Practice Interview Question Thread

[kotoloper]

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?

I completely agree that regardless of your position, you should definitely stand against inappropriate behaviour. However, directly confronting someone about said behaviour can be difficult, especially if it's someone in a senior position to you in the workplace - of course, this is not an excuse not to do anything about it. I personally think that consulting the person in interest would be an ideal way to go forward in certain scenarios, i.e. if you noticed that a doctor didn't wash their hands or something (just off the top of my head). But here, the cardiologist has continually made insulting remarks about an unconscious patient - this behaviour is something I would be extremely uncomfortable with regarding a confrontation, and, going back to my previous point, I think it's highly probable that the cardiologist is going to be defensive; bringing it up could actually even damage the working relationship. For these reasons, I considered it appropriate here to just go directly to someone senior, even just for advice.

Would also love to hear everyone else's thoughts on this!

 

[velvetthundr]

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

I personally agree with your original plan of approaching the cardiologist first by yourself, because it's preferable to privately resolve the situation before dragging other people in. Doing so preemptively might make the cardiologist feel attacked, or put on the spot which could lead to him getting even more angry and maybe even denying your claims or accusing you.
If you approach him privately and he lashes out at you, then you have a good reason/justification to approach a senior supervisor because the cardiologist escalated the situation first. (like the Power Rangers with their megazords! if anyone gets the reference. no? just me? ;-; )
Just be careful because you're 1) just an intern and dealing with a senior member of the medical hierarchy and 2) trying not to escalate the situation and cause people to get angry when it can be avoided - take it step by step.
But other than that, I agree with hazell and kotoloper! great response

 

[kotoloper]

Hi guys, had a crack at this question! I used the voice to text feature on docs again, then rearranged it into paragraphs. Not too sure about my response, any feedback would be awesome!

As a physician at a local hospital, you notice that there is a man with an alcohol dependency who keeps on consuming the hand sanitiser offered at the hand sanitiser stands throughout the hospital. He is not a patient at the hospital at present but has been many times in the past. Consequently, there is often no hand sanitiser for public use. What do you do?

First of all, consuming hand sanitiser can have negative health implications - I’m not sure of what exactly, but as a physician, I would be aware of these consequences and subsequently how this man is being affected by continually consuming the hand sanitiser. The man’s health would be on issue at hand here, followed by the fact that there is often no sanitiser available for public use, especially in a hospital environment where being clean and ensuring that everyone in the hospital has access to these things that can help keep everyone’s health safe is pivotal and as such this also needs to be addressed.

As he is not a patient at the hospital at present it is possible that he is coming just to consume the sanitiser as it would be readily available at the hospital. I assume that the hospital will have cameras and security measures in place, and the next time the man comes in I would try to have a peaceful conversation with him about why he’s consuming the sanitiser. It is possible that he will get aggressive and will not be willing to talk to me or try to run away, but as his health is at risk I will need to take measures to ensure that we can have a discussion not necessarily just about his health but also about the consequences of his actions on other people. Of course, I as a physician cannot force individuals not willing to take measures for their health into being a patient, but the fact is that his actions may be causing his health to deteriorate and I believe that I have a responsibility to try and aid him. I think that one way to do this would be to sit down with the man and try to help him so that he can also come out of this better than before - as he has an alcohol dependency, it is likely that he is relying on the sanitiser for its alcohol percentage. If I’m able to have a conversation with him, I would try to get him comfortable with me, and empathise with any issues he’s having - namely his alcohol dependency, but also other factors which could’ve led to this dependency, such as family situation. After finding out more about him, I would gently tell him that there can be side effects from consuming sanitiser and try to discourage him from doing so. I will also try to address his alcohol dependency issue by recommending him to support groups or hot lines available as well as hospital services, which can help in potentially overcoming his dependency which is beneficial for his long-term health. If he has been a patient before at the hospital, I could talk to whichever colleague of mine was his physician, and discuss what to do next with them as well. I will try to do my best to persuade him to take these measures to ensure that his health is kept at its best potential.

To address the issue of no sanitiser being available, of course the hospital could theoretically just replenish the supply but this is costly and does not tackle the cause of the problem; the man could just keep coming back. If the man is unwilling to cooperate, hospital security may need to escort him from the premises should he continue to come to the hospital purely for these reasons. However, this also raises a question about how he has been able to consume so much hand sanitiser without anyone stopping him - is no one being aware of this? Is everyone too busy to take notice? Is it a complacency issue or shrugging of responsibility? I recognise that hospitals can be busy and that the teams and personnel may not have witnessed him doing so, but I believe that being aware of surroundings is essential and if patients are doing things such as these, intervention needs to be immediate and prompt.

 

[Crow]

Regarding the cardiologist/racism scenario, I've read the responses and the key things were addressed by everyone, so well done all.

I'll add an extra "view" that was touched on but not really addressed in detail. Something very significant (and this was my main reaction to part a) of this scenario) is the key power differential between an intern and a consultant. If I were to answer the question honestly, I couldn't see myself directly confronting an authority figure with a significant influence on my daily practice and potentially career opportunities.

There was a similar scenario earlier in the thread but it involved a medical student rather than an intern - I left my opinion on that here and feel the sentiment still applies: Practice Interview Question Thread.

The consultant can have a major influence on your working opportunities, they may be someone you rely upon to ask for advice on patient management etc, you may want to use them as a referee for another job after this one or to get onto a training program - all of these things would, in my opinion, be valuable discussion points in this question. If you directly/indirectly confront or report them about this, all of these factors could be affected, which is in fact what part b) of the scenario suggests.

It would also be worth mentioning anonymous reporting as a potential option - yes, given the facts of the scenario, you could potentially be identifiable anyways - but it's a discussion point to consider nonetheless, and would avoid you directly confronting the consultant and/or reporting them directly to another authority figure, and could thus preserve your working relationship while still addressing the issue at hand.

Great to see all of your insightful answers. I am blown away by the engagement in this thread this year! Keep it up everyone

 

[Crow]

Hi guys, had a crack at this question! I used the voice to text feature on docs again, then rearranged it into paragraphs. Not too sure about my response, any feedback would be awesome!

As a physician at a local hospital, you notice that there is a man with an alcohol dependency who keeps on consuming the hand sanitiser offered at the hand sanitiser stands throughout the hospital. He is not a patient at the hospital at present but has been many times in the past. Consequently, there is often no hand sanitiser for public use. What do you do?

First of all, consuming hand sanitiser can have negative health implications - I’m not sure of what exactly, but as a physician, I would be aware of these consequences and subsequently how this man is being affected by continually consuming the hand sanitiser. The man’s health would be on issue at hand here, followed by the fact that there is often no sanitiser available for public use, especially in a hospital environment where being clean and ensuring that everyone in the hospital has access to these things that can help keep everyone’s health safe is pivotal and as such this also needs to be addressed.

As he is not a patient at the hospital at present it is possible that he is coming just to consume the sanitiser as it would be readily available at the hospital. I assume that the hospital will have cameras and security measures in place, and the next time the man comes in I would try to have a peaceful conversation with him about why he’s consuming the sanitiser. It is possible that he will get aggressive and will not be willing to talk to me or try to run away, but as his health is at risk I will need to take measures to ensure that we can have a discussion not necessarily just about his health but also about the consequences of his actions on other people. Of course, I as a physician cannot force individuals not willing to take measures for their health into being a patient, but the fact is that his actions may be causing his health to deteriorate and I believe that I have a responsibility to try and aid him. I think that one way to do this would be to sit down with the man and try to help him so that he can also come out of this better than before - as he has an alcohol dependency, it is likely that he is relying on the sanitiser for its alcohol percentage. If I’m able to have a conversation with him, I would try to get him comfortable with me, and empathise with any issues he’s having - namely his alcohol dependency, but also other factors which could’ve led to this dependency, such as family situation. After finding out more about him, I would gently tell him that there can be side effects from consuming sanitiser and try to discourage him from doing so. I will also try to address his alcohol dependency issue by recommending him to support groups or hot lines available as well as hospital services, which can help in potentially overcoming his dependency which is beneficial for his long-term health. If he has been a patient before at the hospital, I could talk to whichever colleague of mine was his physician, and discuss what to do next with them as well. I will try to do my best to persuade him to take these measures to ensure that his health is kept at its best potential.

To address the issue of no sanitiser being available, of course the hospital could theoretically just replenish the supply but this is costly and does not tackle the cause of the problem; the man could just keep coming back. If the man is unwilling to cooperate, hospital security may need to escort him from the premises should he continue to come to the hospital purely for these reasons. However, this also raises a question about how he has been able to consume so much hand sanitiser without anyone stopping him - is no one being aware of this? Is everyone too busy to take notice? Is it a complacency issue or shrugging of responsibility? I recognise that hospitals can be busy and that the teams and personnel may not have witnessed him doing so, but I believe that being aware of surroundings is essential and if patients are doing things such as these, intervention needs to be immediate and prompt.

I think your response is very reasonable and I love the final paragraph. To be honest, I am questioning what the scenario was going for with "consuming" - are they trying to imply he is actually ingesting the sanitiser? Or just using it on his hands? I would genuinely seek clarification from an assessor before answering if I was asked this in an interview setting. The former would be very harmful for this man's health, the latter far less so.

Otherwise, I think your approach is great: gently approach the man, ascertain his reasoning for using the sanitiser and being in the hospital, alert other staff members, escalate to security if necessary. The final part of your answer is honestly very insightful and something I hadn't even thought about, which I think is perfect.

This is a good example of the importance of considering all stakeholders in the scenario. The man using (abusing?) the sanitiser is an obvious one. The others are the staff and patients of the hospital. No sanitiser available = serious infection control risk = potential for infections to spread and affect vulnerable patients. If no sanitiser is available, the staff may very well just treat their patients as they normally would but without the necessary infection control measures. This is topical in the age of Coronavirus as well and something you could definitely discuss!

 

[chinaski]

I think your response is very reasonable and I love the final paragraph. To be honest, I am questioning what the scenario was going for with "consuming" - are they trying to imply he is actually ingesting the sanitiser? :') Or just using it on his hands? I would genuinely seek clarification from an assessor before answering if I was asked this in an interview setting. The former would be very harmful for this man's health, the latter far less so.

Perhaps your inexperience of D&A showing through here. Alcoholics will not infrequently resort to other substitutes if they can't procure alcohol. As such, actual consumption of things like hand sanitiser, methylated spirits and products like Listerine are not uncommon, unfortunately.

My comment on the response above would be to point out that it's all well and good show concern for the well-being of an addict when they become an inconvenience to you (ie when they start stealing your hand sanitiser)... but where was your concern for their well-being beforehand? If you feel you have to intervene now he's pinching your hand sanitiser, why not before that occurred?

And yes, it's kind of unreasonable to expect hospital staff to be aware of people stealing products off the ward. They are busy places, people have other priorities, and people are not stationed at the end of every corridor, monitoring for shoplifting. Furthermore, you're assuming clinicians have lots of time on their hands to engage in opportunistic drug and alcohol counselling of people who aren't even a patient of the hospital in which they work, which simply isn't the case in reality.

 

[Crow]

Perhaps your inexperience of D&A showing through here. Alcoholics will not infrequently resort to other substitutes if they can't procure alcohol. As such, actual consumption of things like hand sanitiser, methylated spirits and products like Listerine are not uncommon, unfortunately.

Indeed I am very inexperienced in the area, though I found the aspect of the scenario that "there is no hand sanitiser available throughout the hospital" to be largely unrealistic then, as one person could surely not "consume" an entire hospital's (regardless of the size) supply, surely? That's where I found it to be vague/difficult to interpret exactly what they are going for.

 

[chinaski]

First, you're assuming this behaviour is isolated to one person affecting one hospital (which in reality, is not the case). Regardless, even one dead person as a result of drinking the stuff is what you want to avoid, even if that means changing hospital-wide procedure. In real life, policy can dictate that liquid hand sanitisers in "high risk/high traffic" areas (eg emergency departments, general access areas of wards etc) be removed in response to repeated theft, and sometimes replaced with substances with less likelihood of being consumed (eg viscous gels instead of liquid). Liquid sanitiser may be available to staff in areas that are less likely to fall prey to patients or passers-by stealing it. Many high-risk areas may not supply sanitiser at all as a matter of course (eg D&A wards, psychiatry). Worth pointing out that hand hygiene is not necessarily contingent on the presence of hand sanitisers - so when push comes to shove, you can always resort to soap and water.

 

[velvetthundr]

hi guys, I used the google docs voice-to-text dictation before editing the response. any feedback would be great!!
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?

In this scenario, I'm a doctor who has a mother and child as my patients. The child has a pattern of bruises on his body that seem to hurt when I touch them, but his mother claims that the bruises are the result of a cultural practice called “coining”. The main issue in this scenario is the conflict between cultural practices and modern medical practices. As a doctor, I'm obligated to report any signs of possible patient abuse, especially at the hands of any family members. However, there is an ambiguous aspect to the situation, as the mother has openly admitted that the bruises were directly caused by her but for good Intentions, and resulted from a form of alternative therapy.

What I would do is I’d tell the mother that the child seems to be in pain, and I’d ask her more about the procedure. I’d get more information from her about how exactly the procedure goes, when the child underwent the procedure, and how often he undergoes the procedure. I would inform the mother empathetically and kindly that the procedure seems to have had a negative physical effect on the child, and it seems to have left him in pain. I’d also tell her that if done improperly, this form of alternative therapy could lead to more negative physical consequences, and possibly even permanent damage.

I think that in such a case, a physician has to be particularly careful because of the cultural aspect of the situation. While the mother may not have intended to do harm to the child, the child has clearly been harmed and as a doctor, everything I do should be for the wellbeing of the patient. I would then recommend to the mother not to do this procedure again and I’d inform her of the risks. At this point I realize that the mother might be offended or insulted by what she might perceive as an offense towards her culture and cultural practices. As such, I would try to convince her that I'm not trying to insult her culture intentionally, and I'm just doing my job as a doctor; I have the best interests of my patients at heart and am simply informing her of the risks. As someone who comes from a Asian background with a Chinese Malaysian family, I'm familiar with the fact that many Asian cultures have similar forms of traditional treatments that do not have scientific backing, and might actually cause harm to the patient. I'm also aware that people might take offense when questioned about their cultural beliefs and treatments. A physician has the responsibility to be respectful and open-minded to his patients, but must still have the best interests of his patients at heart. Even if his professional opinion may offend the patient. he has a responsibility to tell his patients the truth.

I would not call Child Protective Services because the mother isn’t intentionally abusing the child, although I would warn her about the risks of the treatment. This is because calling child protective services would escalate the situation unnecessarily, and it would have a negative effect on both the patient’s family relationship and the way that the patient sees the hospital. If I call Child Protective Services, they would probably take the child away as they evaluate the family situation and whether or not the child is truly being abused. Obviously, it would be preferable to avoid the removal of a child from his mother; furthermore, the mother might see the clinic or hospital that I work at to be hostile, and she might view us as someone who is taking her child away from her. This could cause her to view the entire Australian healthcare system in a negative light, and instill a sense of distrust in Western medicine as a whole.

 

[whoartthou]

hi guys, I used the google docs voice-to-text dictation before editing the response. any feedback would be great!!
You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?

In this scenario, I'm a doctor who has a mother and child as my patients. The child has a pattern of bruises on his body that seem to hurt when I touch them, but his mother claims that the bruises are the result of a cultural practice called “coining”. The main issue in this scenario is the conflict between cultural practices and modern medical practices. As a doctor, I'm obligated to report any signs of possible patient abuse, especially at the hands of any family members. However, there is an ambiguous aspect to the situation, as the mother has openly admitted that the bruises were directly caused by her but for good Intentions, and resulted from a form of alternative therapy.

What I would do is I’d tell the mother that the child seems to be in pain, and I’d ask her more about the procedure. I’d get more information from her about how exactly the procedure goes, when the child underwent the procedure, and how often he undergoes the procedure. I would inform the mother empathetically and kindly that the procedure seems to have had a negative physical effect on the child, and it seems to have left him in pain. I’d also tell her that if done improperly, this form of alternative therapy could lead to more negative physical consequences, and possibly even permanent damage.

I think that in such a case, a physician has to be particularly careful because of the cultural aspect of the situation. While the mother may not have intended to do harm to the child, the child has clearly been harmed and as a doctor, everything I do should be for the wellbeing of the patient. I would then recommend to the mother not to do this procedure again and I’d inform her of the risks. At this point I realize that the mother might be offended or insulted by what she might perceive as an offense towards her culture and cultural practices. As such, I would try to convince her that I'm not trying to insult her culture intentionally, and I'm just doing my job as a doctor; I have the best interests of my patients at heart and am simply informing her of the risks. As someone who comes from a Asian background with a Chinese Malaysian family, I'm familiar with the fact that many Asian cultures have similar forms of traditional treatments that do not have scientific backing, and might actually cause harm to the patient. I'm also aware that people might take offense when questioned about their cultural beliefs and treatments. A physician has the responsibility to be respectful and open-minded to his patients, but must still have the best interests of his patients at heart. Even if his professional opinion may offend the patient. he has a responsibility to tell his patients the truth.

I would not call Child Protective Services because the mother isn’t intentionally abusing the child, although I would warn her about the risks of the treatment. This is because calling child protective services would escalate the situation unnecessarily, and it would have a negative effect on both the patient’s family relationship and the way that the patient sees the hospital. If I call Child Protective Services, they would probably take the child away as they evaluate the family situation and whether or not the child is truly being abused. Obviously, it would be preferable to avoid the removal of a child from his mother; furthermore, the mother might see the clinic or hospital that I work at to be hostile, and she might view us as someone who is taking her child away from her. This could cause her to view the entire Australian healthcare system in a negative light, and instill a sense of distrust in Western medicine as a whole.

It's more of an issue of cultural practices that don't align with the law (not modern medical practice). In some cultures genital mutilation or marriage at 13 may be considered culture but if these acts are committed they are breaking a law and the repercussions should be sought.

You said if the practice was "done improperly" but what if the nature of the practices will result in harm. It wouldn't necessarily matter if it was done improperly or properly. However, I see where you are coming from but I would word it differently.

Talking about practices not having "do not have scientific backing" doesn't pertain to the scenario so there is no need to mention this.

I think you extrapolated a bit too much in your last paragraph about Child Protective Services on them taking the child away.

Overall, you did excellent as you explained the difficulties in managing quite a complex situation. You were empathetic to the patient and to the mother and the cultural practices of the mother but you didn't excuse the potential harm this practice may have caused to the child. This scenario reminds me of cupping I had done as a child, although the bruises look nasty it didn't hurt that much.

 

[DrPotato]

Hey everyone. This is my first speech to text response to an ethical scenario (rearranged it a bit though). Any feedback is appreciated!!

You are an emergency room physician at a local hospital. A patient comes in requesting painkillers for his back. Upon reviewing his file, you realize that he frequently comes to the hospital requesting painkillers and he has already capped his prescription for the month. Upon examination, you notice no new injuries to indicate an increase in painkillers. You politely tell the patient that you will not increase his dosage or re-fill out another prescription for him. He tells you that he will go and inject himself with heroin right now if he does not get the painkillers. What do you say next? What do you do?



From this scenario, I understand that I am an emergency room physician at my local hospital and my patient is requesting pain killers for his back while I did not notice any new injuries upon examination and that he has already maxed his prescription for this month. The patient also becomes verbally aggressive towards me when I decline his request to increase his dosage or re-fill out another prescription. So, my course of action would initially involve setting up an environment where I can have a calm, private conversation, given that we are in the emergency room and that conversations like these are easily overheard. In order to gather more information, I would approach him in a non-confrontational and polite manner again to understand exactly why he believes he needs these painkillers after I already examined him and I would use his response in order to gauge the situation further. It is very possible that he becomes more violent in the likely case that he has developed a dependence to the drug even after threatening to inject himself with heroin if his requests are not fulfilled, and in that case I would notify security to escort him out of the building as he may become a danger to other staff or patients in the emergency room.

If I am able to continue the conversation in a calm fashion, I would remind him that it is my responsibility to decline these request as I am not legally permitted to prescribe painkillers to anyone who claims to need it in order to maintain professional medical practice. In addition to this, I think it's also really important to recognise that in a hospital setting if the doctor decides against prescribing medication upon the patient’s request, there are many other ways to acquire the substances they are after illegally. And so, as a doctor I must warn him of the dangers involved in taking illicit substances like heroin and the effect it can have on his physical wellbeing but also the potential legal ramifications of possessing the drug. Overall, I would avoid prescribing him the painkillers even though he threatens to take heroin immediately after the consultation. In addition to this, the scenario has stated that he is a frequent visitor and I think it is appropriate to investigate whether or not his previous visits involved receiving prescriptions for this painkiller. I would ask him if this was the case in his previous visits and also personally check his medical records and if it were, I would further investigate the reasons behind doing so, by reading the medical notes left by the attending physician after their consultation if available, to make sure the painkillers were prescribed for valid reasons. It is entirely possible that other doctors may have given in and prescribed the medication upon request from the patient which may be due to a variety of reasons like the patient’s persistence, for example, and if that is the case then there is further investigation needed and potential change or modification of hospital policy in order to preserve the medical profession's image and to maintain the public’s confidence and trust in the health care they receive. This is particularly important as health care workers require this trust in order to acquire accurate information from patients to diagnose, treat and manage patient symptoms reliably.

 

[hazell]

Hey everyone. This is my first speech to text response to an ethical scenario (rearranged it a bit though). Any feedback is appreciated!!

You are an emergency room physician at a local hospital. A patient comes in requesting painkillers for his back. Upon reviewing his file, you realize that he frequently comes to the hospital requesting painkillers and he has already capped his prescription for the month. Upon examination, you notice no new injuries to indicate an increase in painkillers. You politely tell the patient that you will not increase his dosage or re-fill out another prescription for him. He tells you that he will go and inject himself with heroin right now if he does not get the painkillers. What do you say next? What do you do?



From this scenario, I understand that I am an emergency room physician at my local hospital and my patient is requesting pain killers for his back while I did not notice any new injuries upon examination and that he has already maxed his prescription for this month. The patient also becomes verbally aggressive towards me when I decline his request to increase his dosage or re-fill out another prescription. So, my course of action would initially involve setting up an environment where I can have a calm, private conversation, given that we are in the emergency room and that conversations like these are easily overheard. In order to gather more information, I would approach him in a non-confrontational and polite manner again to understand exactly why he believes he needs these painkillers after I already examined him and I would use his response in order to gauge the situation further. It is very possible that he becomes more violent in the likely case that he has developed a dependence to the drug even after threatening to inject himself with heroin if his requests are not fulfilled, and in that case I would notify security to escort him out of the building as he may become a danger to other staff or patients in the emergency room.

If I am able to continue the conversation in a calm fashion, I would remind him that it is my responsibility to decline these request as I am not legally permitted to prescribe painkillers to anyone who claims to need it in order to maintain professional medical practice. In addition to this, I think it's also really important to recognise that in a hospital setting if the doctor decides against prescribing medication upon the patient’s request, there are many other ways to acquire the substances they are after illegally. And so, as a doctor I must warn him of the dangers involved in taking illicit substances like heroin and the effect it can have on his physical wellbeing but also the potential legal ramifications of possessing the drug. Overall, I would avoid prescribing him the painkillers even though he threatens to take heroin immediately after the consultation. In addition to this, the scenario has stated that he is a frequent visitor and I think it is appropriate to investigate whether or not his previous visits involved receiving prescriptions for this painkiller. I would ask him if this was the case in his previous visits and also personally check his medical records and if it were, I would further investigate the reasons behind doing so, by reading the medical notes left by the attending physician after their consultation if available, to make sure the painkillers were prescribed for valid reasons. It is entirely possible that other doctors may have given in and prescribed the medication upon request from the patient which may be due to a variety of reasons like the patient’s persistence, for example, and if that is the case then there is further investigation needed and potential change or modification of hospital policy in order to preserve the medical profession's image and to maintain the public’s confidence and trust in the health care they receive. This is particularly important as health care workers require this trust in order to acquire accurate information from patients to diagnose, treat and manage patient symptoms reliably.

Hey! I just stumbled across this and thought I'd give my thoughts (I'm also preparing for interviews so take my thoughts with a grain of salt).

I don't think the patient has become verbally aggressive in this scenario, but actually gives the physician some crucial information- that he possibly uses illicit drugs or is considering using illicit drugs. I think it would be of benefit to gather more information regarding his drug use/future drug use (as you have stated and elaborated on well) and whether he uses these drugs in order to ease his pain. I feel as though it would be useful to give the patient benefit of doubt and investigate his medical presentation further- it could well be the case that the first check up has missed something and he really is in excruciating pain and relies on illicit substances for this reason, it could also be the case that he doesn't use illicit substances but is considering it as an option due to his pain not subsiding. In this case, your second paragraph addresses this as you would explain the dangers, ramifications, etc. of the drug. However, by being empathetic to the patients needs you can investigate their case further and this will give you more information to make a reasoned and valid judgement about prescribing the painkillers.

I really like how you would take the patient to a more private area to discuss your concerns however I feel as though escorting him out of the building if he becomes irritated would probably not be the best action to take. If you do escort him, it is likely he will do what he said "inject himself with heroin" and this puts the patient's health and safety at risk. Maybe you can consider calming him down, talking to him and empathising with him more.

Another point to consider, I feel as though your answer is great in the sense that you prioritise the medical profession's image and maintaining the public's confidence in the health care system- however, I feel as though you could be a little more empathetic towards the patient. It seems as though you make a few assumptions (maybe because of the wording), for example: assuming he is already using drugs, pressured other doctors to prescribe him the painkillers, and that he is violent due to taking drugs. I understand that you're really considering every possibility (which is great!) however, it sounds like you aren't being empathetic to the patient's needs and sort of making assumptions.

I'm sorry for nit-picking but this is the type of feedback that really helps me so I thought it would help you too! Good luck and all the best

 

[forevafrensbear]

These questions are tough. I would have hoped interview question are pitched at the level being applied to (e.g. ED RMO or registrar)

Firstly I would endeavour that I have taken a thorough history and examination of the patient to exclude any new potential pathology. Differentials for increase in back pain would include musculoskeletal disease (e.g vertebral fracture, discogenic or facet joint). I would also ensure the patient, given their IVDU history has no recent history of systemic constitutional symptoms. Red flags such as 'pain waking the patient up at night' or new neurology might mandate further investigation. I personally would check the FBP/CRP/ESR as if normal would effectively exclude embolic osteomyelitis. NO new injuries does not mean no new pathology. I would also review his past history and recent imaging (e.g. MRI spine). A frequent presenter may indicate drug-seeking behaviour but is also a red flag that there may be real pathology.

The acute on chronic pain issue is a more complex matter. A thorough pain history is also required.

Regarding the pain killers, I am aware there is the Opioid S8 prescriber line and would discuss the patient's history with the Health Department delegate. If he has in fact reached his opioid cap, I would inform him that the Department of Health has restricted my ability to prescribe an outpatient opioid script. One could pursue non opioid adjuncts for back pain and discuss neuropathic/biopsychosocial pain theories and multimodal analgesia. I would explore if the patient is known to the acute pain service. However, I would also take a thorough pain history and see if there are any aggravating/relieving factors to explore or whether the patient is in fact "drug seeking". A calm, empathetic approach but with an awareness to escalate if required. If there is a significant pain component and the patient has not had a proper work up, then it would not be unreasonable to see what I can do to help this patient explore solutions to his pain. This may involve discussion with the acute pain service (e.g. ketamine as a short term inpatient only adjunct) and exploration of regional blocks as an opioid painkiller sparing option. The latter depends upon the pathology and ascertaining that diagnostic dilemma is important.

The "I will inject myself now with Heroin" angle is tough. As are borderline manipulative personality traits. I would refer the patient on to the Acute Medical Unit! On a more serious note, exploring potential drug use and self harm is a Pandora's box. And one that would warrant a second opinion. A firm but polite response that the comment is inappropriate, that I am attempting to help. And that he has a choice to maintain a professional relationship or be referred on. Such a response is counterproductive may go down well. Or may not.

 

[hazell]

These questions are tough. I would have hoped interview question are pitched at the level being applied to (e.g. ED RMO or registrar)

Firstly I would endeavour that I have taken a thorough history and examination of the patient to exclude any new potential pathology. Differentials for increase in back pain would include musculoskeletal disease (e.g vertebral fracture, discogenic or facet joint). I would also ensure the patient, given their IVDU history has no recent history of systemic constitutional symptoms. Red flags such as 'pain waking the patient up at night' or new neurology might mandate further investigation. I personally would check the FBP/CRP/ESR as if normal would effectively exclude embolic osteomyelitis. NO new injuries does not mean no new pathology. I would also review his past history and recent imaging (e.g. MRI spine). A frequent presenter may indicate drug-seeking behaviour but is also a red flag that there may be real pathology.

The acute on chronic pain issue is a more complex matter. A thorough pain history is also required.

Regarding the pain killers, I am aware there is the Opioid S8 prescriber line and would discuss the patient's history with the Health Department delegate. If he has in fact reached his opioid cap, I would inform him that the Department of Health has restricted my ability to prescribe an outpatient opioid script. One could pursue non opioid adjuncts for back pain and discuss neuropathic/biopsychosocial pain theories and multimodal analgesia. I would explore if the patient is known to the acute pain service. However, I would also take a thorough pain history and see if there are any aggravating/relieving factors to explore or whether the patient is in fact "drug seeking". A calm, empathetic approach but with an awareness to escalate if required. If there is a significant pain component and the patient has not had a proper work up, then it would not be unreasonable to see what I can do to help this patient explore solutions to his pain. This may involve discussion with the acute pain service (e.g. ketamine as a short term inpatient only adjunct) and exploration of regional blocks as an opioid painkiller sparing option. The latter depends upon the pathology and ascertaining that diagnostic dilemma is important.

The "I will inject myself now with Heroin" angle is tough. As are borderline manipulative personality traits. I would refer the patient on to the Acute Medical Unit! On a more serious note, exploring potential drug use and self harm is a Pandora's box. And one that would warrant a second opinion. A firm but polite response that the comment is inappropriate, that I am attempting to help. And that he has a choice to maintain a professional relationship or be referred on. Such a response is counterproductive may go down well. Or may not.

For undergraduate interviews, is this the level of detail we have to go into? I was under the impression that we don’t need any prior medical knowledge and that we’re tested on our approach to the situation.

 

[ucatboy]

For undergraduate interviews, is this the level of detail we have to go into? I was under the impression that we don’t need any prior medical knowledge and that we’re tested on our approach to the situation.

Kinda confused because I got asked nothing medical-related in my interviews save for health issues, but those topics are broad and accessible to everyone i.e. everyone kinda knows a bit about them to piece together a few sentences, but answer quality can be easily differentiated by the depth and breath of your knowledge. Other than that, pretty much all scenarios related to school/friends/classmates/group members.

 

[chinaski]

For undergraduate interviews, is this the level of detail we have to go into? I was under the impression that we don’t need any prior medical knowledge and that we’re tested on our approach to the situation.

You are not expected to have any prior medical knowledge. This level of detail would not be expected of any medical school applicant (undergrad or not). Similarly, you are not expected to be across medicolegal policy and specific laws.

 

[whoartthou]

You are an emergency room physician at a local hospital. A patient comes in requesting painkillers for his back. Upon reviewing his file, you realize that he frequently comes to the hospital requesting painkillers and he has already capped his prescription for the month. Upon examination, you notice no new injuries to indicate an increase in painkillers. You politely tell the patient that you will not increase his dosage or re-fill out another prescription for him. He tells you that he will go and inject himself with heroin right now if he does not get the painkillers. What do you say next? What do you do?

Most universities are moving away from medically based scenarios. If you are given a medically based scenario my advice is to consider the ethical dilemmas rather than focusing on the knowledge aspect.

The key considerations here that need to be discussed are:
1. The patient seems to display signs of drug seeking behaviour which means you have a duty of care to not perpetuate this behaviour.
2. Is the patient actually experiencing pain? No new injuries doesn't meant there aren't internal causes for pain which the naked eye cannot see. Just because the patient is a drug seeker doesn't meant they cannot be in pain. I once diagnosed peritonitis in a patient who I thought was drug seeking but the symptoms didn't add up.
3. Navigating your responsibility as a doctor to a patients want. If you have come to the conclusion that the patient does not require additional medication you should empathise and explain this to the patient. If you continue to prescribe to drug seeking patients your licence can be suspended or restricted. Your refusal should not be based on this fear but rather your professional judgement of the clinical situation.
4. Addressing the patients behaviour regarding illicit drug use. Is it a threat or a genuine cry for help?

 

[Poppy101]

The usual way you would appreciate a situation where an "error" has been made is.
1. Firstly de-escalate the situation by apologising even if it isn't your fault. It's hard for someone to be angry at someone who is being apologetic and taking responsibility for the situation. If you feel threatened (ie. if there is an immediate danger to you or other staff) then you will need to call for security.
2. Offer any assistance you can for the current circumstances. Does the patient need monitoring because a wrong medication was given? Offer the family assistance, is there anything that can be done now?
2. Figure out what happened for this situation to occur. This may need to be delegated to a senior member sometimes but it is important to document and raise the issue with senior management. A formal investigation may arise out of this situation.
3. Depending on the outcomes of the formal investigation there may need to be policy changes. How do we identify patients who need dietary requirements and record them? Does there need to be more cultural awareness training for staff? Ensuring kitchen staff labels food correcting? Could this be automated?

If the question asks you as a nurse it may not be necessary to raise the third point but this is later addressed in the latter follow up questions.

Question 2
Despite there being no recorded dietary requirements the circumstances that arose here is still a learning experience for the hospital. This patient has dementia and therefore, the recording of dietary information may have been missed as a result of their medical condition. I would not direct blame or place responsibility on the patient or the family but again apologise and address what could have been done to prevent the situation from occuring. There is an opportunity here to address policy issues here if you want.

Question 3
Aboriginal & Torres Strait Island (ATSI) Population - eye contact, multiple languages, spirituality attachment to their land, family/community importance. Great time to address the ATSI issues.
Jehovah's Witnesses - Unable to accept blood products in general not just red blood cells although I think there may be different sects that can
Vegans/Vegetarians/Pescitarians - Along the same line of food
Christianity - Last rites for dying patients
islam - Burial within 24 hours, no cremation
There are plenty more.

Question 4
See above

You don't need to know the exact protocol to give an answer but having "real life experience" in the world can potentially help you answer this particular question.

Hi! What exactly do you mean by addressing ATSI issues? Like would you kindly elaborate

 

[whoartthou]

Hi! What exactly do you mean by addressing ATSI issues? Like would you kindly elaborate

Disparities in health outcomes for chronic health conditions especially diabetes, kidney disease, cardiovascular disease, mental health etc.
There is a greater proportion of those using alcohol, smoking and other drugs.
More prone to infectious disease given their close living situations and community gatherings as this is part of their culture. This also exposes children for example to passive smoking etc.
Lower income means they can't afford to access health care.

You should read up on it especially if the medical school you are applying to has a focus on Indigenous health.

Social determinants and the health of Indigenous peoples in Australia – a human rights based approach | Australian Human Rights Commission

Improving the health status of Indigenous peoples1 in Australia is a longstanding challenge for governments in Australia. The gap in health status between Indigenous and non-Indigenous Australians remains unacceptably wide.2 It has been identified as a human rights concern by United Nations...

humanrights.gov.au

 

[DrPotato]

Hey again! I thought I’d give this question a go. any feedback is appreciated as usual (nit-picky ones as well ofc)

There is an outbreak of an incredibly contagious life-threatening disease. The disease is spreading across the country at a rapid rate and the survival rate is less than 50%. You are a senior health care administrator, and when the vaccine is developed, you have priority to receive the drug. Do you take the vaccine yourself or give it to another person? Why or why not?

I believe that in a difficult scenario such as this, there are multiple considerations to be made in order to make an informed decision. I think that, as a senior health care administrator, when the vaccine is developed there definitely is a sense of priority when it comes to the allocation of this vaccine with numerous advantages and disadvantages of receiving the drug myself first or giving it to another person.

By taking the vaccine myself, I become essentially shielded from the disease allowing me to take on more responsibilities in the care of those who have contracted the disease. However, by taking the vaccine this does not necessarily mean that I won’t be able to transmit the disease to others, in fact it may reduce my own cautionary measures when interacting with patients as I may not be experiencing any symptoms. This becomes especially important in the hospital setting, where if I make multiple ward rounds per day while carrying the disease, I am placing the attending staff and patients at risk, which can potentially cause a spike in the number of cases within the hospital, going against the principle of ‘do no harm’ or non-maleficence, hence adding further stress to the health sector. I feel like there’s also a certain level of guilt that comes along with this decision in the event that a vulnerable patient was waiting to receive their vaccine, for instance, and so while my physical health might be taken care of, my mental and emotional health may be impacted negatively as a result.

Conversely, providing this vaccine to another member of the community ties into the medical principle of beneficence as I am doing the best for my patients by prioritising them for the treatment. Additionally, I feel like there are situations where certain patients may be more deserving of receiving the vaccine before myself such as those who are immunocompromised due to chemotherapy for example, and that if these types of patients were to contract the virus, their chances of survival would be much lower than that of the general population. Furthermore, I feel like my decision may impact the public’s perception of the health profession, as society holds an expectation of receiving care when in dire situations, when a family member has contracted the disease for instance, in which they believe the priorities of health professionals should be their patients under all circumstances. Hence if I decide to choose myself as the vaccine recipient, this could cause some backlash from the public and they may potentially lose faith in the medical profession.

To conclude, by weighing up the positive and negative impacts in this scenario, I would give the vaccine to another, more deserving person who is more vulnerable to the disease, as I will be doing the best for others while maintaining the public’s perception in the medical care they receive.