Sample Scenarios

Question 1

While on a cruise, Mr. C developed flu-like symptoms. He felt too ill to go on a prepaid shore excursion. Upon returning home, he is informed by the travel company that the money spent for the excursion can only be refunded with a signed doctor’s note. He asks his physician to write a note indicating that he was ill. How would you handle this situation if you were the physician?

(source: MMI book)

Answer 1

• this scenario pertains to honesty and deception
• acknowledge that while physicians should have the patients best interest in mind; this presents as a difficult situation because it involves deceiving a third party which may have greater implications in the trust expected of a physician.
• deception is never okay unless the benefits outweigh the harms and since this is not a medical issue, as a physician I wouldn’t feel obligated to write the letter
• I would explain the reasons why I wouldn’t to my patient and hope that they understand. I would try and help them explore other options as I understand this is an important matter to my patient.

Question 2

Mr. J is a 62-year old man who returns for a follow-up appointment. At the last appointment, he had reported upper abdominal pain and weight loss. Test results suggest a concern for possible pancreatic cancer. The diagnosis can be established by needle biopsy. As the physician prepares to disclose the test results, the patient says, “The Missus and I are getting ready to take a cruise. I sure hope the news is good.” The physician silently debates whether to delay this discussion until after the cruise. Should the physician inform the patient of his concerns about possible cancer?

(Source: MMI book)

Answer 2

• this scenario also concerns honesty and deception.
• while I understand how this bad news can affect the patient’s upcoming trip and plans, I would inform the patient so that they can make an informed decision. They can decide whether they want to do the biopsy before or after.
• now may not seem a good time but there also may never be a better time. Timing is always uncertain so sometimes it is better to cease that moment.
• talk about how I had a patient who also was about to go to Europe on a trip and ended up in the hospital because of cardiac issues. He was able to get his trip fully refunded and was actually glad because he’d rather leave for the trip healthy than have to seek medical care in Europe.

Question 3

You realize at the end of your shift, that your fellow intern is in a state of distress. It turns out, she had been asked to begin a blood pressure medication on Mr. Smith but hours after she put in the order, she realized she out the order in the wrong patient chart. The mediation has already been administered to Mr. Jones who had to be given IV fluids to normalize his blood pressure. After she tells you what happened, she urges you not to share this incident with the supervising physician. Discuss his you would handle this situation.

(Source: MMI book)

Answer 3

• this scenario is about integrity and taking ownership/responsibility for one’s mistakes
• I would first try to comfort her and offer her emotionally support. I’d say that we are all human and make mistakes.
• I would ask her why she doesn’t want to let the supervising physician know and try to allay her fears (as I can understand there is a fear of losing future job prospects, reflected in her evaluations, etc.)
• I would tell her that although it can be difficult to admit fault, it is the right thing to do because it shows your character, integrity, and reliability. The stakeholders isn’t just your reputation but the patient and their safety.
• it’s better to find out from you than from someone else (give example of me in lab-putting bacteria into DNA instead of the other way around). Additionally we can learn from each other’s errors and work on improving. We can have a discussion on how to better avoid such errors. (This is probably why we have certain policies at my work where to waste or count drugs, for instance, you need two nurses to do it.) cross checking isn’t a bad thing.

Question 4

At a party, you see one of your physician partners. He has a glass of wine in his hand; however he is on call. As the evening progresses, he continues to drink and it is clear that he is tipsy. Having taken call before, you know how busy it can be, and you worry about your colleague’s ability to provide care in such a state. How would you handle this situation?

(Source: MMI book)

Answer 4

• this scenario concerns physician responsibility and potential conflict
• as a physician, one’s personal life needs to be separate from one’s professional life because other people’s lives are at stake. Drinking while technically “on duty” can pose a serious danger to not only patients but also the group. Patient safety should always come first above anything else. It is an ethical and legal responsibility.
• there is a lot to consider because I would also be potentially risking jeopardizing my relationship with my colleague but I would approach the situation cautiously.
• I would urge my colleague to let me or someone else in our group to take call for him for the night but if he refuses, I would immediately notify our superior to ensure no harm results from his actions.
• out of concern for his well-being, I would also try and ask him if everything is okay and encourage him to seek help if necessary before he jeopardizes his career or request time off.

Question 5

You are the nurse manager on a busy hospital floor. One of your nurses is upset after a difficult patient encounter. The patient was in considerable pain but the nurse was unable to give him anything because the next dose of pain medication was not scheduled for another couple hours. As she tried to explain the situation, the patient became very angry and questioned the nurse’s dedication to her profession. Hurt by this, the nurse lost control of her emotions and the situation escalated with the patient requesting to speak with the nurse manager. You are the nurse manager and the patient is now waiting for you in the room.

(Source: MMI book)

Answer 5

-this scenario is in regard to problem solving and dealing with difficult patients as well as empathy

-I would first address the patient and her emotions; take the time to listen so that the patient feels cared for.
“Hi Mrs. X, I understand you want to speak with me. How are you feeling… I can see your upset, can you tell me what happened?”

-recap to show you have a solid understanding of the patient’s concerns and seek to offer a solution.
“So if I understand correctly, it sounds like the current medication for your pain is not providing adequate relief, let me see if I can get a hold of your doctor. Perhaps he can make adjustments to keep your pain under control.”

• or ask the patient what he/she would like you to do.
• apologize and ask if there is anything else you can do for the patient.
• BLAST* pneumonic to diffuse and resolve such situations
  1. BELIEVE in the patients concern and distress
  2. LISTEN
  3. APOLOGIZE
  4. SATISFY by offering solutions
  5. THANK them for sharing their concerns and the opportunity to make things better

Question 6

A 14-year old girl comes in requesting birth control pills and asked that you not tell her parents. How do you, as her physician respond to this?

(Source: Grace; advisor)

Answer 6

• this scenario poses an ethical situation concerning minors and patient confidentiality
• I would ask the girl why she wants the pills and ask her about her knowledge about birth control. I would try and figure out why she doesn’t want her parents to know.
• I would then fill in any gaps by discussing with her the potential negative side effects of the pills given that she is experiencing puberty (interference with hormones, unexpected weight gain, acne outbreaks, etc). Each person responds to birth control differently snd therefore different risks.
• I’d also emphasize that the pills are intended to prevent pregnancy but does not protect her from STDs, so there may be some more appropriate alternative options for her (I.e: condoms).
• the goal is to educate her on consent and practicing safe sex but I would also try to approach the situation in a non-patronizing manner and explain that because she is a minor, she should involve her parents in this discussion. Getting her parents involved may help he make a better, more informed, and wise decision.
• according to the Gillick Ruling and Fraser rules however, if the physician deems the child has a clear understanding of the risks of sex, they have the right to confidentiality.
• I would also mention resources she can seek such as Planned Parenthood.

Question 7

As the chief fireman, there is a building on fire and you and a team of 10 firefighters have to evacuate the building. There are 50 people inside, some injured, some dead. How would you approach this?

(Source: Grace; advisor)

Answer 7

• this scenario looks for your leadership skills and ability to think critically
• my goal is to prevent as many deaths and injuries as possible so I would split my team up and have half of the firefighters go in and mobilize other people in the building who are capable, to help evacuate those around them who need some assistance (I.e: the elderly, anyone who is handicapped, etc.). This would maximize efficiency. The other half of my team would be putting the fire out in order to avoid the spread of the fire and more injuries.
• communication is crucial in this situation so I would ensure that everyone understand the plan and have walkie talkies for the team to update their location, status, and make clear where the hot spots are. Marking rooms that have already been evacuated would help to prevent rooms being rechecked and wasting critical time.
• I would also definitely try and call for more help on the way if necessary.

Question 8

In 2011, the Vancouver riots occurred after a hockey team lost. Stores were ransacked and cars burned. Hundreds of people were hospitalized. What would you to prevent this from happening again?

(Source: Grace; advisor)

Answer 8

• this scenario looks for your problem-solving ability
• I would ensure a trained response team and alert system is implemented.
• like the airport TSA, implementing measures such as checking for harmful substances or weapons at the gate upon entry would be wise. Best to take preventive precaution than to improvise for the unexpected. Also have surveillance cameras.
• hospitals should also be informed in advance of such a large event in case of a catastrophe so they can be prepared to receive and triage.
• mention how I noticed at football games or the balloon race, there is an ambulance on site or first aid tent, so they are already here in case of an emergency.
• organization is also crucial: having multiple routes of entry and exits so that vehicles can easily access. (Crowd control).

Question 9

You ran into your neighbor’s cat while reversing your car. You have 5 minutes to talk to her.

(Source: Grace; advisor)

Answer 9

• this scenario deals with taking responsibility and breaking bad news
• I would first call for help and immediately deal with the situation at hand.
• I’d go over to my neighbor and apologize. I would tell her help is on the way and that although I know I can’t replace her, I would like to make amends, so I’d ask what I can do.
• show that you empathize and convey that you will try to do everything you can to rectify your fault, no matter how irreparable it is.

Question 10

You are a physician and a mother brings in her son for flu-like symptoms. When you ask the boy to remove his shirt, you notice bruises on his torso. You are thinking whether you should report this or not. How do you talk to the mother?

(Source: Grace; advisor)

Answer 10

• this is a scenario that challenges cultural diversity
• me: Mrs. X, your sons symptoms aren’t severe and should be resolved in a week or two; however another matter came to my attention. I noticed some bruises on your son and wanted to know if you were aware of them or what they may be from?
• her: yes, in our culture, we use cupping to cure illness.
• me: how long had he had them?
• her: only a week.
• me: well maybe we should consider other options as this may not be helping him and if he keeps getting bruises, it isn’t good for him. He could be too young for this sort of treatment.
• her: but this is our culture send I always had it done on me when I was young.
• me: I respect your culture but not everyone responds favorably to the same treatment technique. We don’t have to prescribe medications but maybe we could consult a doctor who understands alternative medicine better than myself. How does that sound?
• her: okay I guess I’ll give it a try.
• I would also check to see if the history snd ethnicity is consistent with the cultural practice the mother claims
• if I suspect abuse, I would try to confirm my suspicions by asking the son be brought in 2 weeks later and check for signs
• I’d educate the mom on how home remedies may not always work and may have associated dangers and risks
• if child abuse is suspected and confirmed, I would be legally required to report it.

Question 11

Mrs. Jones just got into an accident and is declared brain dead. Before the tragedy, she had already been registered as an organ donor for science, without her husband or son being made aware of her decision. You want to use her body for medical students to study but you need to first discuss this with the family.

(Source: Grace; advisor)

Answer 11

• this scenario poses an ethical dilemma and also requires having to break bad news
• the death of a loved one is a sensitive matter and so I would deliver the news with empathy, offering emotional support as needed before consulting them regarding her decision to donate her body to science.
• provide resources for coping with loss and the grieving process
• if the family expresses concerns regarding the deceased’s body being disrespected, I would attempt to assure them that I will do whatever I can, in my power, to make sure students treat her body with respect.
• mention how tzu chi medical school provides a memorial service and ceremony of respect and how I would also push for this type of commemoration service as a future physician.
• the situation is time-sensitive so I need to be careful not to come off as rushing the family to make such a big decision. Know though that her body can be placed briefly on a mechanical ventilator until a decision is reached.
• it is mandatory to notify the organ procurement agency.
• if there is disagreement between the two family members, there is an order of succession if responsibility.

Question 12

A 17-year old had a major nose bleed and is now in a coma from all the blood lost. A nurse discovers a card indicating that she is a member of the Jehovah’s Witness Church and they cannot receive blood transfusions under any circumstances. How do you approach the family?

(Source: Grace; advisor)

Answer 12

• this is another ethical scenario
• empathize with the family when delivering the news that their daughter is in a coma
• convey to the parents that I understand they are Jehovah’s witnesses but I also do hold an oath and that my duty is to save lives. So I would respect their beliefs.
• there is often a resource/service at many hospitals where they can call a member of the church for consultation or who can come and access the situation snd help the family negotiate through such a difficulty.
• explore other possibilities aside from a transfusion

Question 13

Far too many diseases do not have a proven means of prevention or effective treatments. Many efforts are underway to understand the epidemiology of diseases, particularly cancer through the Precision Medicine Initiative (PMI)- a bold new enterprise to revolutionize medicine seeking to enroll over 1 million participants in the largest biomedical research study ever.

*Discuss the pros and cons of such initiative on oncology treatment.
*What thoughts do you have about research into the difficult problem
of treatment resistance?
*Would your answer change if the participants involved are pediatric
patients?

(Source: Grace; advisor)

Answer 13

This scenario tests your ability to think about research and the political and ethical issues of such an initiative.

INCOMPLETE

Question 14

Social media sites such as Facebook, Twitter, and Youtube are powerful symbols of a new generation of online tools and applications that foster user-generated content, social interaction, and real-time collaboration. These technological platforms will invariably be a part of the landscape of modern medicine.

• What do you see as areas of opportunities, as well as areas of danger for social media in medicine?
• At the policy level, what professional and institutional guidelines should be considered?
• What resources or strategies should be provided to practitioners who may have less experience with social media than younger generations of medical professionals?

(Source: Grace; advisor)

Answer 14

This scenario assesses your ability to think critically and weigh potential pros and cons concerning the future of medicine.

Areas of opportunity and danger include:
-promoting healthy eating, disseminate mass information about the importance of exercise, and educating the public about preventive medicine so they can be more proactive in their own health. Extend care, networking, professional development.

-like finding info on the internet, not all can be credible. Much like how professors don’t recommend utilizing Wikipedia for school work. Depending on the audience too, some people may use information on social media (which may be false) to self-treat or medicate and that can have serious implications without seeking medical advice.

(Examples to mention: Dr. Mahadeva proposed seeing patients via FaceTime which can be beneficial if the patient cannot physically come into the clinic and also maximizes efficiency in terms of time and communication but this could also call into question the quality of care being given… not being able to physically assess a patient.
also Dr. Oz for instance-his show has a lot of information and because he is a physician, is credible but also there are politics and marketing issues to consider. Often he promotes some product and he could be getting some sort of incentive by the seller to promote it… like the raspberry ketone for weight loss

-Because the millennial generation is the population most engaged in social media, using such platforms can also prove to be a disadvantage to certain groups such as the elderly, socioeconomically disadvantaged, or rural communities. So some guidelines to consider would be implementing a well-rounded team competent in all areas. We would want to represent all backgrounds: ages, races, cultures…and ensure wide-spread accessibility. Guidelines would involve ensuring content is credible, accessible, and reliable. Guidelines should emphasize maintaining confidentiality, privacy, and appropriate boundaries.

-resources would include training sessions and educational classes to keep everyone on the same page. Just as employees at renown do OLAs (online learning academy modules). Maybe offering simple step by step brochures or pamphlets to patients and in all languages on how to login, etc.
(Ex: renown and myChart)

**https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863578/

Question 15

You had been asked to head a Task Force in primary care interventions to prevent child abuse and neglect. Part of your charge is to finalize recommendation statements summarizing important action steps- both short-term and long-term -to decrease the risk of a child being maltreated. These statements are meant to assist health care professional prevent future abuse or neglect in children who show no signs or symptoms.

• What do your recommendation statements include?
• What skills and strategies should primary care physicians develop in order to participate in this effort?
• Should a multi-disciplinary approach to treat and protect abused children be established?

(Source: Grace, advisor)

Answer 15

This scenario calls for you to demonstrate leadership and how you deal with the challenges faced with sensitive matters.

INCOMPLETE

Question 16

> > Role-play«
You are working alone in a convenience store as a cashier late at night. An older man comes in and buys a coffee. He is staggering, seems disoriented, and you smell alcohol on his breath. On the way out, he bumps into a shelf and knocks some cereal boxes off. He tries to put the boxes back, but cannot manage this task. How do you handle this situation?

(Source: Grace; advisor)

Answer 16

This role play scenario is about your ability to assess a situation and propose a solution.

• Me: Hi Sir, are you alright?
• Him: Sorry, I just want my coffee and to be able to go home.
• Me: No worries, I understand. Here I can help you with these boxes.
• Him: It’s just been a rough day.
• Me: I can see that. Is there anything I can help with? The store isn’t busy now, if you need someone to talk to, I’m here.
• Him: no, it’s okay.
• Me: okay but before you go…I smell alcohol on your breath, you might have had one too many drinks, am I correct?
• Him: who are you? Are you the police? You’re asking a lot of questions and I just want to be home. I don’t want to get arrested, please.
• Me: Sir, I apologize-I didn’t mean to interrogate you with questions. I am just worried about your safety in this state. Have you eaten anything? Maybe we should get you some water to sober up instead of that coffee.
• Sir: okay… and I actually don’t have a home
• Me: okay do you have a friend or anyone you can call and who can maybe let you stay for a night?
• Him: No
• Me: okay I want you to be safe and warm tonight. It’s raining so here is what I’m going to do. I’m going to call you a cab and reserve a room in that hotel down the street and make sure the cab driver gets you there okay. Meanwhile drink some water.
• Him: thank you. I’m sorry about the boxes.
• Me: don’t worry I can take care of those.
• Key points: access his stability, mobility, does he need medical attention, arrange for a ride and shelter to ensure his safety and that he is not a harm to himself or others if he goes back out on to the streets in his intoxicated state. Come up with some solutions.

Question 17

> > Pathway Questions«

Why medicine?

Answer 17

• working as a CNA, I have had a few patients tell me “you must love what you do” and while I do find being a nurse assistant incredibly rewarding, I tell them, I like my job but I don’t love it. I want to become a physician because I want to have a more crucial role in people’s lives and their health. There is a greater desire to understand a patient’s health issues, the science and role in making them better, than to just provide care.
• My motivation for pursuing medicine is because I want to make a difference: be a pioneer, especially in closing the gaps in disparities of healthcare. Through my shadowing and various volunteer experiences, I have seen the adversities people suffer when health care is inaccessible, when financial matters simply make seeing a doctor, not an option. Mobile clinics exist to meet those needs but there needs to be a more reliable, consistent means of care. Health is a basic human right yet so for so many it has become an obstacle; something only attainable by more privileged individuals.
• I believe medicine is a partnership between the heart and the mind and I am confident that my experiences and compassion will enable me to become an influential future physician. It isn’t just about helping people but being there for people at their most vulnerable time where all their trust is in your hands. I want a career where I know I’m making a positive impact everyday and medicine provides just that opportunity. I know there will be challenges but I am eager to let them make me a better provider if it means making Nevada healthier.
• also review personal statement

Question 18

> > Pathway Question«

Why do you want to attend UNRSOM?

Answer 18

First off, I’m a Reno native and I want to give back to the community that has given me so much. I’ve had the opportunity to complete two 86 hour internships in the operating room and other fields of medicine. I’ve also had invaluable experience working as a CNA through various channels.

Another reason I want to attend UNRSOM is because I completed my bachelor’s here and take pride in that because the school has faculty who genuinely care about their students and even after graduation, have continued to be supportive and approachable.

My main reason ties into my passion for working with the underserved population. As an undergrad, I have shadowed 80 hours in Elko and volunteered at the SOC and served the less privileged in our community through various mobile clinics. I have seen the impact inaccessible healthcare had had on these individuals who aren’t entitled to the same amenities I am and want to help minimize such disparities. And I know UNRSOM mission strives to do the same, giving students opportunities to engage in rural clinical rotations. The things I am looking for in a medical school that best fits me are here. Hands on anatomy and SIM lab learning, small class, early exposure to patient interaction, problem-based and service learning.

Question 19

> > Pathway Question«

What do you believe are the healthcare priorities for the state of Nevada?

Answer 19

Nevada ranks 49th in healthcare and in the bottom 10th percentile in most specialties, so I think that the healthcare priorities are in all areas except for plastic surgery.

One of the greatest research needs in the community is on mental health and addiction (talk about my rise and dine volunteer experience).

Other areas are orthopaedics (talk about how in Reno, the main clinic for orthopaedics is ROC), pediatric endocrinology, and rural medicine. Accessibility is a major priority for Nevada.

Question 20

> > Pathway Question«

How will you support your peers who may feel overwhelmed with med school expectations and demands?

Answer 20

I would first ask what aspect of medical school is overwhelming them.
And suggest appropriate resources. I.e: daycare for students who are parents, joining a wellness program…

I believe that my classmates and I will be each other’s greatest resources so really helping one another. I may be good at say anatomy but terrible at pharmacology, so I would try and help those who are struggling with anatomy and seek help from those who are good at pharmacology.

Tutoring is a passion of mine-something I’ve done for over 6 years because of how rewarding it is to see others succeed. I also make my own study guides for classes and so I wold share them with my peers to help aid in their studying.

If they are feeling burnt and overwhelmed, I would remind them to keep pushing forward because they’ve already come so far. I’d try and encourage them not to give up but also to take study breaks whether it be exercise or another activity.

As a CNA, I saw many people at their most vulnerable times so I would try to apply what I’ve learned in my experiences as a CNA to helping my peers stay motivated. Having a strong reason for why you want to pursue medicine in the first place is a good motivator. (Talk about how one of my friends-a 4th year, everyone time he starts to slack off, he remembers his single mom who works a minimum wage job to feed her 3 kids).

*read over secondary response

Question 21

> > Pathway Question«

How do you de-stress?

Answer 21

Whenever I begin to feel overwhelmed with having to accomplish several tasks or have a busy week, I write it out on paper and break it down. I love checking things off a list so I out all the things I need to get done on paper and prioritize. I remind myself to take one thing at time. That’s the best I can do- excessively stressing isn’t productive for me.

Also plan and plan ahead! I feel INCOMPLETE without a planner! Ex:) independent study course-mentally I told myself I needed to take one exam a month to finish on time. Of course that didn’t go according to plan after the first exam so I made goals for when I needed to take the next exams (not hard dates but I.e: week of the 28th). While studying for the 3rd exam, I knew I would have a busy month at the end of November so I worked on the 4 the study guide as well. So wft r taking the 3rd, all I had to do was focus on reviewing.

As for hobbies and ways to de-stress, I love going snowboarding or paddle boarding in Tahoe. But those activities can be time consuming so sometimes I like to go for a run to reenergize or I’ll sign up for a Zumba or bikhram yoga class.

Junior year of undergrad was one of my toughest, academically intensive semesters but taking a dance and yoga class definitely helped. I remember that even though I had test that day, while I was in the yoga class, I didn’t think about anything other than to getting the poses right.

Question 22

C. difficile is a type of bacteria that increases its activity with most antibiotic use and is therefore very difficult to treat. Research shows that the most effective way to prevent the spread of infection is frequent hand-washing. However, many people have flat-out refused to wash their hands in the hospital. The government is contemplating passing a policy to make it mandatory for people entering hospitals to wash their hands or else risk not being seen by doctors and being escorted out of the building against their will. Do you think the government should go ahead with this plan? Consider and discuss the legal, ethical, or practical problems that exist for each action and conclude with a persuasive argument supporting your decision.

(Source: Grace; advisor)

Answer 22

This scenario concerns the ethical issues that come with a mandate and patient rights.

While implementing such a law can be perceived as a violation of individual human rights, there is also the collective population to consider. It is a matter of utility, what will give the greatest good for the greatest number of people. Utilitarians would say that as long as the greatest good is produced, it doesn’t matter how many laws are broken.

I think there are should be some exceptions in terms of sacrificing individual rights in order to protect the greater public. After all, we do that in other respects. Seat belts for example: some people hate wearing them but we enforce them by law because it is for the sake of safety.

Similarly, I think implementing this law has its grounds. I believe that although it isn’t right to refuse patients from being seen, there are many stakeholders involved. Other patients, the healthcare team members. Hand washing is a preventive measure that we all take to keep germs from spreading. Just as in the food industry. We would have to access the risks and how great the harm can pose. We already encounter antibiotic resistance with C. diff, so if people don’t wash their hands, their could be a possible endemic.

Just as with the Ebola crisis, there was heated discussion about the ethics of quarantine. I would make that last resort and consider less restrictive alternatives. In the nursing home, we try to put residents who have C.diff in the same room to halt transmission and in the hospital, we place isolation precautions on patients suspected of TB to protect not only the healthcare personnel but other patients.

Question 23

> > Role-Play«
You are a medical student shadowing in the OR and although the patient is placed under general anesthesia, you hear the surgeon name calling and making comments about her weight. You aren’t comfortable with this, how do you approach the physician about this?

(Source: Grace; advisor)

Answer 23

This role-play scenario deals with conflict resolution.

Me: Dr. X, do you have a moment? There’s something I would like to talk to you about.

Him: sure, what is it?

Me: I just thought I’d share with you my feelings about what happened in the OR and I hope you don’t take it personally. It made me feel a bit uncomfortable how you were talking about the patient. A few others have also shared that they felt the same way.

Him: so what, you don’t know how many times she comes in asking me to help her lose weight but she doesn’t listen. It’s repulsive how big she’s got. She needs to watch what she eats and exercise, instead of relying on surgery to lose weight.

Me: maybe we should go to the break room or somewhere more appropriate to discuss this so other patients won’t be offended by our conversation.

Him: you’re right, let’s go to the break room.

Me: I understand that it can be very frustrating, especially when patients don’t comply but she’s coming to you because she trusts you to help her through this.

Him: you don’t understand. I’m done and how dare you tell me what to do.

Me: I’m sorry, please don’t take it the wrong way. I just wanted to share how some of us felt in the OR.

Question 24

> > Role-Play«
You and your housemate have an interview the same day and the same time but there is only one decent pair of dress shoes. How would you propose this to him?

(Source: Grace; advisor)

Answer 24

This role-play scenario seeks to see if you are selfless and if you can think of options.

Me: hey buddy, are you ready for your big day?

Him: I hope so. You have yours today too right?

Me: yes. I also just realized that our interviews are at the same time but we only have one pair of dress shoes.

Him: oh right, what are we going to do?

Me: since we have some time, why don’t we go shop around and see what we can find.

Him: okay sure

Me: if we can’t find anything in time though, I don’t mind if you wear them. I know how much this job means to you and I want you to get it.
I get the whole dress to impress but you and I are both qualified candidates so I hope they can see past a pair of shoes.

Him: thanks man! I agree.

Me: or I have another idea, we can ask some of our buddies and see if they have a pair to borrow.

Him: perfect, let’s do that. Why didn’t we think of that first?

Question 25

> > Role-Play«
Sara is terrified of flying because she heard about a friend and the plane crashing into the World Trade Center, but you are chosen to travel with her on a business trip to a meeting in San Diego. How do you consult her?

(Source: Grace; advisor)

Answer 25

This role-play scenario assesses how you are as a listener and your ability to confront someone.

Me: Hey Sara, good morning. You all ready to go?

Her: No…not really

Me: What’s the matter?

Her: I’m just petrified right now. I really don’t want to go on this trip.

Me: you’re afraid to fly after what happened to your friend, huh?

Her: yes

Me: I know fears aren’t easy to overcome but the company thinks of you as an asset and that’s why they have chosen you to come.

Her: I know but I just would rather drive there.

Me: But there are just as many risks on the road as in the air. You may be a cautious driver on the road but someone else may be careless and hit you.

Her: true, but what if the plane crashes?

Me: the pilot is trained to deal with emergency situations en route, so I’m sure we’ll be fine. Besides, the odds of that happening isn’t as great as other means if transportation, but I’ll be sitting next to you on the plane. I’ll be with you the whole time. And there is also a call button for a flight attendant, if you need.

Her: okay I guess I’m just feeling really nervous.

Me: it’s okay, here, take a deep breath to calm your nerves. We have some time before we have to get to the airport. Maybe bring your iPad or computer to watch a movie or listen to music. It may help take your mind off of your fear.

Her: sounds good, I guess I will go.

Question 26

> > Role-Play«
Jesse is an athlete who is competing for a collegiate scholarship for soccer that is a week away. All the evaluators from the colleges will be there. However, you just found out that he has a severe fracture. He says he is in a lot of pain but he thinks the adrenaline on the big day will carry him through. What do you say to him?

(Source: Grace; advisor)

Answer 26

This role-play scenario is about breaking bad news, keeping the patient’s best interest in mind, and coming up with options.

Me: Hi Jesse, how is school going? You’re a senior now right?

Him: Yes, its going well. I’m ready to graduate.

Me: excellent, well I’m happy for you. So I heard you have this huge soccer competition coming up? Sound like a pretty big deal.

Him: yes, but I’m still in a lot of pain. What should I do? This competition means everything to me. I want to win this scholarship.

Me: I bet and your parents must be proud of your accomplishment. I know as an athlete, how much this means to you but you aren’t going to like what I have to suggest. So your x-ray shows that you have a fracture and fractures don’t heal in a week. It typically takes 4-6 weeks.

Him: my competition is in a week.. I don’t have that time to heal.

Me: I understand but my concern is that if you don’t give it the time it needs to properly heal, it will likely affect you in the long run. My sister twisted her ankle recently and didn’t give it enough time to rest and heal. 3 months later, she’s still in pain. Keep in mind, that not letting it heal means you may injure it more during the competition and the possibility of not being able to play any longer. It also would mean more expenses, office visits, and more time.

Him: I think I can tough it and show them in the field.

Me: have you spoken with your coach about this to see what other options you may have?

Him: no, but you know how he is. I’ve been working so hard to get here, I’d hate to give up now.

Me: I understand and you aren’t giving up. You have a valid reason. Maybe what we can try and do is give you some pain killers and rest as much as you can. Elevate, toes above the nose and ice. We can schedule another visit and we can see where you are at closer to the end of the week, before your competition. We can do another x-ray and assess it from there. How does that sound?

Him: okay, sounds like a good plan, Doc. Thank you.

Me: if course, I want you to get better so you can be back on the field and doing what you love. Anything else I can do for you?

Him: no, I think that’s it.

Question 27

> > Role-Play«
Mark is going to be competing in the Olympics and has been taking antibiotic steroids. He wants you to keep an eye on his liver function. As his physician for years, he requests that you see him and not report his use, but says that if you refuse, he will go to a walk-in clinic.

(Source: Grace; advisor)

Answer 27

This scenario deals with conflict and patient autonomy as well as raises ethical issues.

Me: Hi Mark, how are you doing?

Him: Hey Doc, I’m doing pretty well. How about yourself.

Me: Great, I’m glad to hear. I’ve been good. Thanks for asking. So I heard about you making it to the Olympics?!

Him: Yes and that’s what I’m hear to talk to you about too.

Me: That is wonderful. Congratulations! Must not have been easy preparing for such an accomplishment. What can I do for you?

Him: Well, so I have been using steroids to train but I’m worried about it damaging my liver. I was hoping you could keep an eye on my liver function?

Me: okay.. you’re right to be concerned and I appreciate your honesty. Let me ask though, why are you using them?

Him: I really want to win the games. I’ve dreamed of this for so long and I feel that the steroids give me a competitive edge.

Me: Right, but Mark, let me tell you. Knowing you for the past few years, I genuinely think you are capable of placing without relying on substances to get you there.

Him: but what about other people who are using it too? It’s very competitive.

Me: I understand how important this is to you and how fierce the competition is but I’m also worried about your health. Don’t worry about what others are doing. Besides would you want to risk getting disqualified after having made it so far?

How I see it, is that this is an integrity situation. Like in school, people cheat and yes it is unfair, but are they really gaining anything? If you win without relying on steroids, that’s something to be proud of because you let yourself reach your greatest potential. I know you’re capable of it. Performance should be genuine not feigned.

Him: I just don’t know if I can do it.

Me: even if you don’t win, there’s more reason to push and motivate yourself but adhering to my values and legal issues, I will kindly decline your request. However, I can refer you to someone else if that is something you’d like. I’m sorry this may have not turned out the way you intended it to go but I would be happy to help you wean off the drugs.

Him: okay I guess I can try.

Me: okay do you have any other questions or concerns for me?

Him: no, thank you for your input.

Me: I will be rooting for you Mark. I’m proud of you making it to the olympics.

*remember: try not to jump into the situation first. Establish rapport and acknowledge concerns before addressing it.

Question 28

You are on the committee for selecting a new Dean of Science. What characteristics and/or qualities would you look for when selecting an effective Dean?

(Source: Grace; advisor)

Answer 28

This scenario reveals some of your own values and character traits.

If I were in charge of selecting a new Dean, there would be three key qualifications, I would be looking for in choosing the candidate that best fits the position.

• Academics
• where did they go to school?
• what degree do they hold?
• what research have they done? Any publications?
• achievements and recognition (I.e speaking at national conferences…)
• Experience
• long-standing?
• what expertise can they bring to the school?
• science background?
• extent of experience in dealing with student affairs?
• ask then why they think they best fit the role of Dean
• plan if they get the job?
• Skills set/technical standards
• strong communication
• ability to manage and deal with conflicts
• approachable and open to new ideas, willing to negotiate and make compromises
• collaborations and integration
• organized
• dedicated

I want a Dean who will not just work within the college but seek innovative opportunities for students and be an approachable resource to them. I would look for a person who has shown that they are dedicated and has the students best interest in mind.

Question 29

> > Role-Play«
You are shadowing a family physician. A mother and daughter come in and they aren’t getting along. The daughter wants her mom to not be in the room with her. The physician steps out for a moment no the daughter confides in you that she has been smoking a pack of cigarettes a day. When you talk to the mom, you accidentally tell her about her daughter’s smoking. Would you tell your physician about your mistake? How?

(Source: Grace; advisor)

Answer 29

This role-play scenario relates to ownership and responsibility and trust.

Me: Doctor, do you have a moment? I have something I would like to tell you.

Her: Yes, what is it?

Me: When you stepped out, the patient told me about her smoking and specified not to mention it to her mom but I accidentally did. I’m really sorry about the incident.

Her: Why did you tell her?

Me: It was unintentional. The mother was asking me some questions and had suspicions and it slipped out.

Her: Well that is a violation of patient confidentiality. I’ll have to rectify that.

Me: I realize that that is the case and I really apologize. Is there anyway I could possibly contact the daughter and apologize personally, on my behalf, for my mistake?

Her: I will have to contact her.

*you should be the one to ask, how you can rectify the situation of violating the daughter’s trust and convey to the physician that you will make sure that this will not happen again.

Question 30

> > Role-Play«
You are the principal of a prestigious school and discover a student had posted an inappropriate comment on Facebook about a professor. You are tasked with the decision to expel her or not. The student awaits in your office.

(Source: previous cycle)

Answer 30

This role-play situation is about dealing with conflict and decision-making.

What I did this cycle:

• thanked student for coming in to meet with me
• asked if they knew why they were asked to see me
• tried to understand why the student did what they did
• explained the consequence of the student’s actions
• Suggested other ways to deal with student’s frustration- talk to professor, etc.
• offered a second chance but asked student to apologize and take down the post
• tried to compromise

Question 31

> > Role-Play«
You notice Elina who has been a really good friend of yours for years has been losing weight. You suspect she is losing weight intentionally because she no longer joins you when you ask her to grab dessert or food with you. You are concerned about her well-being. How do you approach her?

(Source: previous cycle)

Answer 31

This role-play scenario concerns a sensitive matter and assesses your ability to listen and provide help.

INCOMPLETE

Question 32

You are the doctor in a busy medical practice. Today, you are running 1.5 hours late. Earlier in the day, a patient came to see you, and you realized that she was having a heart attack. Concerned for her, you stabilized the situation, made arrangements for transfer to the hospital, and called the cardiologist to let him know of the patient’s situation. Your next patient is waiting for you. Before you enter the room, your nurse informs you that he is very angry about waiting so long to see you.

(Source: MMI book)

Answer 32

• This scenario assess how you deal with upset patients while maintaining professionalism and how you are as a listener.
• First, always acknowledge the patient’s emotions. (“I can tell your upset, or it sounds like you’re feeling frustrated.”)
• allow the patient to explain/talk
• be genuine in your apology. (“I can see how upsetting this would be. I know you’ve been waiting a lot longer than you anticipated. And I do apologize for that.”)
• while addressing the patient’s anger by giving an explanation (“you know how hard I try to stay on schedule but what I can’t predict is when I encounter a patient emergency. A patient before you was experiencing a heart attack which required me stabilizing her and transferring her to the hospital. Your time is precious and important to me. I hope you can understand why I am late for your appointment.”)

Question 33

As the manager of an electronics superstore, you are in charge of 10 employees. One of your employees, Larry, has been receiving and sending texts regularly during work hours. He has even done so while providing service to customers. Today, you noticed a customer become visibly upset when Larry pulled out his phone in the middle of their conversation. You are puzzled by Larry’s behavior as he has been one of your best employees. You have decided to discuss the situation with Larry. He is waiting for you in your office.

(Source: MMI book)

Answer 33

• This scenario is about resolving a conflict and confrontation skills.
• thank Larry for meeting with you today then bring up the concern.(“I’ve noticed you’ve been using your phone frequently during the work day. Today, one of our customers was upset when you were on your phone. Is there a reason for this behavior?”)

-if he chooses to disclose what is going on, listen patiently and attend to his emotions and offer possible ways you can help.
(“I’m sorry Larry, sounds like you are going though a lot at home. If you’d like to take some time off to resolve these issues, that would be just fine with me. Just let me know.”)

• come back to the matter at hand and reiterate the importance of the company’s value in customer service and kindly ask him to limit his cell phone use during work. (“Meanwhile, I believe it’s important for all of us to deliver the highest quality customer service so can I ask you to leave your phone in your locker. During break or lunch, by all means, you are more than welcome to use it.”)
• like most confrontations, end with a good to remind the employee they are a valued member of the team. (“Larry you have always been one of my best employees and earned recognition for the service your provide. I appreciate your devotion to our team in the past years and I hope you can keep it up.”)
• seek the employee’s input and confirmation (“do you feel that this is a reasonable request?”)

Question 34

Mr. T, a 75-year old Mandarin-speaking man, has just been diagnosed with colon cancer. The son asks the doctor not to disclose the diagnosis to his father. He maintains that people from China of that generation are not told they have cancer. The son says that Mr. T will lose hope if he’s told he has cancer. How would you handle this situation if you were the physician?

(Source: MMI book)

Answer 34

• This scenario deals with cultural considerations and poses an ethical dilemma.
• When a scenario seems to have many parts, summarize and ask the interviewer if you have a good understanding of the situation?
• talk about what are the issues in this situation. (1. Trust in the doctor-patient relationship, 2. cultural values)
• 1. By not disclosing the diagnosis to the patient, trust may be undermined and deception may leave the patient feeling distrustful of the provider.
• 2. Understanding that in some cultures, disclosing a serious diagnosis could have devastating effects on the patient.
• the key here is: would the patient want to know? Never assume all patients would behave the same.
• I would also consider what I know about the patient, would letting him know he had cancer pose a harm. Is the patient depressed or suicidal?
• ask the family about their concerns regarding what the patient may do if he is told the truth? Explain to them, how withholding information could also be harmful. (The cancer if at an early stage can also progress if early treatment isn’t sought.)
• if I were the physician, I would respect the patient and ask how he would like to proceed. (Patient autonomy)
• end with a powerful summary of how you would approach this situation. (“I believe letting a patient know his diagnosis is crucial so that they can make informed decisions, ask appropriate questions, and understand what options they have. But I also recognize that you have to be sensitive to different cultural beliefs and values, so I would take those into consideration, when making my decision.”)
• remember there is no right or wrong answer, as long as you justify the position you take and show that you have taken all issues into consideration.

Question 35

An attending physician is in the habit of introductions third-year medical students rotating with him in the hospital as “Doctor.”
Discuss the ethical issues raised by this practice.

(Source: MMI book)

Answer 35

• This scenario is mainly an ethics question and addresses deception.
• Although introducing medical students as “doctors” might seem a minor offense, there is the issue of deception. And if the patient finds out the true status of the student, he/she may feel betrayed.
• secondly, patients have a right to know who is involved in their care, their roles and responsibilities.
• medical students, the hospital, etc., may also have policies in place that should be adhered to.
• another possible issue that may arise is that the student may perceive the role of the doctor as their status and perform in ways that they otherwise shouldn’t be. (Similar ex: former nurse a medical student putting in orders at Renown) and that may result in legal consequences when you practice medicine without being licensed.

Question 36

At a party, a group of medical students lament the good old days of medicine in which doctors were wined and dined, and sent on lavish trips at the expense of pharmaceutical companies. “I don’t get it,” said one student. “We should still be able to receive gifts from drug companies.” Discuss reasons for and against accepting drug company gifts.

(Source: MMI book)

Answer 36

• This scenario raises questions about ethics and boundaries in medicine.
• Although the gifts may serve as an incentive and marketing purpose, I also perceive it as sort of an act of bribing. Therefore, I believe there are strong reasons against accepting gifts.
• however, I’d like to cover reasons for accepting gifts before I explain my opposing argument. Accepting gifts could pave networks or because some drug companies subsidize educational courses, it could be beneficial. Medications given as gifts can also help doctors give low-income patients a supply to help set off the cost of prescriptions (like what Dr. M does for his patients).
• but i would argue against, because in receiving gifts, doctors may feel obligated to prescribe the drug being promoted instead of choosing the better option for the patient’s individual need. There could be bias in prescribing. The pharmaceutical company would gradually dictate how the practice of medicine runs and that may jeopardize healthcare.

Question 37

You are an employee working in the shoe section of a major department store. A customer returns to the store upset about a problem with shoes she bought five weeks ago. The store policy allows for returns with full refund within 30 days of purchase. For older items purchased from the store, employees can issue store credit, exchange items, or arrange for repair when items are defective.

(Source: MMI book)

Answer 37

• This scenario involves problem solving in dealing with difficult customers.
• allow the person to vent their feelings, frustration,…
• offer expressions of understanding and remain calm, even when the person is angry. (“I would be upset too, if I were in your position. I’ll see what I can do for you. Is it okay if I ask you a few questions?” When purchased? Receipt?)
• mention store policy and offer alternative solutions (store credit, exchange, or free repair service.) do what you can to satisfy the patient but don’t agree to something you can’t offer.

Ex: “if you would like, we can have the heel repaired. Since I know you need them soon, I will take them to the repair shop personally and make sure they are ready for you, in time.”

• if the customer is still being difficult, offer to call in someone else to talk to them, such as the manager.
• your goal is to connect with the actor; don’t worry about the evaluator.

Question 38

Following the death of their 17-year-old daughter in a car accident, the parents donated her organs and received permission from the courts to remove and freeze their daughter’s eggs. Their intent is to have eggs fertilized with donated stern. Discuss the ethical issues involved.

(Source: MMI book)

Answer 38

• This scenario deals with an ethical situation.
• begin by showing concern for the parents lost. (“My heart really goes out to the parents who lost their 17-year old.”)
• consider perspective of all stakeholders
• -> parents: perhaps harvesting and fertilizing her eggs is a way the parents feel they can keep the memory of their daughter alive.

–> daughter: did she express a desire to have children when she was alive? Was she mature enough to understand what it is like to be a mother? Issue of informed consent.

–> child conceived: would the parents raise the child? What impact would this have on the child’s future, given that she would never know her mother.?

-these are many questions that may be difficult to answer but I would encourage the family to take some time before making such decisions to ensure they are making a sound choice rather than one influenced by emotions.

Question 39

In 2005, after having her feeding tube removed by court order, Terri Schiavo passed away at the age of 41. She had been in a coma for 15 years. During the last 7 years of her life, there was s fierce battle between her husband and parents.

Referring to conversations he had with a Terri, the husband indicated that she never wanted to be kept alive artificially. Terri’s parents were skeptical of his claims, and argued vehemently to keep her alive. They remained hopeful that she would recover despite the facts that doctors disagreed. Terri’s parents appealed to the governor, state legislature, and even the President of the U.S. However, the courts consistently backed her husband’s right to let his wife die. Discuss the issues involved.

(Source: MMI book)

Answer 39

• This scenario concerns an ethical issue and the legal hierarchy of surrogate decision-makers.
• Offer sympathy (“I can’t imagine what it must have been like for her loved ones to go through all of this.”)
• highlight the point this case makes about the importance of advanced directives/living will and medical decisions for family members.
• had she had a living will, it may have prevented the battle that ensued and decreased the amount of emotional stress experienced by the family.
• relate if applicable to my experience of death situations (the patient that was a full code then family told us to make him DNR, just as he was being coded.)
• while these conversations can be delicate, it is crucial to have them.
• note: legal hierarchy of surrogate decision-makers:
• Court-appointed guardians and surrogates selected by patient
• If no court-appointed member exists, family members may serve as surrogates in the following order:

-spouse > adult child > parent > sibling and other relative

If none of the above or a friend exists, the physician can make a decision but preferably after consultation with other physicians or a institutional ethics committee.

Question 40

A 38-year old banker informs his physicians that he recently tested positive for HIV. “Doc, you have to promise me not to tell anyone. I don’t want to lose my job.” The physician urges the patient to disclose the diagnosis to his wife. After a long conversation, the patient adamantly refuses to do so. “Doc, this will end my marriage,” he says. How should the physician proceed?

(Source: MMI book)

Answer 40

• This scenario deals with some ethical conflict and also patient confidentiality.
• Start with why confidentiality is important–> trust in a patient-physician relationship. Consequences of losing patient’s trust
• state position: believe that while maintaining confidentiality is crucial; there are exceptions to this.
• one is the concern for the safety of others (in this case the wife.)
• second is if there is legal requirement to breach patient confidentiality (some communicable diseases are required to be reported to the CDC or health department.) duty to protect public health.
• it would be important for the wife to know for her own safety but we for the job, I don’t see there being any reason for his HIV diagnosis to be disclosed. It doesn’t pertain to his occupation as a banker.
• I would apologize, and try and explain all this to the patient and offer him the opportunity to disclose the information to his wife. If he can’t agree to do so, I would then have the obligation to inform her.

Question 41

Ms. F is a 60-year old woman who recently suffered a heart attack. After an extensive evaluation, her cardiologist has recommended bypass surgery to restore normal blood flow to the heart. The surgery had traditionally required the patient’s breastbone to be split for access to the heart.
A new technique termed “mini” bypass, is now available snd can be done by just several smaller incisions. This technique causes less pain and is associated with a shorter recovery period. The cardiologist has referred Ms. F to a cardiothoracic surgeon who will perform the bypass surgery. This particular surgeon prefers traditional over “mini” bypass and does not perform the newer procedure. Should he even discuss “mini” bypass with Ms. F? Explain your reasoning.

(Source: MMI book)

Answer 41

• This scenario deals with informed consent and patient rights to autonomy.
• Whether it be a test, procedure, medication, or surgery, I believe patient’s should be informed of all the risks, benefits, and alternatives. (Just as with shadowing Dr. M., he always detailed the RBAs of medical marijuana).
• it is the physician’s responsibility to educate patients so that they know what options they have and can make an informed decision. Maybe she would prefer a shorter recovery and a less invasive surgery.
• by not telling the patient about the new technique, the physician would be failing to uphold a patient’s right to informed consent.
• I can understand that the physician may have his own concerns about the new technique (perhaps it is lacking long-term data or he is more comfortable with the traditional approach). But I think it would be appropriate for him to here these concerns as the patient would probably welcome his perspective.
• ultimately what the patient decides is up to them but I feel the physician should discuss all possible options and make recommendations.

Question 42

Family members and friends often ask physicians for medical opinions, prescriptions for medication, and other types of treatment. Discuss the ethical issues raised by such situations.

(Source: MMI book)

Answer 42

• This scenario explores the boundaries in terms of the practice of medicine and family and friend relations.
• Just as with hiring friends or family for employment is not highly recommended, I believe it is in both the patient and the physicians best interest to refrain from dispensing medical advice or prescribing treatment.
• before I go into why, I’d like to offer some reasons why a physician may want to treat friends or family. For one, it is more convenient than having to make an appointment, wait, and taking time off work. Secondly, they may feel inclined to do so and depending, they may not be required to do all the paperwork that comes with office visits.
• the concern in this situation is that the personal relationship may impact the care given. For ex:) if it was a touchy issue, the patient may be hesitant to disclose certain information and the physician may be reluctant to explore certain parts of the history or even aspects of the physical exam.
• according to the AMA code of medical ethics, this practice is not recommended because professional objectivity may be compromised.
• this is not an ideal situation but if the outcome of treatment turns out poorly, what repercussions would this have on the relationship? Family members or friends could also take advantage and ask for what they can’t obtain from another physician. (I.e: narcotics).
• I’m not sure if state laws exist or guidelines but I would consult with authorities.
• one exception; however, is if there is a medical emergency and medical care can’t be easily accessed.

(Time permitting-mention experience of hiring relative for work-made it difficult to enforce company policies and conduct).

Question 43

Mr. N is a 35-year old patient who is concerned about his weight. As the years have passed, he has put on considerable weight, and now weights nearly 250 lbs. He has tried a variety of diets and exercise regimens without success. He recently dad about a Chinese herbal supplement that has shown amazing results. You are not familiar with this supplement but are concerned about potential side effects. Discuss the issues involved and how you would handle the situation.

(Source: MMI book)

Answer 43

• This scenario takes into consideration cultural differences and the issues pertaining to alternative medicine.
• I would first praise the patient for trying and taking an active interest in his health. I know it isn’t easy to stay committed to losing weight.
• not all patients will disclose their thoughts on complementary snd alternative medicine (CAM) so I would be very gentle in the way I discuss it with the patient. It could be a cultural thing so I wouldn’t want to offend him either.
• I would begin by asking the patient how he came across the herbal supplement, how much he knows about it, and if he knows anyone who has taken it.
• taking the time to review why his previous efforts haven’t been successful may also prove valuable to ascertain what factors inhibited him from reaching his goal.
• I know that some doctors also prescribe medication to help with weight lost (medically supervised program), so I would explore other conventional medical therapies first. One common one that the physician I shadowed used was Phentermine.
• I would be honest with the patient and let them know that I don’t know much about herbal supplements but I would be happy to do some research. I would explain to him my concerns for him, in terms of possible side effects and interactions with other medications he is taking.
• if the patient chooses to take it, I would monitor him carefully.

Question 44

You are the head of a committee that has been tasked with developing policy to guide allocation of donated organs for transplant. Discuss the issues you will consider in developing this policy.

(Source: MMI book)

Answer 44

• This scenario deals with the debate over transplant allocation and the ethics of what determines who gets it over another.
• the goal would be to create a just system for determining organ allocation; however I recognize to that there will still be criticism. You won’t be able to make everyone happy.
• this has been a debated topic for quite some time because the demand greatly exceeds the supply and the issues raise questions on ethical decision making. Some of these include:

1. What medical criteria should be used for determining allocation?
2. Should non-medical criteria be considered?

• I would favor considering medical need as a priority; meaning giving patients who would die without the transplantation the organ over those who can wait and are more stable.
• the MELD system is one example of a system used by doctors to determine severity of liver illness. It yields a score based on lab results.
• factoring in non-medical criteria such as social worth can be controversial because how can anyone measure it objectively.
• I would also consider how long a person has been on the wait list and location too. It would make sense to give the organ to someone who lives closest especially if the the success of the transplant decreases the longer we wait.
• I know some people would say to consider age and quality of life, but that is also very subjective and difficult to ascertain. (Mention the 29 year old mom to a 2 year old, how she passed away a few days after her transplant, not because it wasn’t successful but because her heart couldn’t keep up.)
• this is a very difficult decision so I would seek the input and guidance of experts to help me. I would hope collectively we could create a fair system so that the public too doesn’t lose faith in organ donation.
• possible follow-up question: what if the patient is at fault for the disease that now requires transplantation?
• I.e:) alcohol abuse- but there is debate that there are genetic and environmental predispositions to alcoholism.

Question 45

Alzheimer’s disease is an incurable disease of the brain that destroys memory and thinking skills. It is a slow disease that progresses in stages. In its early stage, patients have no symptoms. In its new stage, there are mild symptoms which are often simply attributed to the aging process. Recently, researchers reported promising preliminary results of a blood test developed to detect patients with Alzheimer’s disease at a very early point. Discuss the pros and cons of having such a test available.

(Source: MMI book)

Answer 45

• This scenario deals with the pros and cons of diagnostic tools for debilitating disease.
• Having worked a few weeks in an Alzheimer’s facility, I know how devastating and debilitating the disease is not just for the patient but for family as well. A new test that could detect Alzheimer’s early on could be an exciting development but could also pose some problems.
• PROS
• early diagnosis could mean earlier treatment and possibly slowing down the progression of the disease.
• early detection would also allow patients to make important decisions about their future before their cognitive functions rapidly decline. (These include decisions about how aggressively do they want they disease to be treated, who would help them make decisions if they could no longer make them, nursing home?…)

-another benefit is that knowing that their time is limited may encourage them to do the things they’ve wanted to but delayed, draft a advanced directive, make any necessary amends in their relationships, take care of business, etc.

• CONS
• considerations: how accurate is the test? How much data is there to support it, clinical trials? What if someone was falsely diagnosed? That could very detrimental.
• reactions to the diagnosis such as severe depression, stress, amxiety, SI.
• people such so family and friends my also start to treat them differently.
• there would have to be continued dialogue about the risks and benefits of such a test in order to guide policies and decision making.

Question 46

Your patient returns for follow up on his blood pressure. For the past year, you have been making adjustments to the patient’s blood pressure medications. Although the patient has not developed any problems related to the hypertension, you have been worried about the toll it is taking on the patient’s body. You sure specifically concerned about heart attack, stroke, or kidney disease. You have prescribed medication to control his blood pressure and reduce the risk of problems related to it. Unfortunately, efforts to control the hypertension have not been successful. Today, the patient’s blood pressure remains high. Before entering the patient’s room, the nurse informs you that he hasn’t been taking his medication. Enter the room and talking to him about why he hasn’t been taking them.

(Source: MMI book)

Answer 46

• This scenario deals with patient noncompliance and how to address it.
• Start off by stating that the nurse mentioned your blood pressure was high and that you haven’t been able to take your medications, is that correct?
• ask open ended questions so they don’t feel threatened. (“Are you having a problem taking it? Getting it? Do you have concerns about the medication? Worried about side effects?
• check that patient understand the importance of the medical problem and the health risks that may ensue problem is left untested. (“Do you understand why it is important to keep your blood pressure under control?”)
• if they don’t, explain: that hypertension can lead to heart attacks, stroke, and kidney disease.
• try to use we to show the patient that this is more of a partnership than the doctor imposing his viewpoint on the patient. Ask the patient what other strategies he thinks might be effective? (“What we have tried so far hasn’t been working, what do you think? What can I do differently to help you with this?”)

Question 47

After returning from Sierra Leone where she had nursed Ebola Virus patients, Kaci Hickbox was placed in an isolation tent in New Jersey. At the time, she had no symptoms of infection. Critical over her forced isolation, she was driven to her boyfriend’s home in Maine four days later. The governor of Maine ordered her quarantined but she refused to comply with the order. Medical science has shown that a person infected with Ebola doesn’t become infectious until the onset of symptoms such as fever. Discuss the ethical issues involved.

(Source: MMI book)

Answer 47

• This scenario is an ethical debate over freedom of movement/the practice of quarantine versus protecting the general public.
• I can see how a quarantine order would be controversial because of its impact on individual freedom: the right to choose how we live our lives.
• however we also have a responsibility to protect the community, not to put others, the general public at risk.
• I would leave quarantine as a last resort and explore less restrictive ways first. For instance, having the person stay home voluntarily and upholding the integrity to make sure they don’t out others in harm’s way. I would consult health officials to help guide me in with this situation.
• in accessing the justification for quarantine, I would evaluate the risk involved. Ask questions like is the virus easily communicable, when are they infections?…
• while I understand that public officials may be quick to quarantine out of fear for a possible endemic and out of good intention, the decision should also be based on science and solid evidence, so we are not impeding on people’s individual freedom.
• conclude with a recap on your perspective.