Practice Interview Question Thread

[Scorpion]

Hi guys had a go at this q using the voice typing thing so it does sound a bit dis-jointed ahah but any feedback is much appreciated!!

You work in a school which is located in a socially disadvantaged area, and notice one of your 15 year old students coming to class with bruises which they try to hide from you. Upon questioning, the student is defensive and claims the damage is self-inflicted. You suspect that the bruises are a consequence of domestic violence, even though you know the parents to be well educated. You also have a further suspicion that it is fuelled by substance abuse. By law, if you have a reasonable suspicion of child abuse, you must report it to the Department of Health and Services with a common result being the child forcibly entered into State care, at least for the duration of the investigation.

If you didn’t think you had a reasonable suspicion at this point, how would you investigate further?
The problem presented here is that i am working in a school in a socially disadvantaged area and one of my students, a 15 yr old, is coming to lass with bruises and when i question them about it, they claim that it is actually self inflicted although i have a suspicion that it is actually due to domestic violence. This is a difficult situation because if the child is going through something such as child abuse, that is a very serious concern and of course i would want to report that to the Department of Health and Services for the child’s safety but at the same time I cannot make any assumptions without knowing whether this is actually the case or simply something else could have happened. In order to report this case to the Department of Health and Services, I need to investigate further. It would be best to try and approach the child in a polite, non-confrontational way in private to initiate a general conversation with them and ask them how they are dealing with everything; schoolwork, family life and so on. If they are very closed off and do not want to speak to me, i would remind them that if they are going through something and needed any extra support, the school and myself can offer a range of support systems to help them with whatever they are going thorough and that there are always services such as counselling or even services not related to the school such as beyond blue. By providing them options of support, it lets them know that they are not alone and that in the case where he is going through something serious, there is opportunity to seek help. To investigate further I can also organise a time to meet with his parents to get some insight into the situation of the bruising on the child.

You find out eventually that, unknown to the father, the mother is a frequent amphetamine user, and that her drug fuelled violence have caused the student’s injuries. Do you think that entrance into state care is an appropriate outcome for this child, and why?
Before deciding on whether I think state care is an appropriate outcome for the child I would first need to find out a bit more about the living situation of the child. For example, If i find out that the father is capable of looking after the child and the parents are separated, then the child has the option of living with the father instead as it is known that the mother is a frequent amphetamine user and causing injuries to her child. However in the case the child’s living state is continually with the mother and there is no option to live with the father only, as the parents are living together, then I do think that state care is an appropriate outcome. Unless the mother can manage and stop her amphetamine usage, the violence will most likely continue and cause further injuries to the child which is increasing the risk on their life and negatively impacting them.

What are some positives and negatives of the state care/foster system for this student if they were to be admitted into foster care?
With the state care or foster system, the major positive would be that the child is no longer in the negative living environment that they were in with their birth parents and provides them with a new chance to start over again with a new family that has accepted them. Also they are no longer experiencing any violence or other negative impacts they could have faced with their previous family. However negatives could be that the foster family isn't the birth parents that they have grown up from birth so it is a very new environment. For example, in this case going into foster care at the age of 15 would be quite a drastic change and they may experience some difficulties adjusting to life at the beginning. Also there is the possibility that they may not like the living situation with their foster parents because it is something new and they could be feeling uncomfortable.

As a potential future doctor, do you think you should have no discretion in reporting of suspicions such as these?
In terms of the medical field, patient confidentiality is extremely important and it is up to the patient themself to make the major decisions regarding their treatment and they patient has the right to keep information regarding this private and confidential. However, if the patient appears to be at a major risk to not only themself but others as well and once the situation is evaluated, as a doctor if i feel that there are risks, there should be the option where confidentiality can be broken if i know it will maximise the patients safety. Translating back to this situation, i think i should have some level of discretion in reporting cases like these because in these cases it is quite common for the child to be very closed off and not admit themselves that they are going through something such as child abuse because they could feel threatened by the parents or embarrassed about it so it would be very difficult to get them to open up about it themselves. I think having that discretion in reporting certain cases like this is favourable.
What can be done to help the mother?
About the mother I know that she is a frequent amphetamine user and that her drug fueled violence is what has caused the child’s injuries. I would try to approach the mother in a calm and polite way and ask how she is going with everything, her family, work and so on. I can let her know that there are support systems such as counselling or Lifeline that offer online support. If she wants to remain anonymous for whatever personal reasons then these online platforms are a really good way for her to seek support.

With this prompt because there was 5 parts so i couldn't really go into much detail bc time limit (edit: i did speak a bit over 8 min here but i will keep a stricter limit next time). this might be hard to answer but; how am i meant to know how to pace myself and allocate the 8 minutes equally and not speak too less/too much because i wont know exactly how many follow up qs get asked right, im worried if it was something with 5 parts like this id end up rushing the last few but if it was a prompt with 3 parts i might finish too early.

dano beat me to it, but I'll add my thoughts too

From what I understand about MMIs, you may not actually know how many follow-up questions there are. Instead, if you are talking about one for what they deem to be too long, they may cut you off and ask a follow-up question. Otherwise, if you haven't finished by the time 8 minutes is up, the station ends without you finishing the prompt. So as long as you are concise with your information and hit plenty of points, I don't think you should worry too much about how many follow up questions there are. You may even answer a follow up question in the first prompt, and this is okay too!

Overall, I think you've done well hitting all the main points. If you did want to cut down on the time taken to answer the question, I don't think your first couple of sentences are necessary as they are effectively just repeating the prompt. If they do help sort your thoughts out however, go ahead. Also I have seen quite a few people do this. Is it something that has been recommended?

1. Maybe mention what the support services could help the student with? Explain to the student that these services allow them to talk about what's going on and how he's feeling without fear of judgement. Acknowledge that the student may prefer not to talk to you as they may not want you to think of or treat them differently to the other students in your class.

2. You could say that beyond violence, the student's educational outcomes and social life may be negatively impacted at a time they are crucial to their development. Their overexposure to and potential access to amphetamines through their mother may increase their likelihood of abusing the substance in future, further impacting their health. Furthermore, the lack of stability in the household may impact the mental health of the student. You could mention other alternatives to state care such as living with other relatives offering a more stable home environment. You could consider the fact that the student is 15 and likely already has established relationships in their current environment, and forcing them to move into state care may further distance them from their peers which could have its own health impacts. Maybe even mention the cultural implications of going into state care. For instance, if the student is Aboriginal, moving them into a non-Aboriginal household or away from their community may separate them from the culture they have grown up amidst which again, can isolate them. In summary, I don't think the violence is the only consideration here, although it is certainly a major factor.

3. See above.

4. Maybe mention the consequences of reporting suspicions which turn out to be false. As a doctor, you are seen as a trustworthy source and reporting such suspicions- particularly when they are merely suspicions- could have drastic consequences for those you are reporting about. In truth, I don't really know what this question is asking for, so take this one with a grain of salt.

5. Don't have anything for this one, well done.

 

[watermelona]

Disclaimer ** Yr 12 student
Overall I really like all of your answers, particularly considering you did this by speaking and at the top of your head I think it was done really well. There honestly wasn't too much to critique so ill just suggest a few things which you didn't explicitly mention.

1. I think this is a great answer. I think emphasising in your answer that you first build trust by going upto the student and asking about things in general may be a good addition. You could also perhaps add a bit about how you could reassess her mood in the past few days to see if anything has been different which could aid the decision you make and provide a bit more information.

2. Once again really good answer. I particularly like the way you have approached it and how you structured the answer. If the father is not an appropriate alternative you could also include a consideration of any other family members e.g. grandparents, cousins etc.

3. once again, a great answer. I think another possible negative you may want to include is that they may have a hard time interacting and really establishing a relationship and it may make them feel quite disconnected and unsupported. another thing you could discuss is how sometimes the foster care system often fails children and they often unfortunately get passed around from family to family.

4. good answer again if u ask me. From what I can tell it wasn't until the final answer until you explicitly answered the question (although you were leading us through the answer). I'm personally not sure if its best to answer the question first and then give reasoning or do what you did - it might just be something to consider as im not sure which way is best to do so however I still think its a great answer and works fine - just food for thought.

5. I like it again. maybe you could suggest going to see a medical practitioner for appropriate help so that they can give the best service possible. when approaching the mother you may want to include a consideration of the fact that she could become aggressive so you may want to develop a relationship first.

I just saw how you said you went overtime so some of my suggestions may be too hard to add so they may not be worth fully implementing or changing since your answer was already great for the time.

Also as for your question im not really to sure what to say as I have never done them so maybe someone who has done one before can better answer - maybe there is a clock or something?. As for finishing too early I dont believe that that is a problem because from what ive heard, the interviewer would ask if there is anything you would like to add and you can go back and add to your answers if thats the case so I dont think it should be ok if you do so.

dano beat me to it, but I'll add my thoughts too

From what I understand about MMIs, you may not actually know how many follow-up questions there are. Instead, if you are talking about one for what they deem to be too long, they may cut you off and ask a follow-up question. Otherwise, if you haven't finished by the time 8 minutes is up, the station ends without you finishing the prompt. So as long as you are concise with your information and hit plenty of points, I don't think you should worry too much about how many follow up questions there are. You may even answer a follow up question in the first prompt, and this is okay too!

Overall, I think you've done well hitting all the main points. If you did want to cut down on the time taken to answer the question, I don't think your first couple of sentences are necessary as they are effectively just repeating the prompt. If they do help sort your thoughts out however, go ahead. Also I have seen quite a few people do this. Is it something that has been recommended?

1. Maybe mention what the support services could help the student with? Explain to the student that these services allow them to talk about what's going on and how he's feeling without fear of judgement. Acknowledge that the student may prefer not to talk to you as they may not want you to think of or treat them differently to the other students in your class.

2. You could say that beyond violence, the student's educational outcomes and social life may be negatively impacted at a time they are crucial to their development. Their overexposure to and potential access to amphetamines through their mother may increase their likelihood of abusing the substance in future, further impacting their health. Furthermore, the lack of stability in the household may impact the mental health of the student. You could mention other alternatives to state care such as living with other relatives offering a more stable home environment. You could consider the fact that the student is 15 and likely already has established relationships in their current environment, and forcing them to move into state care may further distance them from their peers which could have its own health impacts. Maybe even mention the cultural implications of going into state care. For instance, if the student is Aboriginal, moving them into a non-Aboriginal household or away from their community may separate them from the culture they have grown up amidst which again, can isolate them. In summary, I don't think the violence is the only consideration here, although it is certainly a major factor.

3. See above.

4. Maybe mention the consequences of reporting suspicions which turn out to be false. As a doctor, you are seen as a trustworthy source and reporting such suspicions- particularly when they are merely suspicions- could have drastic consequences for those you are reporting about. In truth, I don't really know what this question is asking for, so take this one with a grain of salt.

5. Don't have anything for this one, well done.

Thank you both very much for your suggestions !! Also with the spoken response, it might seem somewhat okay as typed words but my delivery was honestly very bad haha and i paused alot, so definitely will be working more on that!!!

 

[kotoloper]

Hi guys, trying another prompt, I think I'm getting more used to talking aloud (yay). Any advice as always is appreciated! I don't know when everyone's exams here, but mine start tomorrow so just also wanted to wish everyone good luck

A 14-year-old patient requests birth control pills from you and asks that you not tell her parents. What would you do?

First, I would need to gather the facts about the situation at hand. I’d sit down with the 14 year old in a comfortable and private environment, and initiate a friendly conversation, e.g. asking how’s she’s doing at school, etc. to get her more settled in. I would then ask her reasons for requesting the birth control pills - it could be that she is just curious about them or has heard about the pills and/or sex from her friends and is eager to jump in without fully knowing the implications. In this case, I would explain to her clearly and in an easy to understand manner, as she is only 14, that they are contraceptives used to prevent pregnancy, and give her handouts or direct her to credible sources that can help inform her after the session so that she can explore further.

However, if she is fully aware of what the pills are and requested them for the obvious reason, I would first establish that she is not being forced or coerced into having sexual activity - I would ensure to do this in a non-confrontational manner as if this is the situation, she may feel shame or fear, and reassure her and reiterate that she should not be forced into doing anything she does not want to do. If she is engaging in sexual activity of her own free will. Given that she’s only 14 and the legal age of consent is 16, there may be some legal implications, however I think that at the age of 14 you can choose to have sexual intercourse with someone at an appropriate age? I would need to check that no one significantly older is taking advantage of her and manipulating her into having sex.

I would then judge whether she is capable and mature enough to be making these decisions and is also informed of any implications of having sex, i.e. the risk of transmitting STIs. If I understand her to be fully capable, I would prescribe her the pills and reassure her that everything said is confidential, and I will not tell her parents anything without her consent. However, if I am of the impression that she is not capable of making this decision by herself, I would inform her that it would be best to sit down with her parents and discuss this prior to prescribing her the pills. I would remind her that everyone has her best interests at heart, and that if it is safe to do so, she should share this information with her parents. Parents probably wouldn’t like the idea of their 14 year old child engaging in sexual intercourse, so she may fear the backlash from telling them, however, I would encourage her to do so and if she wants, she can bring her parents into the next session and we can talk about it together. If the parents are against the prescription due to them not wanting their child to engage in these actions, I would remind them that she is capable of making her own decisions and that if she wants to have sex, it would be important for her to have these pills to prevent any unwanted pregnancies at such a young age.

 

[N182]

Hi guys, trying another prompt, I think I'm getting more used to talking aloud (yay). Any advice as always is appreciated! I don't know when everyone's exams here, but mine start tomorrow so just also wanted to wish everyone good luck

A 14-year-old patient requests birth control pills from you and asks that you not tell her parents. What would you do?

First, I would need to gather the facts about the situation at hand. I’d sit down with the 14 year old in a comfortable and private environment, and initiate a friendly conversation, e.g. asking how’s she’s doing at school, etc. to get her more settled in. I would then ask her reasons for requesting the birth control pills - it could be that she is just curious about them or has heard about the pills and/or sex from her friends and is eager to jump in without fully knowing the implications. In this case, I would explain to her clearly and in an easy to understand manner, as she is only 14, that they are contraceptives used to prevent pregnancy, and give her handouts or direct her to credible sources that can help inform her after the session so that she can explore further.

However, if she is fully aware of what the pills are and requested them for the obvious reason, I would first establish that she is not being forced or coerced into having sexual activity - I would ensure to do this in a non-confrontational manner as if this is the situation, she may feel shame or fear, and reassure her and reiterate that she should not be forced into doing anything she does not want to do. If she is engaging in sexual activity of her own free will. Given that she’s only 14 and the legal age of consent is 16, there may be some legal implications, however I think that at the age of 14 you can choose to have sexual intercourse with someone at an appropriate age? I would need to check that no one significantly older is taking advantage of her and manipulating her into having sex.

I would then judge whether she is capable and mature enough to be making these decisions and is also informed of any implications of having sex, i.e. the risk of transmitting STIs. If I understand her to be fully capable, I would prescribe her the pills and reassure her that everything said is confidential, and I will not tell her parents anything without her consent. However, if I am of the impression that she is not capable of making this decision by herself, I would inform her that it would be best to sit down with her parents and discuss this prior to prescribing her the pills. I would remind her that everyone has her best interests at heart, and that if it is safe to do so, she should share this information with her parents. Parents probably wouldn’t like the idea of their 14 year old child engaging in sexual intercourse, so she may fear the backlash from telling them, however, I would encourage her to do so and if she wants, she can bring her parents into the next session and we can talk about it together. If the parents are against the prescription due to them not wanting their child to engage in these actions, I would remind them that she is capable of making her own decisions and that if she wants to have sex, it would be important for her to have these pills to prevent any unwanted pregnancies at such a young age.

Disclaimer med applicant
Very nice answer covers pretty much everything some more points that I thought of:
1. I think you can talk about what would happen if a doctor doesn't prescribe pills in these circumstances. The outcome could be very similar to a doctor refusing abortion and similar issues, the patient would either get the pills illegitimately (causing more risk) or simply continue to have sex without pills which may result in an unplanned pregnancy.
2. 'I would need to check that no one significantly older is taking advantage of her and manipulating her into having sex,' maybe expand on this how exactly will you check? Would you ask her directly? In which case she may lie. I'm not sure how you could reliably check this without invading the patients privacy, maybe someone else could provide ideas.
3.'I would remind them that she is capable of making her own decisions and that if she wants to have sex'- Most teens don't have fully developed brains and make really terrible decisions (this could be one of them), so I would argue that the parents would probably know better in this case. At the same time you don't want to directly say this as it may come across as condescending to the patient.
edit, actually I think you touched on the 3rd point already but what happens if the patient still doesn't want to tell her parents even after your advice? What if she gets aggressive etc, maybe you could say how you would deal with the patient then.

 

[Sir]

I hope it's okay if I try this question too! I used the voice dictation, any advice would be greatly appreciated. Thanks!

You work in a school which is located in a socially disadvantaged area, and notice one of your 15 year old students coming to class with bruises which they try to hide from you. Upon questioning, the student is defensive and claims the damage is self-inflicted. You suspect that the bruises are a consequence of domestic violence, even though you know the parents to be well educated. You also have a further suspicion that it is fuelled by substance abuse. By law, if you have a reasonable suspicion of child abuse, you must report it to the Department of Health and Services with a common result being the child forcibly entered into State care, at least for the duration of the investigation.

If you didn’t think you had a reasonable suspicion at this point, how would you investigate further?
There are many different approaches I could take to investigate this further. Firstly I would most likely contact the department of health and services to ask them advice on how to best approach this as they have a lot more experience and knowledge than I do in this situation. Alternatively I could speak to the school councillor about this or my colleagues to see if they had notice anything or any strange behaviour from the student as collaboration from different perspectives could reveal some insight. I would then arrange to meet with the child in a private space where they did not feel threatened. I would be non-confrontational and try to make them feel as comfortable and calm as possible by first asking them how they were, how they were coping with school and any responsibilities they may have in their life. I would want to remind them but I was available as a resource not only educationally but if they needed any emotional support at the school was there for them and there were different resources and counselling options available to them. Further, if they didn't want to do this school they could reach out to various organisations such as headpsace, the child help line or beyond blue.

You find out eventually that, unknown to the father, the mother is a frequent amphetamine user, and that her drug fuelled violence have caused the student’s injuries. Do you think that entrance into state care is an appropriate outcome for this child, and why?
Again there are many factors that would impact whether or not entrance into state care was an appropriate outcome for this child. Although in some situations it may be best for the child to go with the non-abusive parent, I would have concerns as to why the father was unaware that the child was being abused as well as that the mother was a frequent amphetamine user. It is important that the child's care outcome and living situation is dependable, stable, as caring as possible alongside having adequate resources to support the child through his emotional struggles, education and development. Although the father is not necessarily to blame, he potentially may have not been around a lot to realise this or involved enough to step in and help the child before it got to this point.
If there were genuine reasons the father may have been unaware of the abuse towards the child and the mother's drug problem, he was not a substance abuser himself and he could provide a stable and loving home for the child with the appropriate resources and care the child required then I think the best outcome would be for him to stay with the father and potentially another appropriate family member could help out. This would however involve dealing with the mother's drug problem as well most likely with her going to rehab and keep in contact with the department of health and services or an appointed family psychologist who could assess the situation on an ongoing basis. An investigation conducted by the department of health and services would most likely be the best way to determine the appropriate care outcome for this child. Entrance into state care may be appropriate if the father showed neglect towards the child abuse or could not provide a stable and supportive home.

What are some positives and negatives of the state care/foster system for this student if they were to be admitted into foster care?
Children who are placed into the state care or the foster system by the department of health and services are placed there because the proper governing bodies and professionals believe it will be better for them. Positives include they may be placed with a more caring and resource providing family, they could have been taken away from an abusive and toxic family situation and there are ongoing support options available to them. Negatives include they are taken away from their family and this can come with a lot of psychological trauma and there would be a multitude of things to adjust to entering a new family or state care.

As a potential future doctor, do you think you should have no discretion in reporting of suspicions such as these?
As a doctor your primary duty is to make sure that patients are not in dangerous situations, a risk to themselves or others. Especially in terms of caring for minors who may not be able to make their own decisions regarding a lot of things including their care, it is a sensitive issue that doesn't always follow the general rules of adult confidentiality. Confidentiality is paramount in patient care and fundamental to patient/Dr trust and the relationship. However if you believe a child is in danger it should be reported to the appropriate body and a social worker may have to be introduced as their safety and health is more important to having discretion regarding suspicions of abuse.

What can be done to help the mother?
It has been stated that the mother is a frequent amphetamine user and that had drug fuelled violence has caused her son to be injured. There are many resources available to families in toxic situations and individuals struggling with substance abuse. It may be appropriate for her to go to rehab, join and commit to various support groups, have ongoing appointments with a psychologist or appropriate professional to monitor her health and psychological state as substance abuse can take an extreme toll on ones emotional state and relationships.

Disclaimer: Fellow med applicant

I think this is definitely quite a good response and hits most if not all of the main points. For the first question I really like how you firstly asked for advice before taking any course of action and I think I would pretty much do the same where I would check up with the child in an private space and ensure their welfare is good as well as letting them know I am always there. I also liked how you outlined a number of possible options towards the child that they could take including a number of organizations that they could potentially reach out to. One thing you could possibly add is to continually monitor the child's progress and bruises in the near future as if they reappear regularly, maybe this could be a cause for some greater suspicion. For the second question I like how you continually refer to the Department of Health and Services for advice and even though they definitely have more expertise, maybe one limitation is that they might not understand the situation on a personal level like the father does. I agree that the father not knowing might definitely be a sign of negligence and another possible alternative could be to look to other relatives that could take care of the child. But other than that I agree that depending on the father/relatives capacity the options are either to live with them or to be entered into state care. For the third question I agree with everything you wrote. From the top of my mind, the main pro was that there was definitely a guaranteed standard quality of life in state care which is definitely not something to be taken for granted including food, shelter, safety, public education and health and professional services from the department of health and services. The main con that came to mind was maybe the lack of personal attention from relatives and family members. For the fourth question, I agree that the doctors duty of care towards the patient and even children definitely has the capacity to encompass abuses like these, especially with the prospect of further physical harm towards the child and should be balanced with confidentiality. I guess autonomy (for the parents and child) as well as justice and legal guidelines could also be assessed. Finally for the fifth question I think you definitely did a good job of covering the professional options but I also thought a bit about considering personal options that could help eg close family members or friends, religious services. Overall great job on a tough MMI scenario!

 

[velvetthundr]

Tried another question with voice dictation, hope I'm improving?? any advice would be appreciated, thanks!!

You are a new doctor at the Children's Hospital: An 8-year-old boy, who presents with multiple bruises and lacerations on his body. The patient arrived with his mother to hospital. The bruises and lacerations seem to follow a particular pattern, but are unable to confirm it. You ask the patient what happened and he replies in fear, “I fell from the tree when I was climbing it”. What are the relevant ethical issues in this scenario?
There are multiple ethical issues with this scenario. The first issue relates to whether or not the patient is being abused by his mother, and if so, how I would confirm the abuse. As the boy’s mother, the patient's mother has a degree of authority over her son, to the extent where she has the right to make medical decisions for him. However, if the patient is being abused by his mother as evidenced by the multiple bruises and lacerations in a particular pattern on his body, then it is essential to preserve the boy’s mental, emotional and physical well-being as soon as possible. This would be difficult, since the mother has control over her son and as such, there's a certain degree of ethical ambiguity with me interfering in the family relationship. Furthermore, confirming whether or not the boy has been abused will be difficult since his mother is present along with the patient, and the boy might be intimidated by his mother's presence. Another issue would be how I’d confront the issue if the boy is being abused. As I mentioned before, it's essential to keep the boys safe, and as my patient I have a duty to keep his best interests in mind. I also have the duty as a doctor - if I suspect a patient is being abused - to report signs of abuse to the authorities in order to protect my patient. However this may necessitate the removal of my patient from his mother, and would cause strain on the family relationship.

What would your course of action be?
I would first take the patient's mother aside in a private room and I would ask her bluntly whether or not there has been any sign of family abuse to her son, perpetrated by either her or another family member. I will then try to use her facial expressions, tone and reaction to determine whether or not she's telling the truth. If she becomes angry and defensive, then it may be a good indication that the child is being abused, and I will tell her that I have a duty to report this to the authorities/child services, in order to confirm whether or not the patient is safe at home. If necessary, I would call my colleagues to assist me in the process of moving the child to child services, and if necessary to restrain the mother. I would also have to keep in mind that the mother may not be the one abusing her son; it could also be a father at home, caretaker or even a grandparent. If the mother seems to be telling the truth when saying that the patient isn't being abused, then I would ask her how exactly her son received the injuries, because falling from a tree would most likely not cause injuries in a particular pattern, which is a clear indication of the child is hiding something. I will keep in mind that the injuries could result from a variety of reasons, such as being bullied at school or being attacked by someone or something else. After confirming what the true reason behind his injuries were, I will then go back into the consultation room and treat the patient to the best of my abilities.

How would your answer change if the patient were a 19-year-old woman who presented with the mother?
My answer wouldn't change if the patient were a 19-year-old woman who is presented with the mother. In either case if a patient shows up with multiple injuries following a particular pattern then it's a probable indication that he or she was attacked or just recently and as such I would take similar actions. However we are contacting the authorities to report injuries in case of abuse or attack, I would not contact Child services in the case of the 19-year-old woman but rather I was just calling to the police. Furthermore there's it could be a different variety of reasons if a patient or a 19-year-old woman; for example abuse by a spouse or a significant other would be more viable reasons then a parent in the case of the child.

 

[N182]

Tried another question with voice dictation, hope I'm improving?? any advice would be appreciated, thanks!!

You are a new doctor at the Children's Hospital: An 8-year-old boy, who presents with multiple bruises and lacerations on his body. The patient arrived with his mother to hospital. The bruises and lacerations seem to follow a particular pattern, but are unable to confirm it. You ask the patient what happened and he replies in fear, “I fell from the tree when I was climbing it”. What are the relevant ethical issues in this scenario?
There are multiple ethical issues with this scenario. The first issue relates to whether or not the patient is being abused by his mother, and if so, how I would confirm the abuse. As the boy’s mother, the patient's mother has a degree of authority over her son, to the extent where she has the right to make medical decisions for him. However, if the patient is being abused by his mother as evidenced by the multiple bruises and lacerations in a particular pattern on his body, then it is essential to preserve the boy’s mental, emotional and physical well-being as soon as possible. This would be difficult, since the mother has control over her son and as such, there's a certain degree of ethical ambiguity with me interfering in the family relationship. Furthermore, confirming whether or not the boy has been abused will be difficult since his mother is present along with the patient, and the boy might be intimidated by his mother's presence. Another issue would be how I’d confront the issue if the boy is being abused. As I mentioned before, it's essential to keep the boys safe, and as my patient I have a duty to keep his best interests in mind. I also have the duty as a doctor - if I suspect a patient is being abused - to report signs of abuse to the authorities in order to protect my patient. However this may necessitate the removal of my patient from his mother, and would cause strain on the family relationship.

What would your course of action be?
I would first take the patient's mother aside in a private room and I would ask her bluntly whether or not there has been any sign of family abuse to her son, perpetrated by either her or another family member. I will then try to use her facial expressions, tone and reaction to determine whether or not she's telling the truth. If she becomes angry and defensive, then it may be a good indication that the child is being abused, and I will tell her that I have a duty to report this to the authorities/child services, in order to confirm whether or not the patient is safe at home. If necessary, I would call my colleagues to assist me in the process of moving the child to child services, and if necessary to restrain the mother. I would also have to keep in mind that the mother may not be the one abusing her son; it could also be a father at home, caretaker or even a grandparent. If the mother seems to be telling the truth when saying that the patient isn't being abused, then I would ask her how exactly her son received the injuries, because falling from a tree would most likely not cause injuries in a particular pattern, which is a clear indication of the child is hiding something. I will keep in mind that the injuries could result from a variety of reasons, such as being bullied at school or being attacked by someone or something else. After confirming what the true reason behind his injuries were, I will then go back into the consultation room and treat the patient to the best of my abilities.

How would your answer change if the patient were a 19-year-old woman who presented with the mother?
My answer wouldn't change if the patient were a 19-year-old woman who is presented with the mother. In either case if a patient shows up with multiple injuries following a particular pattern then it's a probable indication that he or she was attacked or just recently and as such I would take similar actions. However we are contacting the authorities to report injuries in case of abuse or attack, I would not contact Child services in the case of the 19-year-old woman but rather I was just calling to the police. Furthermore there's it could be a different variety of reasons if a patient or a 19-year-old woman; for example abuse by a spouse or a significant other would be more viable reasons then a parent in the case of the child.

Disclaimer Med applicant
This is a good question as it really showcases your intrinsic bias towards the issue. I think (again I'm only another applicant) that these types of questions are more about how many different scenarios can you think of and how you will deal with them. I can see from your answer that the bulk of it is you assuming a) there is abuse and b) it's from the mother (you do also mention it could be from other people). While most people would naturally be inclined to think that bruises in a pattern=abuse it could very well be possible that those bruises could just be a coincidence and the question itself states that it isn't clear. So I think it would be best to consider multiple viewpoints rather than immediately start suspecting abuse.

For question two asking the mother bluntly whether there is any signs of family abuse could be seen as a bit offensive (imo), as you are casting suspicion on the mother with very little evidence. Instead simply asking the mother why the boy has bruises or engage in small talk (first) I think would be more appropriate and from there you could ask some follow up questions. Also you say " If she becomes angry and defensive," wouldn't anyone be defensive if you are suddenly asking them if they are abusing their child? So in summary It's very good that you are considering the implication of the bruises but I feel you are being a bit too aggresive towards the mother and should give her the benefit of the doubt first before questioning whether there is abuse.

Also some more points you could consider:
-How would you comfort the patient if they were a victim? They must feel immense emotional and physical pain.
-A better way to identify whether there is abuse would be to examine the patient to determine and confirm signs of abuse rather than ask the mother immediately, then if there are signs of abuse you can do the steps you mentioned for question 2.

 

[kmhm12]

This is my first time writing a response- give me some honest feedback on what I should consider for next time

You are a new doctor at the Children's Hospital: An 8-year-old boy, who presents with multiple bruises and lacerations on his body. The patient arrived with his mother to hospital. The bruises and lacerations seem to follow a particular pattern, but you are unable to confirm it. You ask the patient what happened and he replies in fear, “I fell from the tree when I was climbing it”. What are the relevant ethical issues in this scenario?
The first ethical issue would be confidentiality between the patient and myself, by ensuring that I create a comfortable environment in which the patient is comfortable to share the truth without repercussions. Considering the patient is a 8 year old, I will try to gauge his interests and appeal to a topic of conversation that he feels comfortable with, such as talking about cartoon characters or sports, and observe how he reacts to questions about his mother. Furthermore, confidentiality may be challenged by the fact that I am a new doctor at the hospital, and will be inclined to ask senior doctors for advice- if I decide to do so, I will ask them in an environment that does not jeopardise the identity of the patient, for example by speaking to seniors in private consultation rooms.
The second ethical issue would be how reasonable my suspicions of domestic violence is. I may decide to bring a more experienced and available doctor on the ward to examine the pattern of the bruises and lacerations, and consider their insight before making a decision to inform the senior supervisor. I would avoid contacting outside institutions or government departments before confirming my suspicions.

What would your course of action be?
The first course of action I would take is to observe body language and communication between the patient and his mother, and see whether the patient avoids eye contact from his mother or winces when she approaches him, or whether the mother is cautious of others around her, all possible signs that suggest a strained relationship between the two. Afterwards, if there is a senior or more experienced doctor available on the ward, I would bring them to the patient and seek their advice regarding the pattern of lacerations on the patient, before privately discussing the possibility of domestic abuse to them. I would consider both my suspicions and their opinions in guiding my next action- if I am still unsure, I may have a private conversation with both the patient and the parent separately, perhaps asking why the patient was climbing a tree. In listening to their response, I would gauge their body and verbal language and look for signs of discomfort such as sweating or avoiding answering the questions, and further compare the responses of the patient and his mother to check whether there are any differences in their accounts. I would make sure there is reasonable doubt for abuse before reporting to the senior doctor.

How would your answer change if the patient were a 19-year-old woman who presented with the mother?
Whilst my consideration in ensuring there is reasonable doubt before reporting anything would remain the same, the fact that the patient is 19 means that she has autonomy in disclosing information to me directly, meaning I am able to discuss with her privately without the consultation of the mother, thus streamlining the process in determining whether domestic abuse exists. Still, I would first create an environment in which the patient is happy to speak truthfully to me, asking whether they would rather have their mother be part of the consultation, before gauging the possibility of domestic abuse. Moreover, the fact that the patient is a female, and the fact that women are statistically more likely to be victim to family violence, is likely to increase the urgency of the issue, compelling me to consider the advice and involvement of a social worker or the Department of Health and Services.

 

[Sir]

Hey everyone. I’m going to have a crack at this question. As usual all feedback is much appreciated

You are a new doctor at the Children's Hospital: An 8-year-old boy, who presents with multiple bruises and lacerations on his body. The patient arrived with his mother to hospital. The bruises and lacerations seem to follow a particular pattern, but you are unable to confirm it. You ask the patient what happened and he replies in fear, “I fell from the tree when I was climbing it”. What are the relevant ethical issues in this scenario?

This is definitely a very tricky situation as there is an initial temptation to voice concerns about possible other causes of bruises and lacerations, however doing so before being absolutely sure could potentially bring serious issues regarding potential family separation. A major ethical issue is definitely the safety and welfare of the child/patient which I believe should be the number one priority in this situation. Therefore my first response would definitely be to treat any symptoms he initially has, however I believe my role would also extend to the overall wellbeing of the child. Therefore this ethical issue would definitely extend towards potentially informing the parents of this negligence and letting them know that anything causing injuries like these should be prevented if possible in any way. Finally, the suspicions I have could lead me to reassure the child in a quiet space and time but also monitor the child at least for the near future in case a similar situation that heightens my suspicion again comes up. Another ethical issue is the rights of the parent and its conflict with the rights of the state/legal requirements. In this instance from my knowledge some corporal punishment is allowed however up to this extent is definitely too far, where the parents autonomy now conflicts with the childs safety. This concern would also arise when considering potential state care. However I would always keep in mind that I should not assume that the parents caused these injuries unless there is very good reason to believe so or the claims are very unreasonable for a fall from a tree.

What would your course of action be?
My initial response would be to ensure the health and safety of the child and ensuring their treatment is underway. However if not immediately urgent, the major issue as established above was whether the child is lying, and I believe further questioning could potentially solve this. It could simply be questions like "what type of tree" and "how high" and "where/when did this happen" all of which might be useful information anyway in treating the patient. Additionally, given the seriousness of lacerations especially to a child that is just 8, I believe it would be reasonable to assess the pattern and deduce whether it is indeed plausible with a fall from a tree or there could potentially be other causes. Depending on my suspicions, I would either let the child go but continue monitoring any health problems that might arise with them in the near future, or if serious enough given I am simply a new doctor, I would refer it to a more senior doctor within the ward from which we could decide whether it is appropriate to refer to the department of health and services. After treating the patient with the given treatment I would definitely try and ensure this doesn't happen again by talking to the parent and child about the seriousness of negligence and also that if injuries like this arise again in the future to definitely come and see me.

How would your answer change if the patient were a 19-year-old woman who presented with the mother?
I believe ideally it would be good to be nonjudgmental and someone's age as simply because they are 19 years old is not an indicator that they cannot be subject to events like domestic violence especially if an argument arises. Moreover adults could still be just as vulnerable health wise as children, can still be coerced into potentially lying to physicians to avoid consequences and can still fall from trees. However one difference that stands out is that a 19 year old is assumed to be significantly more mature than an 8 year old, can give informed consent and could move away from abusive parents if required to live independently. I believe one way my answer would change is that I could have a proper discussion about my concerns of their health and safety (depending on my level of suspicion) as they are definitely more mature at this age assuming they don't have learning disability or something like that. I would do this in a safe space and time, let them know I as well as other domestic violence related services are there for them if required and that if they were a victim they could always speak out. If it turned out there was insufficient suspicion and they just fell from a tree, as a 19 year old I would more likely place the onus upon them to do their best as inducing these cuts and lacerations are definitely a serious health concern.

 

[whoartthou]

Have been busy working on multiple projects so I probably won't be visiting much unfortunately.

You are a new doctor at the Children's Hospital: An 8-year-old boy, who presents with multiple bruises and lacerations on his body. The patient arrived with his mother to hospital. The bruises and lacerations seem to follow a particular pattern, but you are unable to confirm it. You ask the patient what happened and he replies in fear, “I fell from the tree when I was climbing it”. What are the relevant ethical issues in this scenario?

1. Need to address the initial presenting health complaint meaning treating the injuries. Your resonsibility is to the child not the mother as the child is your patient not the mother. However, given the child is under the age of consent then you should ideally be involving the mother in his care.
2. If you have concerns that this could be a case of child abuse it may not be wise to initially raise this with the parent as it might dissuade them from seeking medical attention in the future. It is not your duty as a the doctor to investigate and confirm your suspicions. If you have suspicions you contact Child Services or if you very concerned the the police.
3. No one that I saw discussed the implications of breaking confidentiality which is allowed if you suspect child abuse.
4. Practically speaking monitoring patients coming in and out of the hospital setting is almost impossible as it is unlikely you come across most patients multiple times however, you may an eye out.

Most responses here tend to elaborate on the non-important aspects of the case rather than focussing on the key issues where you will be obtaining the most marks.

If the patient is 19 years of age you cannot involve anyone else unless you believe their life is in imminent threat. You will be breaking confidentiality if you disclose this information to other parties without their consent.

 

[hazell]

Hi everyone, I hope interview prep is going well!
I have a question about this scenario and sample answer provided, I would greatly appreciate if someone could shed some light on the regulations and laws regarding age/consent in Australia.

QUESTION: A 14-year-old patient requests birth control pills from you and asks that you not tell her parents. What would you do?
SAMPLE ANSWER:
As a physician, my main concern here is the wellbeing and safety of my patient, the 14-year-old. First, I must gather more information. I would ensure my patient and I are in a private area and she does not feel rushed. I should sit down and ask her why she is interested in birth control. I can also find out what she knows about birth control, and if she has taken birth control pills or used other contraceptive methods in the past. I should also ask if she has any other medical issues. Importantly, I need to sensitively ask if she is sexually active and to ensure she is not being forced or coerced into anything. Based on the information she gives me, we can plan together. She could simply be curious and not be sexually active right now, in which case I would give her resources (ex. websites, pamphlets) to find out more information.
If she is planning on being sexually active and is consenting to this activity, and I feel she understand the risks and benefits, I would go ahead and prescribe the birth control for her. My concern is my patient, and prescribing the pills is important for her safety; however, I would address that birth control pills do not prevent STIs, and would give her the appropriate recommendations for preventing them. I would tell her that our conversations are confidential and I would not share anything with her parents without her consent. Physicians must judge whether a patient is a mature minor, and can consent to treatment without parental input. If I feel she is not able to consent as she does not understand the risks and benefits, I would let her know that I need to have a discussion with her and her parents present prior to prescribing the pills. If I feel that she is being abused or coerced into sexual activity, for example by a person over 18, I would need to report this to the appropriate authority. I would ensure to set a follow-up appointment in place with this patient prior to ending our visit. To summarize, I would ensure my patient’s safety and find out more from her prior to planning with her input for further steps. Thank you and I am happy to address any follow-up questions if you have them.

My questions:
-In Australia I believe the legal age of medical consent is 16, since the patient is 14 is she allowed to give consent or do her parents have to give consent on her behalf? And if that is the case, how do you possibly maintain the confidentiality of the patient as she doesn't want her parents to know?
-Also, if she is competent enough (with a good mindset for her development age and is capable of reasoned decision making) is the practitioner legally allowed to prescribe the birth control to her despite her being 14 and not 16?
I just couldn't quite wrap my head around the age of medical consent in this scenario- as a practitioner you have to maintain the confidentiality of the patient but at the same time is the patient old enough to give consent?

 

[minecraft4ever]

My questions:
-In Australia I believe the legal age of medical consent is 16, since the patient is 14 is she allowed to give consent or do her parents have to give consent on her behalf? And if that is the case, how do you possibly maintain the confidentiality of the patient as she doesn't want her parents to know?
-Also, if she is competent enough (with a good mindset for her development age and is capable of reasoned decision making) is the practitioner legally allowed to prescribe the birth control to her despite her being 14 and not 16?
I just couldn't quite wrap my head around the age of medical consent in this scenario- as a practitioner you have to maintain the confidentiality of the patient but at the same time is the patient old enough to give consent?

The answer is yes, she could consent. People under 16 can be capable of giving consent as per Gillick's Case (Wikipedia gives a decent enough rundown I think: Gillick competence - Wikipedia ). This is an English legal case that has been adopted by Australia and deals with minors consenting to medical treatment on their own. So, a minor can consent if they have "sufficient understanding and intelligence to understand fully what is proposed." While this would get a bit more complicated if say, there was something life threatening or the treatment would be permanently disfiguring, or a minor was withholding consent to treatment rather than giving it, these aren't really considerations in this scenario. There are also other cases and statute dealing with this topic but Gillick should be more than enough since the interviewers aren't testing your legal knowledge lol.

I also don't see any reason for confidence to be broken as I assume no crimes are being committed or will be, nor will anyone be injured (these aren't the nitty gritty requirements for confidence but that's the gist of it).

 

[hazell]

The answer is yes, she could consent. People under 16 can be capable of giving consent as per Gillick's Case (Wikipedia gives a decent enough rundown I think: Gillick competence - Wikipedia ). This is an English legal case that has been adopted by Australia and deals with minors consenting to medical treatment on their own. So, a minor can consent if they have "sufficient understanding and intelligence to understand fully what is proposed." While this would get a bit more complicated if say, there was something life threatening or the treatment would be permanently disfiguring, or a minor was withholding consent to treatment rather than giving it, these aren't really considerations in this scenario. There are also other cases and statute dealing with this topic but Gillick should be more than enough since the interviewers aren't testing your legal knowledge lol.

I also don't see any reason for confidence to be broken as I assume no crimes are being committed or will be, nor will anyone be injured (these aren't the nitty gritty requirements for confidence but that's the gist of it).

Awesome, thank you!

 

[kotoloper]

Hi guys, I read a question about the implications of accepting gifts, both from corporations and patients and was wondering when, if at all, is it acceptable to receive gifts? If the gift is low in value, does that make it appropriate as compared to one that costs a lot?

 

[velvetthundr]

Hi guys, I read a question about the implications of accepting gifts, both from corporations and patients and was wondering when, if at all, is it acceptable to receive gifts? If the gift is low in value, does that make it appropriate as compared to one that costs a lot?

Generally speaking, it's ok to accept cheaper gifts/gifts of less value (e.g. a box of chocolates or card) because 1) if the patient/corporate representative genuinely wants to show appreciation then why not let them 2) the value isn't so great that the patient/corp. representative might gain leverage over you. If i'm not wrong, most hospital policies should address this...?
On the other hand, if the gift is too expensive (flat-screen TV, a Switch, a Xbox Series X), then it could be seen as a bribe/attempt to gain leverage over you personally, and it would be inappropriate to accept it. At that point, you're supposed to turn it down in an empathetic way while still letting them know that you accept their appreciation (while trying not to offend them).

In the words of Good Medical Practice:
"Good medical practice involves... Not asking for or accepting any inducement, gift or hospitality of more than trivial value, from companies that sell or market drugs or appliances that may affect, or be seen to affect, the way you prescribe for, treat or refer patients."

and:

"Good medical practice involves...Not encouraging patients to give, lend or bequeath money or gifts that will benefit you directly or indirectly." (it doesn't say anything about accepting gifts, so presumably accepting tiny "trivial" gifts should be fine...?)

 

[JL538]

Just had a go at this question, would love to have some feedback

You are an intern at the hospital and currently in the operating theatre witnessing an operation. The patient has been anaesthetised and is unconscious during the surgery. In the middle of the operation, you hear the cardiologist make inappropriate remarks about the patient’s weight as well as racist and stereotypical comments with the registrars. Everyone in the operating theatre gives out a chuckle except you, as you stand horrified at what you have just heard.

1. After the operation, you take off your operation apparel and you glance at the cardiologist who is completing paperwork. Would you approach the cardiologist for his earlier actions? Discuss.

• What has transpired is certainly not acceptable and requires action to be taken, as all patients deserve be treated with respect and dignity, otherwise the trust in the medical profession may be compromised.
• I would approach the cardiologist about their joke in a firm but civil manner and discuss my concerns, keeping in mind factors such as stress that could have sparked their frustrations and inappropriate comments so that I am not too confrontational or judgemental in my approach.
• If the cardiologist shows remorse, I would thank them for taking the time to listen to my concerns and end my approach here, keeping in mind to monitor their actions in case this occurs again.
• However, if they are hostile towards my concerns, I would first reiterate my argument calmly to try again to persuade them to understand the inappropriate nature of their actions.
• If they are still unreceptive, I would politely end the conversation, and instead turn my efforts towards informing the relevant authorities at the hospital like another trusted, senior doctor or a staff member.
• This will allow someone with more power and authority than me to take the appropriate action to reprimand the cardiologist's unacceptable behaviour.

2. You now feel uncomfortable at work and do not want to go on rotations with the cardiologist any more. What should you do now?

• As stated above, I would first need to take action to address the inappropriate nature of the cardiologist's behaviour due to its potential destructive consequences.
• This involves first trying to approach the cardiologist, before escalating the situation if necessary.
• If the latter occurs, and the cardiologist does not accept the criticism, they may develop a disdain towards me.
• This will require me to speak with the relevant authorities about my discomfort with working with the cardiologist, which would hopefully allow me to be assigned some other duties away from the cardiologist.

3. Are the actions of the cardiologist passable, even if the patient didn’t hear them? Discuss

• While the fact that the patient did not hear the comments reduces the severity of the behaviour, it is still not passable.
• This is because it may contribute to a negative working culture where prejudice is normalized, which could eventually lead to a patient overtly experiencing discrimination.
• This is especially possible due to the seniority and influence of the cardiologist, and how the registrars accepted his comments (although this may be due to the power imbalance present and not actual prejudice on their part).
• Overall, action clearly must be taken to prevent damage being caused to the public's trust in the medical profession to provide care in a non-judgmental fashion.

 

[hazell]

Just had a go at this question, would love to have some feedback

You are an intern at the hospital and currently in the operating theatre witnessing an operation. The patient has been anaesthetised and is unconscious during the surgery. In the middle of the operation, you hear the cardiologist make inappropriate remarks about the patient’s weight as well as racist and stereotypical comments with the registrars. Everyone in the operating theatre gives out a chuckle except you, as you stand horrified at what you have just heard.

1. After the operation, you take off your operation apparel and you glance at the cardiologist who is completing paperwork. Would you approach the cardiologist for his earlier actions? Discuss.

• What has transpired is certainly not acceptable and requires action to be taken, as all patients deserve be treated with respect and dignity, otherwise the trust in the medical profession may be compromised.
• I would approach the cardiologist about their joke in a firm but civil manner and discuss my concerns, keeping in mind factors such as stress that could have sparked their frustrations and inappropriate comments so that I am not too confrontational or judgemental in my approach.
• If the cardiologist shows remorse, I would thank them for taking the time to listen to my concerns and end my approach here, keeping in mind to monitor their actions in case this occurs again.
• However, if they are hostile towards my concerns, I would first reiterate my argument calmly to try again to persuade them to understand the inappropriate nature of their actions.
• If they are still unreceptive, I would politely end the conversation, and instead turn my efforts towards informing the relevant authorities at the hospital like another trusted, senior doctor or a staff member.
• This will allow someone with more power and authority than me to take the appropriate action to reprimand the cardiologist's unacceptable behaviour.

2. You now feel uncomfortable at work and do not want to go on rotations with the cardiologist any more. What should you do now?

• As stated above, I would first need to take action to address the inappropriate nature of the cardiologist's behaviour due to its potential destructive consequences.
• This involves first trying to approach the cardiologist, before escalating the situation if necessary.
• If the latter occurs, and the cardiologist does not accept the criticism, they may develop a disdain towards me.
• This will require me to speak with the relevant authorities about my discomfort with working with the cardiologist, which would hopefully allow me to be assigned some other duties away from the cardiologist.

3. Are the actions of the cardiologist passable, even if the patient didn’t hear them? Discuss

• While the fact that the patient did not hear the comments reduces the severity of the behaviour, it is still not passable.
• This is because it may contribute to a negative working culture where prejudice is normalized, which could eventually lead to a patient overtly experiencing discrimination.
• This is especially possible due to the seniority and influence of the cardiologist, and how the registrars accepted his comments (although this may be due to the power imbalance present and not actual prejudice on their part).
• Overall, action clearly must be taken to prevent damage being caused to the public's trust in the medical profession to provide care in a non-judgmental fashion.

Hi! It's my first time interviewing this year so take my advice with a grain of salt

1. I like how before going into detail about what you would do etc. you state that what the cardiologist has said is not acceptable no matter what. My recommendation would be to also ensure you are in a private area before approaching the cardiologist as members of the public could possibly overhear the conversation and possibly lose their trust in the medical profession. The way in which you have described your line of action is very mature and sounds good to me- as you are trying to resolve the issue at a local level before escalation.

2. I agree with your actions for this question but maybe be mindful that patient care might be compromised as a result of you wanting to have duties away from the cardiologist- if it is a rural hospital for example where there aren't as many interns as a metropolitan hospital, it might be difficult to completely avoid the cardiologist without compromising patient care.

3. Perfectly said, I might just add that "normalising" the cardiologists behaviour amongst healthcare staff might lead to discrimination of patients and thus directly or indirectly impact patient care

That's all I can think of for now! Good luck and all the best

 

[kotoloper]

Just had a go at this question, would love to have some feedback

You are an intern at the hospital and currently in the operating theatre witnessing an operation. The patient has been anaesthetised and is unconscious during the surgery. In the middle of the operation, you hear the cardiologist make inappropriate remarks about the patient’s weight as well as racist and stereotypical comments with the registrars. Everyone in the operating theatre gives out a chuckle except you, as you stand horrified at what you have just heard.

1. After the operation, you take off your operation apparel and you glance at the cardiologist who is completing paperwork. Would you approach the cardiologist for his earlier actions? Discuss.

• What has transpired is certainly not acceptable and requires action to be taken, as all patients deserve be treated with respect and dignity, otherwise the trust in the medical profession may be compromised.
• I would approach the cardiologist about their joke in a firm but civil manner and discuss my concerns, keeping in mind factors such as stress that could have sparked their frustrations and inappropriate comments so that I am not too confrontational or judgemental in my approach.
• If the cardiologist shows remorse, I would thank them for taking the time to listen to my concerns and end my approach here, keeping in mind to monitor their actions in case this occurs again.
• However, if they are hostile towards my concerns, I would first reiterate my argument calmly to try again to persuade them to understand the inappropriate nature of their actions.
• If they are still unreceptive, I would politely end the conversation, and instead turn my efforts towards informing the relevant authorities at the hospital like another trusted, senior doctor or a staff member.
• This will allow someone with more power and authority than me to take the appropriate action to reprimand the cardiologist's unacceptable behaviour.

2. You now feel uncomfortable at work and do not want to go on rotations with the cardiologist any more. What should you do now?

• As stated above, I would first need to take action to address the inappropriate nature of the cardiologist's behaviour due to its potential destructive consequences.
• This involves first trying to approach the cardiologist, before escalating the situation if necessary.
• If the latter occurs, and the cardiologist does not accept the criticism, they may develop a disdain towards me.
• This will require me to speak with the relevant authorities about my discomfort with working with the cardiologist, which would hopefully allow me to be assigned some other duties away from the cardiologist.

3. Are the actions of the cardiologist passable, even if the patient didn’t hear them? Discuss

• While the fact that the patient did not hear the comments reduces the severity of the behaviour, it is still not passable.
• This is because it may contribute to a negative working culture where prejudice is normalized, which could eventually lead to a patient overtly experiencing discrimination.
• This is especially possible due to the seniority and influence of the cardiologist, and how the registrars accepted his comments (although this may be due to the power imbalance present and not actual prejudice on their part).
• Overall, action clearly must be taken to prevent damage being caused to the public's trust in the medical profession to provide care in a non-judgmental fashion.

Agree with all the points hazell has made! Here's just a few more:

• Your course of action sounds logical and responsible! However, consider this: Although its great that you're being super considerate, given that there was multiple remarks regarding weight, racial and stereotypical comments, this strikes me as not something prompted by stress, but rather an intrinsic thing; to me, it is unlikely that the cardiologist is going to be apologetic and will instead be defensive and, given that you're only an intern, may lash out at you. For these reasons, it might be best to go directly to a senior supervisor or someone first - just something to consider
• This may be unnecessary, but consider also the other personnel in the operating theatre who laughed at these inappropriate comments; they could be humouring the consultant or feel pressured to respond in that way, but this fosters an environment of leniency surrounding these types of situation; although you are just an intern, you have witnessed numerous members of the medical profession act in appropriately - again, probably best to bring it up with someone senior (just noticed you briefly mentioned this in the third part )
• Also just the blatant fact that making inappropriate comments about anyone, in any situation, should not be condoned

 

[hazell]

Agree with all the points hazell has made! Here's just a few more:

• Your course of action sounds logical and responsible! However, consider this: Although its great that you're being super considerate, given that there was multiple remarks regarding weight, racial and stereotypical comments, this strikes me as not something prompted by stress, but rather an intrinsic thing; to me, it is unlikely that the cardiologist is going to be apologetic and will instead be defensive and, given that you're only an intern, may lash out at you. For these reasons, it might be best to go directly to a senior supervisor or someone first - just something to consider
• This may be unnecessary, but consider also the other personnel in the operating theatre who laughed at these inappropriate comments; they could be humouring the consultant or feel pressured to respond in that way, but this fosters an environment of leniency surrounding these types of situation; although you are just an intern, you have witnessed numerous members of the medical profession act in appropriately - again, probably best to bring it up with someone senior (just noticed you briefly mentioned this in the third part )
• Also just the blatant fact that making inappropriate comments about anyone, in any situation, should not be condoned

Good points! Just regarding your first point, I’ve also wondered the same but would it be inappropriate to report without consulting the individual first? That could possibly harm the working relationship even more and consequently impact level of patient care. Maybe I’m not considering this realistically but just because you’re an intern or junior doctor etc. it doesn’t mean that you can’t stand up for inappropriate behaviour when needed- I understand that in real-life circumstances this might not be plausible as it might damage the working relationship but at the same time reporting it without consulting the individual first would also damage the working relationship. My personal opinion would be to consult them first, if they respond inappropriately then I would report as opposed to reporting first as in both cases there is the possibility of harming the working relationship however the first option might harm the working relationship to a lesser extent as you’ve consulted with them first before escalating/reporting. That’s just my personal opinion and could be very wrong, what’s everyone else’s thoughts on this?

 

[JL538]

Thanks guys for the feedback!

Just regarding one point:

I thought about whether to inform the cardiologist about escalating the situation or not, but ultimately decided not to because if they are already hostile towards my concerns, doing so would like just cause more anger and damage our working relationship even more, and be unproductive towards resolving the situation.

It would be great to get some other views on this