Questions testing critical thinking (including ethics)

Question 1

In what ways can doctors promote good health other than through direct treatment of an illness ?

Answer 1

They can promote good health by setting a good example for patients - keeping fit, not smoking and eating healthily.

can have posters up in their surgery.

during consultations, encouraging patients to have a healthy lifestyle.

advice on disease prevention - screening programmes and immunisation campaigns and services

Question 2

How does politics influence healthcare decisions ?

Answer 2

The political determinants of health care - poor environmental conditions, inadequate transportation, unsafe neighbourhoods, and lack of healthy food options - affect all other dynamics of health.

politics has a major impact on the delivery of healthcare

• working hours
• funding
• pay rises - has led to strikes
• being understaffed - has led to strikes

These are all political decisions, i won’t act as if i know exactly what parties are involved etc but these things are the governments decision as the NHS is public, therefore politics will also play a role

Question 3

Do you think it is right to allow private healthcare to run alongside the NHS ?

Answer 3

In favour :

• private healthcare takes patients away from the NHS waiting lists, in the news that the backlogs are months long. this is both beneficial to the patients and the NHS as treatments can be diverted into the private sector and this would ease strain on the NHS
• some doctors also have high ambitions and want to supplement their income through private work. if this wasn’t a possibility a lot of doctors would leave medicine or leave the country and practice elsewhere
• NHS can’t cope with all the demands because of budgetary constraints
• There is a fundamental issue of personal liberty and individual choice too, private should always be available to them if they need it

Against :

• private healthcare mainly benefits the wealthier part of the population - leads to inequality
• private healthcare is financially driven therefore you could argue about the motivation of the doctor which may not be altruistic

give my own opinion - private should run alongside it

Question 4

How should healthcare be funded ?

Answer 4

There is no right or wrong answer to this but i believe the way its done in the UK is fair - there is a mixed market economy type of style to it

taxation is used to fund NHS which is our public health service but at the same time there is also private healthcare available which can be used by the people who can afford it.

One thing i would say and most people will agree with is that the NHS is underfunded and understaffed - however that is not a problem with the idea behind the system but is a problem with the government and politics. you don’t see this problem in sweden which is also publicly run and funded by taxes - but the state of their healthcare service is a lot better than ours - our problem lies with the government and politics

Question 5

What do you think of the way that doctors are perceived in the media ?

Answer 5

positive

• heroic events such as the role of doctors in the aftermath of tragic events
• covid response and how the uk dealt with that
• documentaries and tv programmes showing all the amazing feats that doctors have accomplished

negative

• Dr shipman killing numerous patients, major scandals as such don’t give doctors a good name
• one main thing that is very recent is the fact that they are perceived negatively because they go on strike to defend pay rights when public perception is that they are very highly paid.
• Media can affect trust in doctor patient dynamics, patients may not believe things that doctors say because they watched or heard something different on social media - shouldn’t be the case but unfortunately it is

media plays an important role in influencing peoples decisions on doctors, normally the media portrays things that will make them money and often sensationalise stories therefore most of the time they only portray negative things. however, i believe people should use personal experiences with doctors to decide their opinions on what medicine really is

Question 6

What does ‘inequalities in healthcare” mean to you ?

Answer 6

there are both socio economic and geographical inequalities in healthcare

socioeconomic - available services may not be used to their optimum by people in vulnerable groups that can’t afford it

geographical - people in urban areas have easier access to healthcare facilities

inequality in both private and public healthcare - wealth gap can affect the quality of healthcare that people receive

Question 7

what are the arguments for and against people paying for their own healthcare ?

Answer 7

for

• would introduce competition on the doctor level and therefore could lead to increased quality of care
• may encourage people to have a healthier lifestyle so they don’t have to pay for it
• would prevent time wasting patients, people will only go if they have to

against

• place the poorest at a clear disadvantage
• may put people off from going to the doctors because they don’t want to pay
• patients with chronic illnesses will be paying all their lives and it will be very expensive - should be subsidised and paid for (only chronic illnesses)
• may lead to a black market in healthcare practices - unregulated and dangerous for patients

Question 8

What are alternative medicines ? What is your opinion of them ?

Answer 8

hypnosis, crystals, acupuncture, homeopathy etc

for

• many therapies do not involve taking substances into the body therefore it is less likely that there will be side effects, whereas medicines can have side effects
• When conventional medicine isnt working, alternative therapies can offer further hope - DAD MIGRAINE HOMEOPATHY

against

• there isnt much evidence backing alternative medicines compared to conventional medicine
• conventional medicine rests on scientific principles of pathophysiology whereas alternative medicines don’t
• alternative therapies are poorly regulated, can lead to the abuse of trust of patients

Question 9

Do you think the NHS should provide alternative therapies ?

Answer 9

it depends on whether the NHS can get around all the negative aspects of it

• If they find evidence that can back alternative medicine working then yes
• conventional medicine rests on scientific principles of pathophysiology whereas alternative medicines don’t
• If they can regulate them and can ensure no patient abuse is taking place

Question 10

Should the NHS deal with patients who have self inflicted diseases ?

Answer 10

first define what a self inflicted disease is - lung cancer because of smoking, obesity because of eating habits, liver cirrhosis because of drinking habit etc

yes they should deal with them

• most of us will need to see a doctor for an issue that will bear some relation to our lifestyle, public perception of NHS would be bad if they didnt
• some self inflicted behaviours may reveal underlying health issues that may need to be identified and treated

e.g. self harm could reveal underlying depression etc

no we shouldn’t deal with them

• patients with self inflicted diseases often relapse, strain on NHS resources if they continually do this.
• Resources are scarce, we should prioritise how budgets should be allocated and where the money should be spent

ultimately it is down to society to decide how it wants to use its health system and if it wishes to refuse treatment to individuals whose diseases are or appear to be self inflicted, then so be it - justice also creeps in - we should treat everyone equally and a core principal of the NHS is to provide free care to those that need it

Question 11

How do you go about researching something you know nothing about ?

Answer 11

give my own example with CAD and how i researched about it because it interested me

• read simple articles and texts on it
• read about what it is, how it can be prevented, what the treatments are, what can cause it
• watched youtube videos surrounding these mentioned things

Question 12

Should the NHS fund non essential surgery ?

Answer 12

first need to define what non essential surgeries are

yes fund

• can have psychological effects on an individual even if they look like they’re not necessary
• people may start to self fund surgeries if NHS doesn’t and this can be financially difficult for them

no don’t fund

• if non essential surgery is funded, people may look to find problems that they never paid attention to before - breast enlargement because she feels she may aswell have it. to prevent this we shoudlnt fund it - it wastes NHS resources
• kind of like the free rider problem, people take advantage of it because no one has to pay for it. as soon as it gets to paying for it, it deters people from using it

Question 13

How do you solve the problem of transplant organ shortages ?

Answer 13

• people should carry organ donor cards with them
• impose that everyone should be a donor - ethical issues will arise tho - autonomy plays a part too - make everyone be a donor and those who do not want to can let the government know and opt out - opt out scheme
• This is already a thing so it may not have too much of an effect

Deceased donor organs Should be Automatically Available

Giving one’s organs after death with the possible consequence of saving someone’s life is arguably within one’s duty of beneficence. If morality demands anything, it demands that we make a very small sacrifice for the significant benefit of others

• Financial incentives

Question 14

Why do you think it is that we cannot give a guarantee that a medical treatment or surgical procedure will be successful ?

Answer 14

patient linked factors

• if the patient doesn’t confide in the doctor and tell them everything when history taking the proposed procedure may not be suitable
• patient may not respond to the procedure
• patient may not adhere to the medical treatment or take the medication

doctor linked factors

• doctor may have made the wrong diagnosis
• surgeon may not be fully competent during the procedure or afterwards, making it difficult for them to deal with adverse consequences
• not all treatments work on all people e.g paracetamol may or may not work on a person

Question 15

What do you think would be the advantages and difficulties of a person with a major physical disability wanting to become a doctor ?

Answer 15

advantages

people whose disability affects one of their senses benefit from the fact that another one of their senses is more developed

blind people have also often developed an ability to retain, analyse and process information efficiently - could prove useful in a medical career - in diagnosis and as a clinician

disadvantages

a blind person may not be able to examine a patient in depth and spot important clinical signs without the help of a colleague (that colleague could be doing something more important) , they may also not be in the right position to ensure that they are administering the correct drug at the right dosage

a person who cannot walk would find it difficult to attend to a patient in an emergency

Question 16

What are the advantages and disadvantages of admitting when a mistake is made ?

Answer 16

advantage

• you can repair the mistake more quickly because you have people around you that can help
• you can openly identify areas of improvement

-people would be grateful for your honesty, it will encourage them to have more trust in you in the long run

disadvantages

• colleagues may lower their opinion of you
• decrease in trust towards you and/or the medical profession

Question 17

Do you think it is right for doctors to have study material sponsored by pharma or corporate sponsors ?

Answer 17

yes

• education budgets are small and this deters doctors from paying out of their own pocket to study so they are more likely to study
• allows greater relationship building with the industry

no

• sponsors might only support speakers who are biased in their favour - always a risk of corruption
• doctors may feel obliged to prescribe certain drugs rather than others as a result

it is right - but in moderation / if NHS had more funding then it wouldn’t be needed - again a problem with funding and the government

Question 18

Do you think it is right for patients to make the choice as to what is in their own best interest ?

Answer 18

YES

• patients are responsible for their own body. they are also likely to go through with the treatment if they have been involved in the decision making process
• several approaches may be suitable, patient should be able to decide what suits them best

NO

• patient may not have the background knowledge to make the best decision
• patient may be influenced by relatives and they may not want to act in their best interests, important to get a holistic view on the individuals life
• patients may make decision on information that is not correct

Question 19

People are living longer. Should doctors take credit for it ?

Answer 19

YES

• medical advancement is a key factor in the increased longevity of peoples lives
• doctors play a key role in educating patients on what to do and what not to do

NO

• medical advancement is not always credited to doctors, bio chemists play a large role too and big pharma
• doctors are not the only healthcare individuals that look after patients - nurses, HCA etc
• patients are also more educated because they have easier access to information through the internet

Question 20

Should doctors show a good example to patients ?

Answer 20

YES

• They need credibility in order to be trusted by their patients. If they don’t do it why should their patients do it ?

NO

• issue of individual choice (autonomy)
• Defining good example is not easy, something that is good example for one person may be bad example for another

Question 21

60 % of medical school applicants are female. why do you think this is ?

Answer 21

there are more girls alive at the age of 17 compared to boys and this is due to many factors such as the fact that during their teenage years, boys have a higher chance of risk taking

girls tend to perform better than boys at exams and achieve higher grades

women may feel more at ease in building a good rapport with patients, as well as this boys may want to take up jobs that pay more such as law, finance and engineering

Question 22

What are the advantages and disadvantages of the increasing roles of nurses ?

Answer 22

+

• It may free up doctors’ time which enables doctors to focus on more complex and detailed patients and procedures
• Nurses may be able to spend more time with their patients, can have a more holistic view and can increase patient satisfaction as they feel they have someone with them there at all times
• nurses are taken away from the frontline nursing care
• if nurses start taking care of the smaller cases and simple procedures, this could decrease the roles that junior doctors can take up and will impact their training
• Patients may not be confident in a nurse treating them so may request for a doctor instead

Question 22

The time that it takes to become a consultant has been decreased. What are the implications of this ?

Answer 22

• The same amount of knowledge may need to be crammed into a shorter period, puts more stress on the doctor and they may not learn it in as much depth, if they had a longer time they would be able to solidify their learning and it would be superficial.
• In the short term there will be a sharp increase in the number of consultants. If this is matched by an availability of positions then this will lead to a more consultant delivered service - if not then this will lead to unemployment

Question 23

What could be the implications of medical advancement on medical training ?

Answer 23

Medical advancement means that the volume of information increases constantly. This could lead to increased training time.

• If we want to avoid lengthening the training to cover that extra content, then a more effective method of training must be found

Having said this, medical advancement has led to a better understanding of the mechanics and chemistry of the human body, enabling good simulation tools to be built, making training easier.

Question 24

Is it best for a doctor to be a good communicator or a good clinician ?

Answer 24

Being a good clinician would mean that you are good at diagnosing conditions and setting out effective management plans but none of this can be done without good communication with the patient beforehand.

• a doctor has to be a good listener, you can’t diagnose a patient without having all the information available - give example of when i was in the clinic
• needs to be a good communicator as they need to get information across to patients and family in a way that they can understand it - give an example TB kid with a brain tumour

can’t be a good clinician without being a good communicator - with patient and colleagues

Question 25

Which question would you most want to ask if you were interviewing others to enter medical school ?

Answer 25

Why do you think you can cope with medical school ?

It will allow the person to tell me about their interpersonal skills, what they know about med school already and their ambitions

i would expect their answer to include :

• a general academic background
• An idea of what they think it is like to go through medical school
• their interests
• how they balance their life
• how they cope with stress

Question 26

For religious reasons, Jehovahs witnesses cannot accept blood transfusions. Would you be happy to let a Jehovahs witness die because he refused a blood transfusion ?

Answer 26

Autonomy

• They do not accept blood and this is their personal decision so it must be respected, if they are competent or have made a living will

beneficence

• is transfusion the only option ? what else could be done to save the persons life that does not involve a blood transfusion
• is there anyone the patient can speak to in order for them to reevaluate their decision and maybe decide for a blood transfusion, if it is the only way to save their lives
• Make sure that they are competent and have capacity to make this decision - if they don’t then go by the decisions of their parents or living will

Question 27

What would you do if a patient came in bleeding and unconscious and needed a blood transfusion (Jehovahs witness) ?

Answer 27

• stop the bleeding
• they can’t give consent so you have to act in their best interest
• try find alternatives to the blood transfusion first
• if there are no alternatives and a blood transfusion is the only option try to contact the persons family and ask for their permission and advice on whether they should give the blood transfusion or not
• if you have no information on what the patient would have wanted or if time is of the essence then act in the patients best interest to save their life and carry out the transfusion if necessary

Question 28

You have one liver available for transplant - between an ex alcoholic mother with 2 kids and a 13 year old boy with a congenital liver defect. who do you give it to ?

Answer 28

is the liver available a direct match to any of them ?

• older patient may be less likely to survive the surgery, however could say that they are fitter compared to a younger person. KID IS BETTER
• co morbidity - if the patient has any other diseases that may substantially affect their life expectancy - in the long run it won’t be as beneficial to that person because they have other external factors KID IS BETTER
• risk of recurrence - kids birth defect is unlikely to recur but the drinking problem is generally a recurring thing and is hard to get out of KID IS BETTER
• will the individual follow up with their medications and therapy and look after their liver ? if they are more likely to do so than you should give it to that person
• look at the impacts on society that may follow, the children of the mother and the parents of the child ? will the child contribute more to society later in his life ? you never know

overall - give to kid

Question 29

What would you do if an obese patient demanded an immediate total hip replacement, which you know will fail in 6 months ?

Answer 29

Justice - the person has a clinical need and doctors are required to follow up on this - could say that this is a basic human right

justice - risk the treatment may not be successful and WILL fail in the long term, injustice to society as you are diverting resources away from them

• could something be done to resolve the obesity problem before proceeding with the hip replacement ? - set a plan e.g. take meds, better diet, do exercise if obesity disappears and the hip replacement will work then we will do it - lets try that first
• However, if the patient is insistent then autonomy plays a part and we are required to go ahead with the total hip replacement

Question 30

a 14 year old girl presents to you asking for a termination of pregnancy. What are the issues ?

Answer 30

• first we need to decide whether or not the girl can actually have an abortion, if the foetus is over 24 weeks then it is not possible
• if she is not fraser competent then you must involve her parents
• if she is competent then confidentiality comes into the question, should the parents be involved or not, must discuss this with her and go about it in a polite and opening way - dont be too paternalistic
• holistic approach afterwards
• what are the physical considerations that may play an effect on her - STIs, can she stand the abortion ?
• What are the psychological considerations ? mental well being and the consequences of the abortion
• What are the social consequences ? her and her parents ? her and the father ? - is it an illegal relationship ? alert authorities too ?
• You need to ensure that you communicate with her on the right level and don’t impose your own views onto her, don’t be condescending or paternalistic.
• if the doctor is against it, refer to another doctor who will do it

Question 31

An elderly lady refuses to take her medication for heart failure after a heart attack. not taking the meds exposes her to risks. she comes to surgery with her husband who wants you to talk sense into her. What are the issues ?

Answer 31

confidentiality

• make sure the lady is happy that you can speak openly whilst her husband is there too

beneficence vs autonomy

• respect her autonomy, she’s deciding not to take the meds even tho it could lead to something bad.
• but you also have to act in accordance to beneficence and must cater for her in her best interest
• provide her all the info she needs with making an informed decision , educate her about the condition, why she needs to take them and what they do

holistic approach

• look at why she doesn’t want to take them, maybe she’s depressed, maybe she wants to die
• if she wants to die you have to guide her and aid her and make sure she’s comfortable until the point of death

competence

• she may not be competent, if she isn’t then check if she has a living will and behave in accordance to that, then ask her husband what he might want, then act in your best interest

Question 32

A patient comes in and asks for a HIV test, what do you need to think about ?

Answer 32

why are they asking for a test in the first place ?

• if they’ve had unprotected sex, then you have to educate them on the risks and what should be done

timing of the test

• some tests only detect the virus 3 months after, so if you have a test within 6 weeks HIV may not present whereas u might acc have it

How old is the patient ?

• if the patient is underage then a criminal element is involved and you have to ask the patient how old their partner was and go about it that way

inform the patient of the consequences of a positive result and what it can lead to

confidentiality, encourage them to gain support from those who are close to them if they feel like they need support

Question 33

a patient with HIV doesn’t tell their wife, what do you decide to do ?

Answer 33

confidentiality towards the patient, but may be able to break this if you believe that the wife is at risk, beneficence and non maleficence towards the wife (if she is a patient of the GPs too)

• inform the husband on what he should do, constantly take meds, and use a condom whilst having sex
• have an in depth discussion with the husband and the reasons behind why he is not telling his wife. could try to convince him and bring in support staff to guide him into telling his wife

overall, tell the person the risks of not telling his wife, inform him of why he should tell his wife and what to do if he doesn’t want to tell his wife, if he doesn’t want to tell his wife and you think it will be a risk to her then make sure that you tell her, even tho you are breaking confidentiality you are preventing the wife from being at risk.

Question 34

What is your opinion on vivisection ?

Answer 34

animal testing - cutting alive

in favour

• we need to understand physiology and pathology using basic cellular studies, animals could be used for this
• ensure that new treatments are safe for humans by testing them on animals first - provides a valid reason
• animal suffering is minimised and they don’t feel much

against

• depriving an animal from its normal life and is cruel
• Animals are defenceless and can not consent
• Alternatives can be used sometimes e.g. computer modelling

i think its fine, needed for medical advancement and its better than testing on humans

Question 35

Do you think that is right for parents to conceive a second child to cure a disease in the first child ?

Answer 35

for

• the life of the child may be saved by the birth of the second child e.g. organ donations that are a direct match, blood stem cell therapy that is a direct match

against

• no guarantee that the second child will be a match with the first so you are taking a risk
• second child may be born with the same condition as the first, make it worse for the family
• could distance the siblings when they are older and find out, second child was born out of necessity and not love

overall, i believe no, risks and possible cons outweigh the positives

Question 36

Do you think that the government is right to impose that the NHS should only allow the MMR vaccine rather than three individual vaccines ?

Answer 36

• the studies showing a link to autism have been disproven - wakefield and MMR scandal
• combined vaccine is safer and more effective
• Role of the NHS is to offer what is believed to be the best solution to a particular health issue taking into account cost considerations

yes they are right and they have evidence to back it but if they want three separate vaccines then the NHS should refer them to a private company

Question 37

You are a junior doctor and just before the morning ward round, you notice that the consultant smells of alcohol. What do you do ?

Answer 37

Patient safety is the main priority, because he’s drunk make sure that he doesn’t spend time with patients and that he leaves the ward, organise something for him make sure he doesn’t drive back to where he’s going

Report the matter as it could have had the potential to lead to something catastrophic, in the short run or the long run, follow the guidelines of your trust

Be understanding towards the consultant and don’t be critical as there could have been some personal reason behind the drinking

First time or not, the approach is the same

Do not cover anything up at all, be understanding and empathic but do not resolve it, just report it

if it happens again, then talk to the person and comfort them if it is a personal matter, still have to escalate and report it

Question 38

What should you do if a colleague asks you to prescribe them some anti depressants ?

Answer 38

• establish why the colleague needs them and why they are not going to a GP to get them the correct way, needs to be properly diagnosed and prescribed in the correct way
• His depression could be affecting his ability to function normally at work
• maybe encourage your colleague to see a senior colleague and get advice from them
• if you feel he’ll present as a risk to patients, let a senior colleague know straight away

Question 39

What would you do if you caught a colleague looking at child pornography on a computer at work ?

Answer 39

• Take note of the date and time that the person did so you can report the situation to a senior colleague
• the actions against the colleague will lead to more stress on the team so make sure to support them
• if action is slow, then follow up and escalate if nothing is being done

This is illegal so there will be repercussions for the individual

Question 40

Under what circumstances is it okay to lie ?

Answer 40

normal life, white lies are fine, sometimes they’re to save yourself from embarrassment or save someone else from embarrassment, and i think thats fine here and there, so does society. social norms. However, deception is completely different and is wrong because you have the aim of gaining a personal advantage unfairly and i believe this is morally wrong, different for different people tho each to their own

as a doctor, even white lies and small lies could be serious so you shouldn’t lie at all, must have patient and doctor trust if you want to treat the patient to the best of your ability. it may be okay to lie if telling the truth breaches the confidentiality of a patient. but should try to say that you’re not at liberty to discuss

withholding info is different, you can withhold info for a period of time until you feel confident in giving that info to someone

Question 41

What can cause a doctor patient relationship to deteriorate ?

Answer 41

patients POV

• doctor is rude and patronising
• doctor is not a good listener and/or communicator
• doctor is not explaining the issue/diagnosis at hand well
• doctor is not offering the patient the treatment they want/need

Doctors POV

• patient is rude or aggressive
• patient is lying/withholding information
• patient doesn’t listen to recommended treatments and does not follow them, they believe what they say is what should be done

Question 42

How can we stop the obesity crisis ?

Answer 42

get people to eat less, be more healthy and do more exercise

• Education on causes of obesity and what it can lead to
• Raise awareness - putting up posters in clinics and school
• better labelling of food - makes people aware of what they are consuming
• Taxation on products that could lead to obesity - deters people from spending money on food that is not good for them

parents MUST act as good role models as the child is likely to follow the parent

Question 43

Do you think that doctors should ever go on strike ?

Answer 43

for

• not all doctors provide services that would suffer greatly if they went on strike e.g. closing a clinic for one day will delay things but will not cause havoc whereas if A&E closed it will
• doctors should be treated as other civil servants
• if they do go on strike, they’ll just have to work harder on a different day to make up for the strike
• underfunding, low pay - they have a reason to go on strike

against

• some patients may be severely affected and even die as a result of the strike - emergency services can’t afford closing
• doctors are paid well and the public knows it, a strike cold lead to the general public losing confidence in doctors, they may not trust them as much and may start to believe they only do their job for the money