Practice Interview Question Thread

[dande]

This thread is looking great so far with all the feedback! Here's my attempt at this ethical/scenario based question. As usual, all feedback is appreciated.

Josh is a 29 year old patient who is a regular patient of yours. Josh was diagnosed with HIV/AIDS 3 years ago, and today he has come in for his regular GP checks. Upon questioning you find out that Josh has been sexually active with someone approximately 6 months ago. He has also confessed that he has not told his partner that he is HIV positive and has also confessed to not using contraception too. You insist that Josh should take better precaution during intercourse by using protection but completely ignores your advice saying that protection ruins the “experience” for him.

1. What should you , as the GP do next?
This situation is definitely an extremely sensitive especially considering the ignorance of the physicians advice. As with many situations like these, I believe my first instinct would be to ensure the health and safety of all individuals involved. Firstly this would initially involve gauging some of the details of this situation including how often he has been sexually active and with how many different partners during this time, as well as explaining to him the ramifications his actions could have on these individuals. Additionally I would check with legal/hospital guidelines surrounding situations like this. Then this would mean potentially first checking up on Josh and ensuring that his condition is improving even given this new discovery followed by contacting the partner recommending she would get tested. Although confidentiality is hugely essential, I believe the health and safety should be prioritized given the potentially fatal consequences of HIV/AIDS and would therefore as difficult as would be, recommend they see a physician.

2. Confidentiality is an important aspect of maintaining the therapeutic relationship between patient and doctor. What are the possible ramifications associated with the breaking of confidentiality.
There are many potentially detrimental impacts of breaking confidentiality. Firstly this could bring a breakdown of the doctor patient relationship as implied in the question, where the often sensitive information that is kept confidential, if exposed, could mean patients and the wider community are less willing to share their health problems with physicians. This especially applies with conditions such as mental health or STI's which have often quite a taboo around them. Secondly, breaking confidentiality could bring great emotional and mental stress towards patients for example through unconscious biases in the workplace, or merely just personal hardship in getting some of their private conditions exposed to others. This is simply the result of privacy being an extension of feeling safe.

3. List some situations, where you think confidentiality should be broken (if any).
Although confidentiality is a hugely important pillar to maintaining smooth relationships, there are some instances where the prioritization of other factors may take precedence. One such situation is where the health and safety of patients or other individuals are jeopardized such as in the example above. Here I believe the priorities of the medical system should lie in ensuring health standards for all of society and if these would be endangered eg unprotected sex by a HIV/AIDS patient, I believe breaking confidentiality is justified. Additionally, I believe confidentiality can be broken ONLY with the patients consent under various circumstances such as for the sake of science, or to family members and other relatives where it would normally be kept secret as the patient may genuinely want to share some aspects of their treatment and improvement.

4. You find out that Josh’s partner who he had the relationship with is HIV positive as well. She breaks down in front of you. What should you do next?
I would initially offer her consolation eg offer her tissues and comfort her, and if necessary give her some time to recover/book a later appointment if she is not in the correct mindset to discuss potential treatment plans. I would tell her I am sorry and inform her this is not her fault. Following this, I would follow the ordinary procedures surrounding the course of action when an individual is diagnosed with a condition like HIV/AIDS which I am not exactly sure what it would encompass, but from work experience would include things such as explaining what would potentially come next in terms of treatment and answering any other questions she might have such as the potential health ramifications of this diagnosis. I would make sure everything was clear so she could understand whether she would have to undertake a treatment plan like Josh's or something else.

Disclaimer: Year 12 student

I like your response overall. for 1. I liked the fact that you gauged more details first. somethingyou might want to add is how you could inform him of what you are going to do next (e.g. contact his partners) in an empathetic manner whilst still possible keeping his identity confidential (not sure if doing both is possible)
2. like your answer overall again, I thought distrust in the medical community was an important one which you hit.
3. your answer is good again. What you said is right but I think maybe more examples could of been listed. i'm pretty sure your allowed to break confidentiality (somebody please correct me if im wrong) if the person is at risk to either themselves or others so maybe you could include some other examples of this such as if you feel somebody is at a real threat of suicuide or hurting others in some way.

 

[cocodreams]

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?

Hello! I decided to try practicing an interview question and this is my very first one I have written Be as harsh as you like, idm and hopefully it makes some sense as a first timer

This is a difficult situation where the doctor can be held partially responsible, not for the actual hemorrhage but for his actions before going on a break. As a doctor, it is important to be proactive and put patient safety and wellbeing first. While the doctor may have needed a good break to rest and maintain a work-life balance, so they could better treat their future patients, it is also important to consider the logistics of the situation. The doctor should have considered whether certain patients who often visit him could suffice for the two weeks and also find someone to cover and provide details to the 'replacement' doctor so they could equally treat his patients well. However we need to know why the doctor did not ask for somebody to cover and whether this happens often? It could be that he knows his patients very well and has a good connection with them and he may believe another doctor could not entirely help the patient's health needs. If this is the case, he should let his patients know that all doctors are equally capable and they should feel confident in booking an appointment with them. It may have also been that he may have forgotten to do so or possibly slacked off. If this is the reason, the doctor should reflect on his actions and how he could better manage his time and priorities and think about patient wellbeing.

It may not be necessary to apologise but the doctor should thoroughly examine patient and go through information about the diagnosis and how both the patient and doctor can work to overcome it.

It still cannot be completely stated that the doctor was responsible for the patient's state because they did not intentionally cause any direct harm. Both the patient and doctor knew that they would see each other after the holiday and none of them may have anticipated the diagnosis. To prevent future occurrences like these, it is important the doctor's team and management staff work and communicate effectively together where a cover is provided and notify patients that they should feel confident and are welcome to book an appointment with other doctors.

 

[Scorpion]

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?

Hello! I decided to try practicing an interview question and this is my very first one I have written Be as harsh as you like, idm and hopefully it makes some sense as a first timer

This is a difficult situation where the doctor can be held partially responsible, not for the actual hemorrhage but for his actions before going on a break. As a doctor, it is important to be proactive and put patient safety and wellbeing first. While the doctor may have needed a good break to rest and maintain a work-life balance, so they could better treat their future patients, it is also important to consider the logistics of the situation. The doctor should have considered whether certain patients who often visit him could suffice for the two weeks and also find someone to cover and provide details to the 'replacement' doctor so they could equally treat his patients well. However we need to know why the doctor did not ask for somebody to cover and whether this happens often? It could be that he knows his patients very well and has a good connection with them and he may believe another doctor could not entirely help the patient's health needs. If this is the case, he should let his patients know that all doctors are equally capable and they should feel confident in booking an appointment with them. It may have also been that he may have forgotten to do so or possibly slacked off. If this is the reason, the doctor should reflect on his actions and how he could better manage his time and priorities and think about patient wellbeing.

It may not be necessary to apologise but the doctor should thoroughly examine patient and go through information about the diagnosis and how both the patient and doctor can work to overcome it.

It still cannot be completely stated that the doctor was responsible for the patient's state because they did not intentionally cause any direct harm. Both the patient and doctor knew that they would see each other after the holiday and none of them may have anticipated the diagnosis. To prevent future occurrences like these, it is important the doctor's team and management staff work and communicate effectively together where a cover is provided and notify patients that they should feel confident and are welcome to book an appointment with other doctors.

Disclaimer: yr 12

Great start for the first interview question you've done. I did pick up on a couple of things, though:

1. You spoke well about the doctor's situation and what he should have done to prevent this, but did not consider the patient's side of things in enough detail. When the patient developed severe headaches, why didn't he go to another doctor in your absence? Did he wait because he trusted you would be back soon enough, or had he been your patient for so long that you're the only doctor he thinks he can call upon? In any case, he should have referred the patient to another doctor just in case of any troubles. No you may not have anticipated the patient's intracranial hemorrhaging but you should have provided an avenue for him to receive help if he needed it. There was previous discussion of this question here which could help a bit more.

2. I personally think it is necessary for the doctor to apologise for what happened. Doctors have a responsibility to act in the interests of their patients' health and in this scenario, the doctor's negligence led to severe complications which may have endangered the patient's life and forced them to take time off work to recover (potentially harming them financially- a secondary consideration considering the state of their health). The doctor needs to at least acknowledge what happened and their part in it, and tell the patient they are sorry for what happened.

 

[chinaski]

Follow up question: The doctor was working in a rural community and was unable to find cover for their leave, and is the only doctor in town. The closest town is 500km away. Does this mean that doctors working in isolated communities are morally and personally responsible for the provision of healthcare cover 24/7 in such communities, even if that means they can never take a holiday or have any time off being on call? What are the implications of this?

 

[Scorpion]

Follow up question: The doctor was working in a rural community and was unable to find cover for their leave, and is the only doctor in town. The closest town is 500km away. Does this mean that doctors working in isolated communities are morally and personally responsible for the provision of healthcare cover 24/7 in such communities, even if that means they can never take a holiday or have any time off being on call? What are the implications of this?

Ooh interesting question, I'll have a go at this one and feedback would be very much appreciated! I've realised it's much easier to critique an answer than actually write one. Looking back at the question now, I think I went a bit off-topic in the second half of the response, but what's written is written.

A healthy work-life balance is essential to doctors being able to provide quality healthcare to their patients whilst staying in good health themselves. For this reason, the doctor is entitled to taking a holiday, even if this means not being able to personally care for his patients for a short time. However, the residents of the rural community may have ongoing healthcare needs for which they depend upon the doctor, and if cover for these patients cannot be found, these needs may not be met. If the doctor has notified the appropriate authorities of his leave and has taken all viable steps to find cover but could not, he should not be held responsible for the endangerment of the community's health. This is instead a failure of the healthcare system in providing alternative methods of care for remote communities and support for doctors working in such areas.

When not on holiday, the doctor would essentially be on call at all times. This could result in the deterioration of the doctor's health and undue stress being placed on them, which by extension could lead to poorer performance at work and poorer health outcomes for patients. Ideally, two doctors would be placed in the town so they could share the burden of responsibility, allowing them both a greater degree of freedom. However in the current healthcare model, this may be financially unfeasible.

Asking the residents of the community to travel 500km for an appointment with the closest doctor is not feasible as many residents may not have access to vehicles and some, particularly those with severe medical issues, may be unable to drive. If it is not possible for another doctor to be located within the remote community, alternative methods such as tele-health should be considered to provide some form of healthcare for the residents of the town. This involves a video-chat style appointment between a patient in the community with a doctor located elsewhere in the state. However, diagnostic ability may be compromised using this method, especially if mobile signal is poor in such a remote area, and procedural work which cannot be carried out by nurses would be impossible using this approach. If severe health complications were to arise, the patients would not receive any care and this could lead to preventable deaths within a marginalised community.

 

[kotoloper]

Ooh interesting question, I'll have a go at this one and feedback would be very much appreciated! I've realised it's much easier to critique an answer than actually write one. Looking back at the question now, I think I went a bit off-topic in the second half of the response, but what's written is written.

A healthy work-life balance is essential to doctors being able to provide quality healthcare to their patients whilst staying in good health themselves. For this reason, the doctor is entitled to taking a holiday, even if this means not being able to personally care for his patients for a short time. However, the residents of the rural community may have ongoing healthcare needs for which they depend upon the doctor, and if cover for these patients cannot be found, these needs may not be met. If the doctor has notified the appropriate authorities of his leave and has taken all viable steps to find cover but could not, he should not be held responsible for the endangerment of the community's health. This is instead a failure of the healthcare system in providing alternative methods of care for remote communities and support for doctors working in such areas.

When not on holiday, the doctor would essentially be on call at all times. This could result in the deterioration of the doctor's health and undue stress being placed on them, which by extension could lead to poorer performance at work and poorer health outcomes for patients. Ideally, two doctors would be placed in the town so they could share the burden of responsibility, allowing them both a greater degree of freedom. However in the current healthcare model, this may be financially unfeasible.

Asking the residents of the community to travel 500km for an appointment with the closest doctor is not feasible as many residents may not have access to vehicles and some, particularly those with severe medical issues, may be unable to drive. If it is not possible for another doctor to be located within the remote community, alternative methods such as tele-health should be considered to provide some form of healthcare for the residents of the town. This involves a video-chat style appointment between a patient in the community with a doctor located elsewhere in the state. However, diagnostic ability may be compromised using this method, especially if mobile signal is poor in such a remote area, and procedural work which cannot be carried out by nurses would be impossible using this approach. If severe health complications were to arise, the patients would not receive any care and this could lead to preventable deaths within a marginalised community.

Disclaimer: year 12
Overall I really like your response! Just random musings off the top off my head'
In the first paragraph where you mention how if the doctor had taken every step to try and cover his leave he should thus not be held responsible for the endangerment of the community's health, does this mean that if every reasonable step had been taken to cover the leave, he could go on vacation without being held responsible for the implications of his actions? The point you bring up after this about how it is a failure of the system to adequately account for healthcare in isolated communities I agree with completely, maybe I'm just being nit-picky.
I also think there's room to really go into the implications of having only one doctor in the community - quite literally means the entire community's health rests on the one doctor's hands. The medical profession is already a stressful one but having that sole responsibility is very likely going to have an adverse affect on mental status and health, which affects not only the doctor but the patients as well as you've mentioned. Also practically speaking, what happens if there is a big accident concerning multiple patients who all need surgery? Because there's only one doctor, this situation would inevitably lead to loss of life which may have been prevented with more personnel. Is the doctor morally responsible for this loss of life? This is also parallel to situations in hospitals where the amount of patients means that some won't get the treatment they need in time, but the implications are exacerbated in an isolated community where there is literally no options. I think I'm kinda going off the rails here so I'm gonna stop haha.

 

[chinaski]

The reason I gave you this prompt is that it's the reality of many doctors who work in rural and remote areas. These places are often very sparsely populated, so it is not realistic to have several doctors working in the same town (or even the same vicinity). Given their geographical, social and professional isolation, they are difficult to recruit to, difficult to find cover and difficult to retain healthcare staff in the long term. Some areas advertise for years without a single applicant. Even in towns that have a handful of doctors, you should not under-estimate the burden of on-call (even 1:2 or 1:3 continuously would be incredibly difficult). The doctor shortage in rural and remote communities does not boil down to a simple matter of doctors not wanting to live somewhere that doesn't have nightclubs, as is often the claim. Try to imagine what it is like to be a doctor in these kinds of situations - because this is literally every-day life for many doctors working out in those communities.

 

[velvetthundr]

Hi guys, any advice would be appreciated regarding my answers of the prompts below, I didn't really know how to expand on the answers

a. You are given 100,000 dollars to address a medical need. What would you spend it on?
Assuming I could only spend the 100,000 dollars on one specific medical need, I would spend it on medical research regarding human genetics and how genetics influence the contraction of chronic diseases and disorders.

b. Why would you choose that topic?
Our genetics have a large influence on how our body reacts to different diseases; however, even to this day, even our most preeminent scientists don’t fully understand how exactly our genetic code affects our chances of contracting or resisting diseases. Many pathogenic viruses interact with our genetic code in order to infect us with diseases. As such, figuring out how genes affect the rates of certain diseases could be greatly beneficial to our understanding of the human body, while giving us a better idea of how to treat certain diseases. Furthermore, research in genomics would give us a better understanding of the inheritance and prevention of genetic disorders alongside pathogenic infections.

c. Who would you speak with to go about your project?
I would go to the Australia Genomics Health Alliance as well as the Genomics Health Futures Mission to discuss with them how the money would be best allocated, and collaborate with others to fund research and pool our resources to get the best doctors, scientists and researchers onboard. I’d work with them to fund a project that researches potential genomic solutions to the most prevalent viral diseases of our time in order of global infection rate.

d. How would you evaluate the success of your project?
I would evaluate the success of the project by the number of breakthroughs and development of medical products available to combat relevant diseases, leading to the number of lives saved/helped. Another way to evaluate the success of the project would be the amount of funding received from third parties and collaboration with others.

 

[chinaski]

The logic is sound, but the costing is not. $100,000 in medical research is a drop in the ocean, so assuming it would lead to the independent funding of a project and measuring your success in terms of "breakthroughs" is a little ambitious.

 

[katespade]

just wondering where everyone is getting these interesting questions from - could someone send me a copy if thats a thing? thanks

 

[ucatboy]

just wondering where everyone is getting these interesting questions from - could someone send me a copy if thats a thing? thanks

From what I can tell (the wildly varying quality), these just seem to be questions taken from the internet.

 

[velvetthundr]

Hi, I was wondering if anyone could advise me on my answer to this prompt (any issues that you see, anything that I missed)? I don't know if my response below is sufficient to talk for 8 minutes straight any advice would be appreciated

You are opening a medical practice in an area with a high immigrant population. What issues do you need to consider?
As a doctor, a major issue I need to consider is the possible conflict in culture between myself and my potential patients. As the immigrant population is high, it stands to reason that a significant percentage of my patients would be immigrants. As these immigrants would all come from a different background as myself or have different cultural values and beliefs from what I’d generally be used to, I would have to be aware of this, and take care to avoid offending my patients by performing actions or saying things that could be considered as culturally offensive during diagnosis and treatment. The language barrier could also be a potential problem as English might not be the first language of many of the immigrants, leading to communication problems during consultations. A translator might be required, or the hiring of a medical professional who is fluent in the language/dialect of the immigrants. Furthermore, I would have to be aware of their economic situation. Many immigrants come to a different country in order to escape their previous conditions in search of a better life; as such, there may be a higher chance that my patients from the immigrant population may not be financially stable. My patients from the immigrant population may not be used to the Australian medical system, including medicine, healthcare or payment. Unfortunately, they might also be used to facing prejudice and stigmatization from locals who look down on them for their economic or cultural situation. Similarly, they themselves might have doubts, fears and stigmas towards Western medicine, and treat me/my medical practice with heavy suspicion. As such, I would be careful not to ignore their concerns or opinions when seeing them or treating them, and treat them compassionately as people instead of a collection of symptoms. I would listen to them respectfully, and make every effort to maintain fluent and clear communication between myself and my immigrant patients. In addition, I might also be running the only medical practice available within the area, and might be overworked with all the consultations and patients that I would have to see. Due to this, I might have to consider working with others and seeking assistance, should the workload become too much for me. A lesser subsequent issue to this would be my own work-life balance. Maintaining my own work-life balance would be even more difficult than usual in this case, so I’d also have to take care of my own mental and emotional health while running my practice.

 

[Sir]

Hi, I was wondering if anyone could advise me on my answer to this prompt (any issues that you see, anything that I missed)? I don't know if my response below is sufficient to talk for 8 minutes straight any advice would be appreciated

You are opening a medical practice in an area with a high immigrant population. What issues do you need to consider?
As a doctor, a major issue I need to consider is the possible conflict in culture between myself and my potential patients. As the immigrant population is high, it stands to reason that a significant percentage of my patients would be immigrants. As these immigrants would all come from a different background as myself or have different cultural values and beliefs from what I’d generally be used to, I would have to be aware of this, and take care to avoid offending my patients by performing actions or saying things that could be considered as culturally offensive during diagnosis and treatment. The language barrier could also be a potential problem as English might not be the first language of many of the immigrants, leading to communication problems during consultations. A translator might be required, or the hiring of a medical professional who is fluent in the language/dialect of the immigrants. Furthermore, I would have to be aware of their economic situation. Many immigrants come to a different country in order to escape their previous conditions in search of a better life; as such, there may be a higher chance that my patients from the immigrant population may not be financially stable. My patients from the immigrant population may not be used to the Australian medical system, including medicine, healthcare or payment. Unfortunately, they might also be used to facing prejudice and stigmatization from locals who look down on them for their economic or cultural situation. Similarly, they themselves might have doubts, fears and stigmas towards Western medicine, and treat me/my medical practice with heavy suspicion. As such, I would be careful not to ignore their concerns or opinions when seeing them or treating them, and treat them compassionately as people instead of a collection of symptoms. I would listen to them respectfully, and make every effort to maintain fluent and clear communication between myself and my immigrant patients. In addition, I might also be running the only medical practice available within the area, and might be overworked with all the consultations and patients that I would have to see. Due to this, I might have to consider working with others and seeking assistance, should the workload become too much for me. A lesser subsequent issue to this would be my own work-life balance. Maintaining my own work-life balance would be even more difficult than usual in this case, so I’d also have to take care of my own mental and emotional health while running my practice.

Disclaimer: Non-Standard Applicant
I think this is actually quite a good answer! Don't worry too much as usually they have more than one question in 8 minutes. I think you pretty much hit all the issues you needed to address such as finances, language barriers, misunderstandings of the Australian healthcare system, potential prejudices and other cultural differences. You also even talked a bit about work life balance which is something I didn't think of but maybe saying your own balance is less important is selfless but a bit illogical, I mean if you are stressed your quality of care probably goes down but I get the point you are trying to get across, patients first. I guess my only suggestion would be to have a bit more structure which I know is hard but it seems there is just a bunch of listing of points rather than grouping it under a heading like stereotypes or something. Just a thought.

 

[chinaski]

Hi, I was wondering if anyone could advise me on my answer to this prompt (any issues that you see, anything that I missed)? I don't know if my response below is sufficient to talk for 8 minutes straight any advice would be appreciated

You are opening a medical practice in an area with a high immigrant population. What issues do you need to consider?
As a doctor, a major issue I need to consider is the possible conflict in culture between myself and my potential patients. As the immigrant population is high, it stands to reason that a significant percentage of my patients would be immigrants. As these immigrants would all come from a different background as myself or have different cultural values and beliefs from what I’d generally be used to, I would have to be aware of this, and take care to avoid offending my patients by performing actions or saying things that could be considered as culturally offensive during diagnosis and treatment. The language barrier could also be a potential problem as English might not be the first language of many of the immigrants, leading to communication problems during consultations. A translator might be required, or the hiring of a medical professional who is fluent in the language/dialect of the immigrants. Furthermore, I would have to be aware of their economic situation. Many immigrants come to a different country in order to escape their previous conditions in search of a better life; as such, there may be a higher chance that my patients from the immigrant population may not be financially stable. My patients from the immigrant population may not be used to the Australian medical system, including medicine, healthcare or payment. Unfortunately, they might also be used to facing prejudice and stigmatization from locals who look down on them for their economic or cultural situation. Similarly, they themselves might have doubts, fears and stigmas towards Western medicine, and treat me/my medical practice with heavy suspicion. As such, I would be careful not to ignore their concerns or opinions when seeing them or treating them, and treat them compassionately as people instead of a collection of symptoms. I would listen to them respectfully, and make every effort to maintain fluent and clear communication between myself and my immigrant patients. In addition, I might also be running the only medical practice available within the area, and might be overworked with all the consultations and patients that I would have to see. Due to this, I might have to consider working with others and seeking assistance, should the workload become too much for me. A lesser subsequent issue to this would be my own work-life balance. Maintaining my own work-life balance would be even more difficult than usual in this case, so I’d also have to take care of my own mental and emotional health while running my practice.

Your response infers that you'd know how to appropriately interact with these communities. What is glaring in your response is the fact that you don't say you'd make an effort to educate yourself about these cultures and communities, because you're likely to be coming from a place of ignorance. Acknowledging your deficits is important here. Showing a willingness to reach out, to interact with these communities, to get to know them and to be educated is much better than just saying "yeah, they will be different to me so I'll have to make sure that I am compassionate, an to not to be offensive and to listen to them respectfully when they come to my clinic" (which is essentially what you should be doing with every single patient you see, not just the ones from marginalised communities!).

 

[DrPotato]

First interview question I attempt. Any feedback is massively appreciated.



A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm. The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an exotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars. Do you believe that the physician's actions can be justified in any way? Is it ever right to take away someone's autonomy?



In this ethical scenario, a group of surgeons have decided to surgically treat a woman who is also a dancer with abdominal aortic aneurysm against her will. From the perspective of the surgeons, they have deemed her situation and condition so severe that they felt the need to proceed with surgery despite the patient strongly refusing this form of treatment because she believes this will negatively impact her career as a dancer. The most pressing issue here is the wellbeing of the dancer and this is illustrated by the fact that the surgeons tried to act in her best interest and may have been under immense stress to save the patient given they understand the magnitude of risks involved with her condition and hence their actions should be at least partially justified. From the patient’s perspective, she may be going through significant emotional strain after the diagnosis and may believe that regardless of the outcome, the presence of post-surgical scars and the impact it can have on her career is worth not undergoing treatment, and as a doctor this view must be validated and respected. However, due to the stress she experienced she may have been incompetent in making an informed decision despite having the surgeons thoroughly explain that this is the only treatment option available and the risks involved in refusing this procedure. Despite this, I believe that if she was in the correct state of mind while making her decision, the surgeons and health professionals should have outlined alternative options to manage an aneurysm burst should it occur and must have respected her choice of not receiving treatment rather than performing the treatment without consent. This raises questions as to whether this has happened in the past by the same or different set of health care professionals. Regardless of the answer, this case alone should raise concerns about the current hospital policies put in place and how these may need to be modified where appropriate to ensure such a scenario where the autonomy of the patient is bypassed does not occur again as it may negatively impact the public’s trust and belief in the health care system as a whole. I believe that the only time it is appropriate to take away someone’s autonomy is if they have been deemed completely incompetent of making health related decisions for themselves and that they have no next of kin or other close family members which have been given the power by the patient to make decisions on their behalf. In all cases, however, where the patient’s autonomy is not taken into account, the physician must act in the patients best interest in accordance with the principles of beneficence and non-maleficence.

 

[Scorpion]

First interview question I attempt. Any feedback is massively appreciated.



A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm. The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an exotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars. Do you believe that the physician's actions can be justified in any way? Is it ever right to take away someone's autonomy?



In this ethical scenario, a group of surgeons have decided to surgically treat a woman who is also a dancer with abdominal aortic aneurysm against her will. From the perspective of the surgeons, they have deemed her situation and condition so severe that they felt the need to proceed with surgery despite the patient strongly refusing this form of treatment because she believes this will negatively impact her career as a dancer. The most pressing issue here is the wellbeing of the dancer and this is illustrated by the fact that the surgeons tried to act in her best interest and may have been under immense stress to save the patient given they understand the magnitude of risks involved with her condition and hence their actions should be at least partially justified. From the patient’s perspective, she may be going through significant emotional strain after the diagnosis and may believe that regardless of the outcome, the presence of post-surgical scars and the impact it can have on her career is worth not undergoing treatment, and as a doctor this view must be validated and respected. However, due to the stress she experienced she may have been incompetent in making an informed decision despite having the surgeons thoroughly explain that this is the only treatment option available and the risks involved in refusing this procedure. Despite this, I believe that if she was in the correct state of mind while making her decision, the surgeons and health professionals should have outlined alternative options to manage an aneurysm burst should it occur and must have respected her choice of not receiving treatment rather than performing the treatment without consent. This raises questions as to whether this has happened in the past by the same or different set of health care professionals. Regardless of the answer, this case alone should raise concerns about the current hospital policies put in place and how these may need to be modified where appropriate to ensure such a scenario where the autonomy of the patient is bypassed does not occur again as it may negatively impact the public’s trust and belief in the health care system as a whole. I believe that the only time it is appropriate to take away someone’s autonomy is if they have been deemed completely incompetent of making health related decisions for themselves and that they have no next of kin or other close family members which have been given the power by the patient to make decisions on their behalf. In all cases, however, where the patient’s autonomy is not taken into account, the physician must act in the patients best interest in accordance with the principles of beneficence and non-maleficence.

Disclaimer: yr 12

Welcome to interview prep DrPotato! I think your response was well-rounded and you considered several different factors which was great. I do have a few suggestions:

• You did mention a little about the public losing faith in the health care system, but you could even address the ramifications of the patient suing the hospital, as this could have been something the surgeons failed to account for when opting to perform the procedure without the patient's consent. Not only could this cost the hospital millions of dollars, but the subsequent bad publicity could also damage the reputation of the hospital, discouraging other potential patients from seeking medical attention when they need it for fear of having their autonomy taken away from them. This could have negative impacts on the health of the community as some individuals may suffer the consequences of not seeking medical help until their conditions have progressed significantly. This is further evidence that the physicians' actions were not justified.
• This was minor but you said, 'the surgeons and health professionals should have outlined alternative options to manage an aneurysm burst should it occur'. The question stated that the only way to fix the problem is surgical and should an aneurysm burst occur, she'd be dead in minutes. I know you're just covering all considerations but I think this one makes it seem like you understand the importance of the scenario less than you actually do, so I'd avoid mentioning it.
• Maybe expand on the autonomy discussion by not just saying that patient autonomy is important, but why you believe it is important. Does it go further than simply maintaining the public's faith in the healthcare system? You might be able to mention that it makes people feel more in control of their health and gives them the freedom to choose what they do and do not want done with their bodies. You could then say these are the reasons you believe any patient with the capacity to make an informed decision about their medical care should have their autonomy upheld etc. etc. You could then even expand on the flip-side and give examples of the circumstances in which a patient's autonomy should not be upheld and why it should not be upheld.

 

[velvetthundr]

Another practice question! once again, any advice would be greatly appreciated

Mr Dent suffers from a painful medical condition for which he has been taking a medication that has been effective. New research shows this drug may cause very serious side effects and the Therapeutic Goods Administration in Australia is considering withdrawing. Alternative medications haven't worked in the past and he is now in agony.
Should he be allowed to make his own decision about the safety of the medication?
In this scenario, I am assuming that I am Mr. Dent’s doctor and I am his only source of access to both medications. In this scenario, the question is whether or not Mr. Dent should be permitted to take the medicine with potentially serious side effects. As a fully qualified medical professional who has examined Mr. Dent’s medical condition extensively and inspected the effects (or lack of effect) of alternative medications, I would be in a better position to understand the potential benefits and risks of the respective medications, and thus make the decision to give the medication to Mr. Dent. Before prescribing either of the medications to Mr. Dent, I would carefully inspect and observe his symptoms while taking his own opinions and feelings into account before using these observations to prescribe a medication to him. An issue that I would have to take into consideration is that the new research may or may not be flawed; the drug may not actually cause serious side effects. Furthermore, I would keep in mind that the Therapeutic Goods Administration may soon withdraw the medication, and the choice of whether or not to prescribe this medication to Mr. Dent could soon be taken out of my hands by the medicatoin’s removal. After making my decision, I would inform him of the possible risks and side effects of taking the medication and make sure he understands them. However, the essential concept of patient autonomy comes into play at this point. Mr. Dent still has his own autonomy regarding the safety of the medication; I cannot force Mr. Dent to take the prescribed medication. Mr. Dent still makes the final decision regarding whether or not he takes the medication. In other words, if Mr. Dent feels that the medication is unsafe to take, he does not have to take it, regardless of my opinion.

Would you encourage or discourage him from purchasing the drug over the internet?
I would discourage Mr. Dent from purchasing the drug over the internet, as the veracity and reliability of medications from a third-party are less easily verified. Drugs sold over the internet may have been tampered with beforehand, or affected by the distance over which and environment in which the drugs were transported (e.g. the heat/cold could’ve chemically altered the drugs to change their function). Furthermore, the instructions on the packaging may not be applicable to Mr. Dent, as his condition could require different doses than stated on the package. All in all, receiving the drug from a local hospital or store is far more reliable, where I - as Mr. Dent’s doctor - could advise him on his doses and decisions regarding the medication.

 

[Scorpion]

Another practice question! once again, any advice would be greatly appreciated

Mr Dent suffers from a painful medical condition for which he has been taking a medication that has been effective. New research shows this drug may cause very serious side effects and the Therapeutic Goods Administration in Australia is considering withdrawing. Alternative medications haven't worked in the past and he is now in agony.
Should he be allowed to make his own decision about the safety of the medication?
In this scenario, I am assuming that I am Mr. Dent’s doctor and I am his only source of access to both medications. In this scenario, the question is whether or not Mr. Dent should be permitted to take the medicine with potentially serious side effects. As a fully qualified medical professional who has examined Mr. Dent’s medical condition extensively and inspected the effects (or lack of effect) of alternative medications, I would be in a better position to understand the potential benefits and risks of the respective medications, and thus make the decision to give the medication to Mr. Dent. Before prescribing either of the medications to Mr. Dent, I would carefully inspect and observe his symptoms while taking his own opinions and feelings into account before using these observations to prescribe a medication to him. An issue that I would have to take into consideration is that the new research may or may not be flawed; the drug may not actually cause serious side effects. Furthermore, I would keep in mind that the Therapeutic Goods Administration may soon withdraw the medication, and the choice of whether or not to prescribe this medication to Mr. Dent could soon be taken out of my hands by the medicatoin’s removal. After making my decision, I would inform him of the possible risks and side effects of taking the medication and make sure he understands them. However, the essential concept of patient autonomy comes into play at this point. Mr. Dent still has his own autonomy regarding the safety of the medication; I cannot force Mr. Dent to take the prescribed medication. Mr. Dent still makes the final decision regarding whether or not he takes the medication. In other words, if Mr. Dent feels that the medication is unsafe to take, he does not have to take it, regardless of my opinion.

Would you encourage or discourage him from purchasing the drug over the internet?
I would discourage Mr. Dent from purchasing the drug over the internet, as the veracity and reliability of medications from a third-party are less easily verified. Drugs sold over the internet may have been tampered with beforehand, or affected by the distance over which and environment in which the drugs were transported (e.g. the heat/cold could’ve chemically altered the drugs to change their function). Furthermore, the instructions on the packaging may not be applicable to Mr. Dent, as his condition could require different doses than stated on the package. All in all, receiving the drug from a local hospital or store is far more reliable, where I - as Mr. Dent’s doctor - could advise him on his doses and decisions regarding the medication.

[Disclaimer: yr 12]

Nice work velvetthundr, you've definitely touched on the main points I can think of. This question seems very broad so I think that opens up different avenues to discuss. With that in mind, I've listed a few extra questions you could consider if time permits, but mentioning these specific points unprompted likely wouldn't be expected of you in an interview:

• Consider the nature of the potential side-effects: By serious, do they mean immediately life threatening? If this is the case, Mr Dent probably shouldn't be taking the drug even if this research is only new and you shouldn't be prescribing it to him regardless of his wishes.
• However, what if Mr Dent was an elderly man who wishes to live his twilight years in relative comfort? Or he was suffering with a terminal illness alongside his painful condition? If you don't expect him to live much longer anyway, and he just wished to be without pain, would this justify giving the patient the drug? Would you respect his autonomy more if this was the case?
• What if Mr Dent was younger, and insisted upon taking the drug so that he could be relieved enough from his pain to work? Is this a valid reason to give the patient the medication, should he choose to take it?

Also, a follow-up question: Mr Dent told you that if you don't give him a prescription for the drug, he intends to purchase it over the internet. Does this change your decision whether to prescribe him the drug?

 

[Crow]

To those engaging in providing feedback, and a special shout out to Scorpion who has been awesome - thanks so much once again. Much appreciated from myself and no doubt the recipients of the feedback!

 

[velvetthundr]

[Disclaimer: yr 12]

Nice work velvetthundr, you've definitely touched on the main points I can think of. This question seems very broad so I think that opens up different avenues to discuss. With that in mind, I've listed a few extra questions you could consider if time permits, but mentioning these specific points unprompted likely wouldn't be expected of you in an interview:

• Consider the nature of the potential side-effects: By serious, do they mean immediately life threatening? If this is the case, Mr Dent probably shouldn't be taking the drug even if this research is only new and you shouldn't be prescribing it to him regardless of his wishes.
• However, what if Mr Dent was an elderly man who wishes to live his twilight years in relative comfort? Or he was suffering with a terminal illness alongside his painful condition? If you don't expect him to live much longer anyway, and he just wished to be without pain, would this justify giving the patient the drug? Would you respect his autonomy more if this was the case?
• What if Mr Dent was younger, and insisted upon taking the drug so that he could be relieved enough from his pain to work? Is this a valid reason to give the patient the medication, should he choose to take it?

Also, a follow-up question: Mr Dent told you that if you don't give him a prescription for the drug, he intends to purchase it over the internet. Does this change your decision whether to prescribe him the drug?

If I had previously decided in my best professional judgment to not prescribe the drug to Mr. Dent, then I would not give him a prescription for the drug. Assuming that I had a good reason not to give him the drug (e.g. extremely negative/lethal side effects), I couldn't prescribe him the drug in good conscience. I would re-iterate to him the risks of the drugs and why I did not prescribe the medication to him. I would urge him not to purchase the drug over the internet for the sake of his own health and well-being; however, if the drug is indeed commercially available on the internet, I cannot force him not to purchase it.