)

I'll be sure to post more difficult questions I have after my next couple of mocks (I know I know, I'm doing a lot of them).

Yeah this topic took a bit of a different turn, didn't it?

And thanks for the topic, certainly gave me more to think about as interviews are coming up fast!

Best of luck!

 

[Gut Shot]

1) The question itself is asking to value one person's life over another, which is not a fair premise. First come, first served.

It's never that simple. From the OPTN:

How long a patient waits depends on many factors. These can include:

- blood type (some are rarer than others)
- tissue type
- height and weight of transplant candidate
- size of donated organ
- medical urgency
- time on the waiting list
- the distance between the donor's hospital and the potential donor organ
- how many donors there are in the local area over a period of time and
- the transplant center's criteria for accepting organ offers

Depending on the kind of organ needed, some factors are more important than others.

 

[SBuck53]

It's never that simple.

I didn't mean to be so reductionist, you make a good point. There are many, many factors at play in that decision.

What I was trying to get across was that the question is asking you to objectively value one person's life over another, which is not a decision anyone, even a doctor, is really "qualified" to make. But lets not get into those kinda judgements

 

[mtremblay]

I'm sure people would have a different few on "universal" health care if they actually worked in the ER..excuse me.. "ED". The thing is as soon as you give someone free access to health care they are sure to abuse it. Why you might ask? Well because they're not paying for it. Oh..and guess what..the tax payers are! So yeah I agree in a perfect world giving everyone access to health care would be great, but unfortunately this isn't a perfect world.

Sorry guys I didn't mean to go on a rant, I just feel pretty strongly about this stuff. I work in the ER and I see it all the time, people coming in 15-20 times a month because they personally don't pay for it. I don't think that free health care is the answer at all. That's it I'm done. Back to unicorns and rainbows!! 🙂

 

[UCFKnight]

I'm sure people would have a different few on "universal" health care if they actually worked in the ER..excuse me.. "ED". The thing is as soon as you give someone free access to health care they are sure to abuse it. Why you might ask? Well because they're not paying for it. Oh..and guess what..the tax payers are! So yeah I agree in a perfect world giving everyone access to health care would be great, but unfortunately this isn't a perfect world.

Sorry guys I didn't mean to go on a rant, I just feel pretty strongly about this stuff. I work in the ER and I see it all the time, people coming in 15-20 times a month because they personally don't pay for it. I don't think that free health care is the answer at all. That's it I'm done. Back to unicorns and rainbows!! 🙂

Hmmm.. where does that come from (the bold part)? Any supporting evidence besides personal ED experience? Please do not mistake me for a troll; I am genuinely asking you.

 

[mtremblay]

Hmmm.. where does that come from (the bold part)? Any supporting evidence besides personal ED experience? Please do not mistake me for a troll; I am genuinely asking you.

Sorry, that part may have been a bit much. That statement is extremely hard to prove, aside from personal experience I have had. I am not trying to say that everyone who gets free health care is sure to abuse it; although this may sound like it. But the fact of the matter is some people (and from what I have seen a lot of people) will abuse it. I also used to live in Canada where we do have universal health care, and from what I've experienced most people do abuse it. They come to the ED for simple thing such as temperatures of 100 (which is not even considered a real fever) and slight coughs or runny noses.

But you are right; this is all from personal experience. I apologize if it came off a bit direct/close minded.

 

[bob99]

It is a civil right but not one that obligates the government (or anyone else) to provide you with it for free. As Americans we have the right to bear arms but no one interpretes this to mean that gun manufacturers or vendors must give them away for free.

Ya bit i think the question would require you to explain why it is a civil right. Additionally your argument about guns is slightly flawed. No on expects the government to require vendors to provide free guns, but maybe the government should charge taxes to provide it. The government does that all the time to ensure rights, such as funding the armed forces to ensure liberty which i think everyone would agree is a right. A right is something that no one has to give us, it is merely ours. Liberty and freedom are innately ours, even without government or even any other people in the world we would have freedom. However healthcare, food, clothing, and shelter are necessities but something that we have to go out and work for. Thats just the natural way of the world.

 

[bob99]

Well I don't have a good explanation for why it's a right. I will say though that if you think healthcare is only a privilege, you are in some sense discriminating in your patient population. Medicine is a highly sought, valuable, and necessary service. Withholding that service on the basis of ability to pay (the privilege), and nothing more, is cruel. It's the principle of humanism. To go a step further even some people with the ability to pay an insurance premium, but not outrageous procedure costs, are denied coverage.

It's easy to call it a privilege when you have it.

Well what happens when people who work for it and have the money to pay for it get inferior care as a result of you giving away free healthcare. Also what about the caregiver? dont they factor into this equation? Having people pay for healthcare is a way to maximize efficiency and give to the ones who work for it first. It would be wonderful if at the end of the day you can go out and help people who cant afford healthcare, but having people pay for it isnt cruel, its FAIR.

 

[LizzyM]

Ya bit i think the question would require you to explain why it is a civil right. Additionally your argument about guns is slightly flawed. No on expects the government to require vendors to provide free guns, but maybe the government should charge taxes to provide it. The government does that all the time to ensure rights, such as funding the armed forces to ensure liberty which i think everyone would agree is a right. A right is something that no one has to give us, it is merely ours. Liberty and freedom are innately ours, even without government or even any other people in the world we would have freedom. However healthcare, food, clothing, and shelter are necessities but something that we have to go out and work for. Thats just the natural way of the world.

It is a civil right in the US to be permitted to sit in a restaurant and enjoy a meal or check into any hotel regardless of one's race or ethnicity. That is a civil right. No one suggests that the government use tax dollars to provide people with restaurant meals and hotel rooms.

If it were not a civl right it would be easy to say that developmentally disabled people and the very old did not have the right to access medical care because of their relative inability to contribute to society in comparision to the young and the intelletually gifted.

As human beings, as a group, we must work to provide ourselves with food, shelter and protection from the elements. How the group (society) treats those who are unable to work due to youth, old age, or disability, tells a lot about the group.

 

[Gut Shot]

What I was trying to get across was that the question is asking you to objectively value one person's life over another, which is not a decision anyone, even a doctor, is really "qualified" to make.

How do you reconcile this sentiment with the fact that such decisions are, in reality, made every day?

 

[SBuck53]

What kind of decisions are made that put a doctor in a position to determine that one person's life is more valuable than anothers? A legitimate question, perhaps I am grossly uninformed.

Transplant decisions are made using computers with assigned critera. While this is somewhat "quantify" the value of someone's life, I see it more as a way to try to objectively determine order.

 

[deleted127837]

.

 

[mtremblay]

It is a civil right in the US to be permitted to sit in a restaurant and enjoy a meal or check into any hotel regardless of one's race or ethnicity. That is a civil right. No one suggests that the government use tax dollars to provide people with restaurant meals and hotel rooms.

If it were not a civl right it would be easy to say that ******ed people and the very old did not have the right to access medical care because of their relative inability to contribute to society in comparision to the young and the intelletually gifted.

As human beings, as a group, we must work to provide ourselves with food, shelter and protection from the elements. How the group (society) treats those who are unable to work due to youth, old age, or disability, tells a lot about the group.

I agree with you that it is a right, especially for those that are physically or mentally unable to contribute financially to have access to healthcare. However my point is that some people who have the physical and mental capacity to work decide not to. This is when it gets tricky, because now those people can take advantage of what we give them without ever giving anything back to society.

Believe me, I've seen it happen first hand. In Canada some people don't work because they get a social security check, they have free healthcare, and they do under the table jobs so they get no taxes on their income and keep their social security checks. I do not believe this is the solution the US is looking for.

 

[SrootsWwings]

Yeah this topic took a bit of a different turn, didn't it?

Best of luck!

Call this thread another drop in the evidentiary bucket for the universality of the Youtube comment effect 🙄

A corollary, good sign is that while this thread may have become consumed by the political concern within all of us, the pre-med community sample in this thread has displayed what I'd call a) above-average syllogistic capabilities, and b) an appreciable ability to keep the conversation civil and respectful - hooray us!

 

[Gut Shot]

What kind of decisions are made that put a doctor in a position to determine that one person's life is more valuable than anothers? A legitimate question, perhaps I am grossly uninformed.

I didn't single out doctors, but any time limited resources are allocated among a population with need you run into this issue. The best example from my own experience is in the blood bank, where on a busy night you can have multiple ORs all screaming for units of O-neg and only so much to go around. Do you give them to the young male who came in first or the young female, who came in second, but runs the risk of alloimmunization affecting her later in life?

You even partially answered your own question:

Transplant decisions are made using computers with assigned critera. While this is somewhat "quantify" the value of someone's life, I see it more as a way to try to objectively determine order.

The generation and application of these criteria is absolutely a way to quantify the value of life. If you really want to go down the rabbit hole just look up the debate on concepts like QALY (quality adjusted life year).

Perhaps a little more subtle is the debate that goes on in almost every tumor board conference I have ever been to, where the oncologists are trying to decide how aggressively to treat various patients. Age is often a factor in these decisions, with less value given to the potential remaining life of older patients and more given to younger ones.

 

[SBuck53]

I didn't single out doctors, but any time limited resources are allocated among a population with need you run into this issue. The best example from my own experience is in the blood bank, where on a busy night you can have multiple ORs all screaming for units of O-neg and only so much to go around. Do you give them to the young male who came in first or the young female, who came in second, but runs the risk of alloimmunization affecting her later in life?

The generation and application of these criteria is absolutely a way to quantify the value of life. If you really want to go down the rabbit hole just look up the debate on concepts like QALY (quality adjusted life year).

Perhaps a little more subtle is the debate that goes on in almost every tumor board conference I have ever been to, where the oncologists are trying to decide how aggressively to treat various patients. Age is often a factor in these decisions, with less value given to the potential remaining life of older patients and more given to younger ones.

I have been mistaken. You make a good point, when resources are limited, decisions have to be made to allocate resources in a responsible way. Being young and naive, I would like to think that this is not true and resources are allocated based on where they will be best used, but I see that even this is a value judgement.

 

[omare61]

I have been doing some mock interviews in preparation for this interview season, and I have come across some questions that I truly cannot find a good answer to. Feel free to pick one, some or all, and provide how you would/will respond to it.

I know that many of these may have become cliche to some of you, but, nonetheless, I am still interested in how everyone really would respond. I know this will not only help me. I also know that many of the answers to these questions will be subjective, but please humor me.

1. If you had the choice of giving a transplant to an elderly woman with various health problems or a 20-year-old drug addict, how and who do you choose? Why?

2. What is your "cause/purpose"?

3. Rank intelligence, compassion, and integrity in the order of importance to you.

4. If you had a magic pen, what would you do to remedy health care in America?

5. I am a dying patient, and you are my doctor. Tell me that I am going to die.

6. Do you think health care is a right or a privilege?


I'm sure I'll have more later, but that is it for now. Thanks ahead of time to anyone who gives input.

Would adcoms ask these kind of questions??😱😱

 

[Frazier]

Would adcoms ask these kind of questions??😱😱

Certainly...

 

[angldrps]

What has this thread turned into?!

 

[omare61]

1.) What's better a doctor who cares deeply about their patients but has little aptitude for medicine, or a doctor who doesn't care about their patients but has a large aptitude for treating diseases.

It seems like both doctors suck! You need to have both

It's messed up but that's reality for you. Resources are limited either way you look at it. Private health insurance drops coverage, public health insurance rations care. Most health spending is used by the elderly in the last few years of their lives. Drug-addicted and obese patients, who are victims of their own habitually poor choices, should not take health resources from otherwise healthy patients.

Not all obese patients are victims of their habitually and poor choices. You have to look at genetics, thyroid function and many other internal problems. Do you think obese people enjoy being obese? I'm sure drug addicts enjoy being addicts? There are some obese patients who just try their best to lose weight, but it just doesn't work. They may even eat less calories than you, but their metabolism doesn't allow them to be as fit as you.

 

[LauraJo08]

These are pretty straight forward questions. Not really tricky. They have right and wrong answers (multiple of each) and do not particularly depend on who is interviewing you. I have answered all of these at least once on the interview trail, or a similarly worded question...

1. If you had the choice of giving a transplant to an elderly woman with various health problems or a 20-year-old drug addict, how and who do you choose? Why?

Purpose: Attempt to trap applicant into comparing elderly vs. young + drug addict. Hard route - picking one and justifying. Easier and generally more fluid - Redirect. Convince the interviewer that the question is invalid, stupid, moot, take your pick.

Personal take: I would attack the simplicity of the descriptions of the patients. No person can be or should be simplified down into "elderly female" or "drug addict". In each of those groups there is a huge variation.

2. What is your "cause/purpose"?

Purpose: Sell yourself. Can also be translated into, "Why should I invest resources in training you?" Or, "Medical training is long and hard. What makes you wake up every day and strive to achieve X, Y and Z?" This is probably the fairest question an interviewer can ask. It is the simplest, most direct and probably one of the most useful questions. If you do not get this while interviewing for medical school, you WILL get it interviewing for residency. Of the 18 programs I interviewed at this Spring, I was asked at 10+ some derivative of this question.

Personal take: You can not fake this question. It is obvious and transparent if you do. When you put a person's answer in the context of their application you can easily derive the sincerity of all the other answers that an applicant gives. It all comes down to having a theme to your application. Activities complimenting a personal statement which in term is reflected in your answer to this question. An ego helps when answering this question as long as it doesn't get out of hand.

3. Rank intelligence, compassion, and integrity in the order of importance to you.

Purpose: Nobody actually cares how you rank these. None are less important than the others. The trap is diminishing the importance of any of them. You should be able to answer the question, "Why is _________ important to the practice of medicine?" Where the blank is filled with intelligence, compassion or integrity. You should also have a specific example or two for each. You can make some arbitrary order if you choose, but in the end you can't order these entities.

Personal take: I would never provide the evidence unless provoked by this type of question, but I can and have easily provided examples for interviewers of how I exemplify each of those. Again, goes along with being able to sell yourself. You have to be able to self promote when asked to.

4. If you had a magic pen, what would you do to remedy health care in America?

Purpose: Translation: "How close do you follow the political atmosphere and the world outside of your little bubble?" There are a lot of ways to answer this. The way you shoot yourself in the foot is going for too much. The second part of that is that you need to be humble when answering. If American health care could be solved that easily, it would have been done. Pick a pet issue, promoting preventative medicine, mandating standardization of EMRs, etc. And propose a solution. Do not try to fix the entire country.

5. I am a dying patient, and you are my doctor. Tell me that I am going to die.

Purpose: Weed out the sociopaths. Do not tell people you know how they are feeling. You don't. Even if you have a closely related experience, you don't know how they are feeling/responding. Do not use words like expire, pass away etc. They are going to die. That has to be crystal clear and up front. What comes after is the important part. Offer support, personal and then in the form of palliative care/hospice as well as grief counseling.

Personal take: I told a 25 year old that they were going to likely die in the next 2-3 months last week. I have told 10+ patients that they are going to lose anywhere from a toe to 50%+ of their leg in the last 6 weeks. The formula for dealing with these issues is among the simplest out there. The hard part is actually seeing someone who is actually going to be in a body bag in a couple months and being able to follow through. As an interview question this is fairly straight forward.

6. Do you think health care is a right or a privilege?

Purpose: Weed out people who have never thought about the question. This is an easy question to answer. Both are easily justifiable. You can easily flip-flop in your opinion between interviews. Which side you fall on does not matter. Having a reasonably thought out answer as well as counters to the basic counter arguments is what is required.

Hey guys, after reading this thread I still couldn't figure out if it is considered standard protocol to say to the patient "I'm sorry, there is nothing else we can do, you are going to die." (or something to that effect)?

 

[Bangersandmash]

Make sure you add in some sort of explanation of palliative care/comfort measures, but essentially, "We have done what we can, we can't do anything else for your disease, you will die, but you won't die in pain. We can do X and X to comfort you and get you in touch with counseling and hospice. I can't imagine what you must be feeling. *Offer tissue*. I'm here for you if you have questions."

And no one has really addressed health care as a right versus a privilege from a philosophical view point. You all make great points about resource allocation, economics, constitutional rights yadda yadda yadda but no one ever mentions it from an a priori philosophical view. I suggest reading this:

http://www.peh-med.com/content/2/1/2

I personally think it is a right for its necessity to promote a healthy and happy human life. Why do governments offer police and fire rescue services in return for tax money? Why is education funded through taxpayer money and offered "free" to children? We enter a social contract with our governments and society in which we pay taxes for certain services and protection. In a perfect world, we wouldn't murder each other and wouldn't need police. Food would be free because it is most essential to pursuing a healthy and happy life. But life isn't perfect, so we must think practically. Anarchism certainly won't be better.

If people become injured and have no way to be healed, that diminishes potential to live out a healthy and happy life. Health care solves that. The problems come in with preventable diseases (self-caused obesity, emphysema from smoking etc). It also doesn't answer WHY humans have a right to health and happiness, but good luck proving that one.

My goal when answering a question is to get to the root of it. Medicine has so many different question scenarios that have philosophical underpinnings. Unfortunately, philosophers spend their entire lives thinking about questions that can't ever be answered with proof.

 

[LauraJo08]

great thanks!

 

[dsoz]

Would adcoms ask these kind of questions??😱😱

I was involved in a mock interview put on by a pre-med club. One of the interviewers was a professor at a local medical school. He asked me the question "is health care a right or a privilege?"

My answer was very unrefined, but when I go interview at that same school later this month I will try to be prepared with a better answer.

The answer I gave was that it is a right up to the point where people have abused themselves into a higher risk category. If they don't care enough about their own health, then it becomes a privilege. Examples that I gave were the chronic smoker that has COPD, the morbid obese patient that has clogged arteries, the drug user that has hep C and needs a new liver.

These cases burden down the system and cause the rest of us to have a shortage of health coverage.

I do think that we should excuse the youth, the aged, and the handicapped (through no fault of their own) from this debt.

dsoz

 

[MedPR]

Would adcoms ask these kind of questions??😱😱

I got asked one of those at a DO interview this week.

 

[Gut Shot]

One of the interviewers was a professor at a local medical school. He asked me the question "is health care a right or a privilege?"

As it is phrased, that question poses a false choice. There are other ways to look at it. Like this one.

The answer I gave was that it is a right up to the point where people have abused themselves into a higher risk category. If they don't care enough about their own health, then it becomes a privilege. Examples that I gave were the chronic smoker that has COPD, the morbid obese patient that has clogged arteries, the drug user that has hep C and needs a new liver.

These cases burden down the system and cause the rest of us to have a shortage of health coverage.

If I were your interviewer this response would earn your application a one-way ticket to the garbage can. The determinants of disease are complex and almost invariably tied to factors beyond the patient's control, so we can't make a tidy little graph or table to determine when someone's rights end. This profession is about promoting health, not promoting health*.

*Pending credit approval

 

[kaige333]

1. If you had the choice of giving a transplant to an elderly woman with various health problems or a 20-year-old drug addict, how and who do you choose? Why?

I would have to see if there are and what are the guidelines for determining priority. In this case though, they both seem equally bad, how about whoever comes first...

2. What is your "cause/purpose"?

I want to help cancer patients through care and research.

3. Rank intelligence, compassion, and integrity in the order of importance to you.

1. Integrity (do no harm)
2. Compassion (how could you last long arse work days and be expected to help when you don't care enough?)
3. Intelligence

4. If you had a magic pen, what would you do to remedy health care in America?

CUT COST and yes, lower medical school tuition =].

5. I am a dying patient, and you are my doctor. Tell me that I am going to die.

I am very very sorry (meanwhile do everything I can to lessen suffering).

6. Do you think health care is a right or a privilege?

It is a right.

 

[09ine]

As it is phrased, that question poses a false choice. There are other ways to look at it. Like this one.



If I were your interviewer this response would earn your application a one-way ticket to the garbage can. The determinants of disease are complex and almost invariably tied to factors beyond the patient's control, so we can't make a tidy little graph or table to determine when someone's rights end. This profession is about promoting health, not promoting health*.

*Pending credit approval

I dunno, the patient seemed in control in those examples...

 

[Gut Shot]

I dunno, the patient seemed in control in those examples...

Nature, nurture, control is an illusion. Besides, show me an obese person with significant blockage of the coronary arteries and I'll show you someone who needs treatment, not moral judgement. You want to deny him emergency room access when he shows up next year with crushing chest pain?