Practice Interview Question Thread

[Sir]

Hey everyone, this is my first ever attempt at a question on this thread. Hopefully its ok, and any feedback no matter how brief would be appreciated

A doctor went on vacation for two weeks. He did not find another doctor to cover it. One of his patients with hypertension developed severe headaches. The patient has an appointment with the doctor upon his return from vacation. The patient did not look for another doctor and decided to wait. The patient collapses suddenly and is diagnosed with intracranial hemorrhage. Is the doctor responsible for this patient?

The situation here is definitely a complicated one given the doctor does have a right to go on vacation but similarly has a significant duty of care towards his patients. In this situation I believe a number of key factors need to be considered before I can arrive at a judgement. One such factor surrounds the doctors advice towards the patient and his observations throughout their most recent appointment. To the extent there were forseeable things that could go wrong with the patient such as an intracranial hemorrhage no matter how mild the symptoms may have been, he should have informed the patient about what they could potentially do in this situation. Some possible suggestions could be informing the patient of other possible physicians that could help with treatment and whether there needed to be lifestyle changes eg working less strenuously to prevent such occurrences from happening. If there is a fair association linking hyperextension with a potential intracranial hemorrhage, then the doctor would likely be responsible largely due to negligence within not taking the required precautionary measures to prevent such events from occurring. However it could be possible that the intracranial hemorrhage was sudden and unexpected, where the doctor was unlikely to have predicted such a deterioration. In that case, it would be unreasonable to place the burden of responsibility on the doctor and rather the focus should be on simply treating the patient and making the best outcome of the situation.
Another important factor to consider is why exactly the patient did not seek another doctor. A few potential reasons include they felt completely well which the doctor could well have told them and therefore did not feel the need to search for another doctor until this sudden deterioration occurred. This would mean that a mistake in judgement (even if this was a difficult scenario where many doctors would have made mistakes) would be the cause and the doctor as well as his team would be responsible. However it also could be the patient putting off a minor headache either because another backup doctor was not provided or that they felt this problem wasn't major. In the former instance this would be the doctors responsibility as their actions directly led to the patient not seeking healthcare, however the latter which could be possible would alleviate some of the responsibility as not seeking assistance where sick is potentially something that is your own choice

A final factor to consider is whether there may have been other individuals within the patients life that a portion of this responsibility could be placed on for example other people in the doctors treatment team who also provided different bits of advice towards this patient. However at the absolute minimum no matter the circumstances the doctor should take some responsibility as ensuring that there is always a doctor to cover and care for the patient in case something goes wrong is part of acting in the best interests of patients. The extent to which this responsibility applies depends on the factors above

 

[whoartthou]

Hey everyone, this is my first ever attempt at a question on this thread. Hopefully its ok, and any feedback no matter how brief would be appreciated

A doctor went on vacation for two weeks. He did not find another doctor to cover it. One of his patients with hypertension developed severe headaches. The patient has an appointment with the doctor upon his return from vacation. The patient did not look for another doctor and decided to wait. The patient collapses suddenly and is diagnosed with intracranial hemorrhage. Is the doctor responsible for this patient?

The situation here is definitely a complicated one given the doctor does have a right to go on vacation but similarly has a significant duty of care towards his patients. In this situation I believe a number of key factors need to be considered before I can arrive at a judgement. One such factor surrounds the doctors advice towards the patient and his observations throughout their most recent appointment. To the extent there were forseeable things that could go wrong with the patient such as an intracranial hemorrhage no matter how mild the symptoms may have been, he should have informed the patient about what they could potentially do in this situation. Some possible suggestions could be informing the patient of other possible physicians that could help with treatment and whether there needed to be lifestyle changes eg working less strenuously to prevent such occurrences from happening. If there is a fair association linking hyperextension with a potential intracranial hemorrhage, then the doctor would likely be responsible largely due to negligence within not taking the required precautionary measures to prevent such events from occurring. However it could be possible that the intracranial hemorrhage was sudden and unexpected, where the doctor was unlikely to have predicted such a deterioration. In that case, it would be unreasonable to place the burden of responsibility on the doctor and rather the focus should be on simply treating the patient and making the best outcome of the situation.
Another important factor to consider is why exactly the patient did not seek another doctor. A few potential reasons include they felt completely well which the doctor could well have told them and therefore did not feel the need to search for another doctor until this sudden deterioration occurred. This would mean that a mistake in judgement (even if this was a difficult scenario where many doctors would have made mistakes) would be the cause and the doctor as well as his team would be responsible. However it also could be the patient putting off a minor headache either because another backup doctor was not provided or that they felt this problem wasn't major. In the former instance this would be the doctors responsibility as their actions directly led to the patient not seeking healthcare, however the latter which could be possible would alleviate some of the responsibility as not seeking assistance where sick is potentially something that is your own choice

A final factor to consider is whether there may have been other individuals within the patients life that a portion of this responsibility could be placed on for example other people in the doctors treatment team who also provided different bits of advice towards this patient. However at the absolute minimum no matter the circumstances the doctor should take some responsibility as ensuring that there is always a doctor to cover and care for the patient in case something goes wrong is part of acting in the best interests of patients. The extent to which this responsibility applies depends on the factors above

I really liked how you considered the issue of duty of care and where do we draw the line? Even in actual practice it is quite a grey area. I have read cases published by the MDO (Medical Defence Organisation) that have placed the burden on the doctor despite in my opinion being quite a stretch. Fortunately or unfortunately Australia is quite a socialist country and usually the doctor is expected to follow up on tests they order.

The issue here remains, was it a reasonably expected outcome from the untreated hypertension. From a medical perspective it really depends on the circumstances surrounding the scenario. Obviously they didn't given enough information and as students you are not expected to know.
The marks in this scenario does not come from whether you come to a conclusion but rather you have discussed the issue of duty of care which I think you have done pretty well.
You could have also emphasised patient autonomy. If the patient understood the risks but still chose to wait then it is more likely to absolve the doctor from his duty of care.
You could also discuss that doctors are human and will require rest and a break too or else they are unable to perform to the best of their abilities. However, they still have a duty of care for example a sole country doctor should find cover.

I think the previous answer by threefivetwo placed blame on the doctor instead of empathising and understanding this isn't a black and white scenario.

 

[kotoloper]

Hi guys, back again with another practice question. Wasn't too sure about this one and reading other questions on the MSO portal, it's starting to look like I need to do some research! Also, as a doctor, is it alright to discuss with colleagues about the best treatment for a patient or is this breaching patient confidentiality - this may be a stupid question but I'm a bit muddled. As always, please roast me, any feedback is appreciated.

A child has cancer and an experimental drug has been suggested. The drug may be the child's only option. There has been no research into the drugs long term effects. What do you do?

First, I would determine whether the drug is definitely the child’s only option – have we explored every possibility already, are there no other alternatives? If we have tried numerous treatments, how is the child holding up? Being treated continuously can be a heavy burden, especially on a young individual, and it is important that I uphold my duty of care to the patient and take a route that will be in positive benefit to their health.

The fact that there was been no research into the drug’s long term effects is a serious issue as it cannot be determined if taking the drug could potentially harm the child’s health further, which is definitely not ideal. I would look into the manufacturer of the drug and any history of use to try and determine whether taking the drug would be a serious risk. Using experimental drugs in medicine is definitely a grey area, as they could give patients false hope and may not have any positive effect, but on the other hand, it could be a lifeline as a last resort for a patient.

The lack of research also means that this is an area to address for the long run – do we need more funding into research for future patients who may be in this same situation? Are there any barriers which have prevented research into the drug? How can we address that? But first and foremost, the patient comes first. I would sit down with the parents and the child and explain the situation to them as gently as possible, that the drug may be the child’s only option. It is important here that I articulate that there has been no research into the drug’s long term effects, and explain the potential risks of taking experimental drugs to them. It is ultimately the family’s decision, and I must ensure that they understand all the options available to them. I would also advise them of their right to seek another professional opinion, as I believe that a broader range of perspectives could be useful in this scenario, and other health professionals may know of other alternatives.

 

[Sokka]

Hi guys, back again with another practice question. Wasn't too sure about this one and reading other questions on the MSO portal, it's starting to look like I need to do some research! Also, as a doctor, is it alright to discuss with colleagues about the best treatment for a patient or is this breaching patient confidentiality - this may be a stupid question but I'm a bit muddled. As always, please roast me, any feedback is appreciated.

A child has cancer and an experimental drug has been suggested. The drug may be the child's only option. There has been no research into the drugs long term effects. What do you do?

First, I would determine whether the drug is definitely the child’s only option – have we explored every possibility already, are there no other alternatives? If we have tried numerous treatments, how is the child holding up? Being treated continuously can be a heavy burden, especially on a young individual, and it is important that I uphold my duty of care to the patient and take a route that will be in positive benefit to their health.

The fact that there was been no research into the drug’s long term effects is a serious issue as it cannot be determined if taking the drug could potentially harm the child’s health further, which is definitely not ideal. I would look into the manufacturer of the drug and any history of use to try and determine whether taking the drug would be a serious risk. Using experimental drugs in medicine is definitely a grey area, as they could give patients false hope and may not have any positive effect, but on the other hand, it could be a lifeline as a last resort for a patient.

The lack of research also means that this is an area to address for the long run – do we need more funding into research for future patients who may be in this same situation? Are there any barriers which have prevented research into the drug? How can we address that? But first and foremost, the patient comes first. I would sit down with the parents and the child and explain the situation to them as gently as possible, that the drug may be the child’s only option. It is important here that I articulate that there has been no research into the drug’s long term effects, and explain the potential risks of taking experimental drugs to them. It is ultimately the family’s decision, and I must ensure that they understand all the options available to them. I would also advise them of their right to seek another professional opinion, as I believe that a broader range of perspectives could be useful in this scenario, and other health professionals may know of other alternatives.

My thoughts:
- I’m not too sure if this is required but I guess you could question the severity of the cancer (is the child in extreme pain, does he have a limited lifespan because of this cancer, basically what are the effects of this cancer). How does the severity of the cancer effect how we approach the situation? If he’s in pain would we be more willing to take the chance?
- You could also see if there are any policies/regulations you have to follow with regards to giving a minor untested drugs.
- This might be a long shot, but you could research similar medications and try to find out the long term effects of those on children. Obviously every drug is different, but if a similar drug happens to be fatal for children that would definitely be a red flag against giving the child this drug.

 

[Sokka]

Any feedback is appreciated (specifically I want to know if I am answering this prompt in an orderly manner- as per whoartthou's previous feedback) Thanks in advance.

• Dr. Blair recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Blair doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches, and muscle aches because he believes that it will do no harm, but will give them reassurance. Consider the ethical problems that Dr. Blair’s behaviour might pose. Discuss.

First and foremost, we need to empathise with Dr Blair as he wants to work in the best interests, evident by wanting to reassure them. It is only after taking this into account that we can investigate the issue at hand.

Now, we must conduct our own research into Dr Blaire’s prescribed medications before having a discussion. We must be careful in conducting our research, as we must use reliable sources such as peer reviewed studies published by academic institutions who are not associated with any businesses (which could potentially be biased). Not only should we look for the benefits of these treatments, but also the side-effects and risks. After conducting our research, we need to come to a conclusion about our findings. Maybe the specific medicines that he prescribes has solid evidence that they work, and in this case he is doing nothing wrong. Moving forward maybe these treatments could become more widespread as other doctors can begin to prescribe similar medications in light of this newfound evidence.

However, assuming our research has shown no evidence for the benefits of homeopathic medicine, in our discussion with Dr Blair we must ask him for his sources that show the benefit of these treatments. Maybe his research was more thorough than ours? We also need to ask him if this treatment actually “reassures” his patients like he claims they do. How does he know this? Has he conducted reliable surveys? What if by prescribing additional medication he is scaring his patients by making them perceive their illness as more severe than it is?

Next, we must look at the ethical implications of this. Does prescribing homeopathic treatments place an added burden on patients as their treatments cost more? If so, we must ask ourselves if it is ethical to charge our patients for a placebo. Are there any current policies in place which prevent doctors from prescribing placebos? If there are none, we must realise that patients trust physicians to make important decisions, and it seems unethical to make patients pay for medication which have little evidence for working. However, if the patients actually want this treatment, we must respect patient autonomy, but in the future there could be some policy changes such as making sure patients are aware of the evidence behind different medications so they can make an informed decision.

Finally, we should also look at how this impacts the reputation of healthcare in general. People generally agree that homeopathic treatment lacks valid scientific evidence, and if a physician is known to prescribe these medications it could send a signal that there are no guidelines that doctors must follow, and that they can prescribe what they want. This could weaken the trust the public has in doctors, due to the perceived lack of agreement in the healthcare industry. If this is the case, we must make policy changes as to what medications doctors can prescribe. Should there be a list that doctors can choose from to ensure all doctors treat their patients equally? What are the benefits of giving doctors the freedom to prescribe what they want?
(For a "discuss" prompt am I supposed to reach a conclusion, or simply unpack the issues)

 

[whys]

I'm only a student, but I feel your answer didn't discuss the implications of patients essentially being 'tricked' into receiving treatments they believe are curing them as much as you could have. You talk about it in light of the public's perception of healthcare and losing trust but not the immediate impacts on the patient actually receiving the fake treatment itself. Giving the patient a treatment that you know doesn't cure them is a big ethical issue which I feel was one of the main things this question wanted you to address but you could have addressed it in more detail.

 

[Sokka]

I'm only a student, but I feel your answer didn't discuss the implications of patients essentially being 'tricked' into receiving treatments they believe are curing them as much as you could have. You talk about it in light of the public's perception of healthcare and losing trust but not the immediate impacts on the patient actually receiving the fake treatment itself. Giving the patient a treatment that you know doesn't cure them is a big ethical issue which I feel was one of the main things this question wanted you to address but you could have addressed it in more detail.

Looking back I do agree that I was way off the mark, thanks.

 

[Crow]

Agreed with the comment above.

Now, we must conduct our own research into Dr Blaire’s prescribed medications before having a discussion. We must be careful in conducting our research, as we must use reliable sources such as peer reviewed studies published by academic institutions who are not associated with any businesses (which could potentially be biased). Not only should we look for the benefits of these treatments, but also the side-effects and risks. After conducting our research, we need to come to a conclusion about our findings. Maybe the specific medicines that he prescribes has solid evidence that they work, and in this case he is doing nothing wrong. Moving forward maybe these treatments could become more widespread as other doctors can begin to prescribe similar medications in light of this newfound evidence.

However, assuming our research has shown no evidence for the benefits of homeopathic medicine, in our discussion with Dr Blair we must ask him for his sources that show the benefit of these treatments. Maybe his research was more thorough than ours? We also need to ask him if this treatment actually “reassures” his patients like he claims they do. How does he know this? Has he conducted reliable surveys? What if by prescribing additional medication he is scaring his patients by making them perceive their illness as more severe than it is?

This seems like you didn't read the question properly. The stem clearly states there's no evidence supporting homeopathic medicines and that the doctor also doesn't believe they work. Therefore this large part of your answer about conducting research and discussing Dr Blair's research seems irrelevant to what the question is actually wanting you to discuss.

Next, we must look at the ethical implications of this. Does prescribing homeopathic treatments place an added burden on patients as their treatments cost more? If so, we must ask ourselves if it is ethical to charge our patients for a placebo. Are there any current policies in place which prevent doctors from prescribing placebos? If there are none, we must realise that patients trust physicians to make important decisions, and it seems unethical to make patients pay for medication which have little evidence for working. However, if the patients actually want this treatment, we must respect patient autonomy, but in the future there could be some policy changes such as making sure patients are aware of the evidence behind different medications so they can make an informed decision.

I like the angle you take in this part of your answer though it could potentially be framed differently. Certainly it is deceptive to patients to recommend medicines when there is no evidence-base for their use and that's an important discussion point (perhaps the most important point which could be elaborated on further), as is the financial aspect. I'd probably avoid the use of "placebo" when answering this question.

Finally, we should also look at how this impacts the reputation of healthcare in general. People generally agree that homeopathic treatment lacks valid scientific evidence, and if a physician is known to prescribe these medications it could send a signal that there are no guidelines that doctors must follow, and that they can prescribe what they want. This could weaken the trust the public has in doctors, due to the perceived lack of agreement in the healthcare industry.

This is the best part of your answer I think! Doctors aren't currently allowed to prescribe any drug they like, so you're aware - there are regulations. Homeopathic medicines aren't prescription drugs at all, so you should also be aware of this distinction.

I think you could elaborate more on your initial point that the intentions behind recommending the homeopathic medicines could be positive. I also think it's worth discussing the benefit vs harm a bit more - some of these medicines have their own side effects and can interfere with the metabolism of other drugs.

 

[Sokka]

Agreed with the comment above.

This seems like you didn't read the question properly. The stem clearly states there's no evidence supporting homeopathic medicines and that the doctor also doesn't believe they work. Therefore this large part of your answer about conducting research and discussing Dr Blair's research seems irrelevant to what the question is actually wanting you to discuss.
I like the angle you take in this part of your answer though it could potentially be framed differently. Certainly it is deceptive to patients to recommend medicines when there is no evidence-base for their use and that's an important discussion point (perhaps the most important point which could be elaborated on further), as is the financial aspect. I'd probably avoid the use of "placebo" when answering this question.
This is the best part of your answer I think! Doctors aren't currently allowed to prescribe any drug they like, so you're aware - there are regulations. Homeopathic medicines aren't prescription drugs at all, so you should also be aware of this distinction.

I think you could elaborate more on your initial point that the intentions behind recommending the homeopathic medicines could be positive. I also think it's worth discussing the benefit vs harm a bit more - some of these medicines have their own side effects and can interfere with the metabolism of other drugs.

Thanks Crow, will take this feedback on board!

 

[whoartthou]

Hi guys, back again with another practice question. Wasn't too sure about this one and reading other questions on the MSO portal, it's starting to look like I need to do some research! Also, as a doctor, is it alright to discuss with colleagues about the best treatment for a patient or is this breaching patient confidentiality - this may be a stupid question but I'm a bit muddled. As always, please roast me, any feedback is appreciated.

A child has cancer and an experimental drug has been suggested. The drug may be the child's only option. There has been no research into the drugs long term effects. What do you do?

First, I would determine whether the drug is definitely the child’s only option – have we explored every possibility already, are there no other alternatives? If we have tried numerous treatments, how is the child holding up? Being treated continuously can be a heavy burden, especially on a young individual, and it is important that I uphold my duty of care to the patient and take a route that will be in positive benefit to their health.

The fact that there was been no research into the drug’s long term effects is a serious issue as it cannot be determined if taking the drug could potentially harm the child’s health further, which is definitely not ideal. I would look into the manufacturer of the drug and any history of use to try and determine whether taking the drug would be a serious risk. Using experimental drugs in medicine is definitely a grey area, as they could give patients false hope and may not have any positive effect, but on the other hand, it could be a lifeline as a last resort for a patient.

The lack of research also means that this is an area to address for the long run – do we need more funding into research for future patients who may be in this same situation? Are there any barriers which have prevented research into the drug? How can we address that? But first and foremost, the patient comes first. I would sit down with the parents and the child and explain the situation to them as gently as possible, that the drug may be the child’s only option. It is important here that I articulate that there has been no research into the drug’s long term effects, and explain the potential risks of taking experimental drugs to them. It is ultimately the family’s decision, and I must ensure that they understand all the options available to them. I would also advise them of their right to seek another professional opinion, as I believe that a broader range of perspectives could be useful in this scenario, and other health professionals may know of other alternatives.

I think you need to discuss the potential impact this decision has on the the family and the child as the emphasis of this question. Usually going to experimental treatment means it is a treatment of last resort as everything else has failed but you can easily word it to say you would explore other alternatives in one sentence.

I don't think you would score too many brownie points on addressing the lack of research for the long run and what you can do about it.

I would move your discussion point about sitting down with the parents and the child to understand their perpesctive on the issue first. This should be the focus on your response.

Imo this question is lacking a lot of information. I am making the assumption you are a doctor.

 

[whoartthou]

Any feedback is appreciated (specifically I want to know if I am answering this prompt in an orderly manner- as per whoartthou's previous feedback) Thanks in advance.

• Dr. Blair recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Blair doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches, and muscle aches because he believes that it will do no harm, but will give them reassurance. Consider the ethical problems that Dr. Blair’s behaviour might pose. Discuss.

First and foremost, we need to empathise with Dr Blair as he wants to work in the best interests, evident by wanting to reassure them. It is only after taking this into account that we can investigate the issue at hand.

Now, we must conduct our own research into Dr Blaire’s prescribed medications before having a discussion. We must be careful in conducting our research, as we must use reliable sources such as peer reviewed studies published by academic institutions who are not associated with any businesses (which could potentially be biased). Not only should we look for the benefits of these treatments, but also the side-effects and risks. After conducting our research, we need to come to a conclusion about our findings. Maybe the specific medicines that he prescribes has solid evidence that they work, and in this case he is doing nothing wrong. Moving forward maybe these treatments could become more widespread as other doctors can begin to prescribe similar medications in light of this newfound evidence.

However, assuming our research has shown no evidence for the benefits of homeopathic medicine, in our discussion with Dr Blair we must ask him for his sources that show the benefit of these treatments. Maybe his research was more thorough than ours? We also need to ask him if this treatment actually “reassures” his patients like he claims they do. How does he know this? Has he conducted reliable surveys? What if by prescribing additional medication he is scaring his patients by making them perceive their illness as more severe than it is?

Next, we must look at the ethical implications of this. Does prescribing homeopathic treatments place an added burden on patients as their treatments cost more? If so, we must ask ourselves if it is ethical to charge our patients for a placebo. Are there any current policies in place which prevent doctors from prescribing placebos? If there are none, we must realise that patients trust physicians to make important decisions, and it seems unethical to make patients pay for medication which have little evidence for working. However, if the patients actually want this treatment, we must respect patient autonomy, but in the future there could be some policy changes such as making sure patients are aware of the evidence behind different medications so they can make an informed decision.

Finally, we should also look at how this impacts the reputation of healthcare in general. People generally agree that homeopathic treatment lacks valid scientific evidence, and if a physician is known to prescribe these medications it could send a signal that there are no guidelines that doctors must follow, and that they can prescribe what they want. This could weaken the trust the public has in doctors, due to the perceived lack of agreement in the healthcare industry. If this is the case, we must make policy changes as to what medications doctors can prescribe. Should there be a list that doctors can choose from to ensure all doctors treat their patients equally? What are the benefits of giving doctors the freedom to prescribe what they want?
(For a "discuss" prompt am I supposed to reach a conclusion, or simply unpack the issues)

The issue with your answer is that you didn't understand the terms. Homeopathic medication is essentially "water" therefore, it is basically a placebo.

The ethical issues here are:
1. Dr Blair may be minimising patient symptoms although some symptoms may not sound serious they may reflect serious underlying pathologies. This might result in under investigation.
2. He is deceiving patients into thinking they are getting an active treatment when infact they are not.
3. He is pertuating the notion that there is something wrong. Patients may become fixated on the idea that they are sick and require medication.
4. Your last point about reputation of healthcare professionals.

On a personal level anyone that believes in homeopathy is a rather special person or haven't done their research.

 

[Crow]

Homeopathic medication is essentially "water" therefore, it is basically a placebo.

Is this always the case though? There are some that contain active ingredients and can actually cause harm to certain patients, yes? In this sense it couldn't simply be labelled as a placebo.

 

[Crow]

Just another reminder that this thread is for discussing practice interview questions and answers. General interview discussion is to go here or in another appropriate thread: General Interview Discussion and Questions - 2021 Entry

 

[whoartthou]

Is this always the case though? There are some that contain active ingredients and can actually cause harm to certain patients, yes? In this sense it couldn't simply be labelled as a placebo.

I don't believe they contain any active ingredients. Would like to see where you got this information from?

 

[Crow]

I don't believe they contain any active ingredients. Would like to see where you got this information from?

Not Australian, I know.

Homeopathic Products

Homeopathy is an alternative medical practice that was developed in the late 1700s.

www.fda.gov

While products labeled as homeopathic are generally labeled as highly diluted, some of these products have been found to contain measurable amounts of active ingredients and therefore could cause significant patient harm.

Additionally, we've been taught at university to always question about homeopathic medications when performing a medication history because they can have interactions with other drugs. The classic example that is given is St John's wort.

 

[whoartthou]

Not Australian, I know.

Homeopathic Products

Homeopathy is an alternative medical practice that was developed in the late 1700s.

www.fda.gov

Additionally, we've been taught at university to always question about homeopathic medications when performing a medication history because they can have interactions with other drugs. The classic example that is given is St John's wort.

I wouldn't consider St John's wort as homeopathy it would be an alternative supplement.

 

[kiko0607]

Are we able to answer older questions? Or just the most recent one? Thanks

 

[whys]

Are we able to answer older questions? Or just the most recent one? Thanks

Any you like!

 

[kiko0607]

You are close friends with a Joan (a mother of five children) whose husband is an entrepreneur who is always travelling. You meet Joan for coffee one day and you notice she is quite withdrawn and upset. Her 18 month old infant has recently been admitted into hospital for measles and is currently in a stable condition. She tells you that she was so busy at home, that she forgot to get him vaccinated. She feels extremely guilty and blames herself for her oversight.

1. What would you suggest to her as a friend?
2. Your friend asks you not to tell her husband. However, the husband suspects something and has called you. What do you say?
3. Your friend’s husband finds out what has happened and he becomes verbally abusive. Their relationship becomes strained. Your friend is asking for your advice.



1 As a friend I would first console her, listen to her worries, understand where she is coming from. From the given information the friend seems to feel guilty for forgetting her child’s measles immunisation and that is why they are currently in hospital. After listening to why she may be feeling guilty or upset with herself. I would reassure her that although the mistake she made was a serious and potentially life threatening her son is currently stable and this is because as a mother she has acted in a way that has helped her son get out of a critical zone for exam e.g. recognising he was ill, taking him to the doctor/hospital. Then I would ask about her situation, reasons why she is so tired/busy. I would offer her some advice which would to first let her husband know of the child’s situation if she hasn’t already. Also that being transparent with her husband is important as it may cause problems in the future if she isn’t being honest or omitting truths for whatever reason such as feeling like a failure or incompetent mother to her children. Since she feels like she has neglected her son, I would recommend she seeks further support first from her husband. If he cannot give her the extra support that she needs, I would try to help her find other avenues for support for example in Australia there is a lot of support for parents who are struggling whether that may be practical help, financial help, emotional help, there are many more options such as family and friends. I know this because I helped my cousin who is a mother of 3 look for some support while her husband had to go overseas for 3 months the website was raisingchildren.net. I would let her know that if she needed help there is nothing wrong with reaching out to her family and friends as well. Its normal to need extra support and it’s something that I would want her to understand. I wouldn’t bring up the fact that her husband should contribute more into raising their children together because every relationship dynamic is different, and they may have something that works for them but is non-conventional. However, If she brought it up as a problem I would suggest she is more transparent with her husband with the amount of involvement she needs/expects from him and together they can find a solution that still considers his career.



2 If she has asked me to not tell her husband but he has called me because he suspects something. If he is asking for details I would respect my friends wishes and let her husband know that if he wanted to know about his kids and wife then he should speak to her directly and I am in no place to speak on her behalf. Although this is suggestive that something is wrong since I am refusing to speak up about the illness, completely reassuring her husband that everything was fine would be wrong as it would be lying to him and would not in the long run help my friend or her situation. It could also tarnish my relationship with her husband. I have simply respected my friends wishes by directing his questions to her as she is the only person who should speak to him about this. I would also give my friend a heads up that her husband called me and was suspicious and worried and suggest that she is be transparent with him.



3 If my friend is asking my advice about her verbally abusive husband. I would first assure her that she is doing great at being a mother despite the lack of physical support her husband shows in raising her children. I say physical because he travels so he cannot physically be there, but he may support the family in other ways such as financially. I would also make it clear to her that under no circumstances is it ever okay for her husband to verbally abuse her or anyone, and especially not over this mistake. The health of a child is not the sole responsibility of 1 parent. He is as equally responsible for this, there are ways he could have prevented this as well such as reminding her to bring their child to get their immunisation after all his child’s health should be one of his priorities as well. This is not an attempt to blame the husband rather to let my friend know that this fault is not just her own and that both of them have to figure out a better system that works for them to minimise problems like these from arising in the future. As for the verbal abuse, she should confront him and make should make it clear that he is not to speak to her that way and that it is not beneficial for the relationship or the family dynamic either. Since their relationship is now strained, I don’t think it would be unreasonable for her to ask her husband to make a trip home if he is away so that they can be together and resolve their issues. Verbal abuse can be an indicator of underlying problems within a relationship and a precursor to domestic abuse. This measles incident may have been the catalyst for the beginning of a breakdown of a marriage/relationship, an indicator of maybe some past resentment or feelings that have not been resolved. I would let my friend know that if anything were to escalate to violence she needs to ring the police and that there are support systems for families experiencing domestic violence, so she can rest assured she doesn’t feel trapped in her marriage.

This is my first attempt. All criticisms are welcome! FANKS GUYS

 

[watermelona]

i saw kiko0607 's post above and decided to start my interview prep as well so i had a go at the same question without reading the response or anything else just to see what i could come up with for my first attempt at a scenario question:

You are close friends with a Joan (a mother of five children) whose husband is an entrepreneur who is always travelling. You meet Joan for coffee one day and you notice she is quite withdrawn and upset. Her 18 month old infant has recently been admitted into hospital for measles and is currently in a stable condition. She tells you that she was so busy at home, that she forgot to get him vaccinated. She feels extremely guilty and blames herself for her oversight.

1. What would you suggest to her as a friend?
2. Your friend asks you not to tell her husband. However, the husband suspects something and has called you. What do you say?
3. Your friend’s husband finds out what has happened and he becomes verbally abusive. Their relationship becomes strained. Your friend is asking for your advice.

1. As her close friend and after hearing about what she is feeling/going through the first thing I would offer to her is reassurance and comfort that as a parent she is doing great and that it takes a lot of strength both mentally and physically to care for 5 children including an infant by herself while her husband is always travelling. I would tell her that balancing all her responsibilities is very difficult and certainly not everyone is able to do that as well as her. Also I would mention that making mistakes is very common and we aren’t perfect, making mistakes prevents something like it happening in the future since now we are more aware of it. With regards to her infant in hospital I would remind her that although he is in hospital he is in a stable condition and will be okay. (edit: i was going to add something about speaking to her husband for support but it sort of overlapped with the next part, would it be best to include it here in part 1?)

2. Since I am Joan’s close friend and have heard her side of the story I would respect her wishes to not mention this to her husband, (if she really does not want to) as I only know Joan’s side of the story and not much about her husband’s involvement with this issue and the family e.g. how often he is travelling, whether he calls Joan and the children often, how close the relationship is between Joan and her husband. However, as the husband has called me I would assume he does care about his family to some degree so I would first speak to Joan (before returning her husband’s call) and say that whilst I understand that she may want to keep this to herself, her husband is suspecting something and has called me. Therefore before I return the call to her husband I would encourage Joan to bring up her situation (her large responsibilities as a parent caring for 5 children, her infant in hospital and her feelings) with her husband as any of her struggles as a parent should be shared with the other parent as well even though he is travelling a lot and not always home beside her. However, if Joan is very very certain that she does not want to tell her husband I would respect this and not mention anything to her husband myself. But out of courtesy I would return the call to Joan’s husband (after I have spoken with Joan) but not provide any details about Joan’s situation, instead encourage him, as general advice, to maintain a strong relationship and sense of communication with his family even if he is not always physically home.

3. As these events have occurred after the day I met Joan in the coffee shop and since then she is going through verbal abuse, I would once again remind her of how well she is dealing with her responsibilities as mother caring for her children by herself and that she is doing her very best as mother without her husband beside her. I would tell her that the verbal abuse she is receiving is unfair and not right at all considering everything she is dealing with and if it progresses further she may have to receive professional help which completely okay to do so and she needs any support in doing that that I am here for her. Then with regards to her strained relationship I would first say that is it definitely difficult to maintain a strong relationship between husband and wife when they are not always physically together, communicating in person and directly sharing the responsibilities of childcare. As her husband’s traveling cannot be stopped as since it is due to work I would tell Joan to see this is an ‘obstacle’ that can be worked around possibly through increasing their transparency within the relationship by sharing what they are going through and not hiding things from each other and this could cause miscommunication and a lack of understanding between them. Again, I would reiterate that she is doing her best in taking care of her children alone.

thank you so much for reading, any feedback/criticism is welcome