as i mentioned the other day, i came across the same question in both USMLE World and Kaplan QBank. the answer choices were the same too, but the “correct” answer was different…
maybe you’ve come across it in your question bank travels. it’s the one about the woman who is told her unborn baby has Down’s syndrome. she gets upset, starts crying and wails “God is punishing me!”
as her doctor, what do you say next?
A) “Why do you think God is punishing you?”
B) “This is a difficult situation. Let me give you some more information.”
Kaplan claims A) is correct because it opens up the discussion and gives the doctor an opportunity to learn more about your patient’s religious beliefs and emotions. with patient-doctor interaction questions like this in the Kaplan QBank, the “right” answer is almost always the most open-ended question available in the answer choices.
however, USMLE World claims that A) would place blame and make the woman feel worse, so B) is better because it takes control of the conversation and makes sure she has more information in an attempt to settle her fears and help her to decide how to proceed.
so, doctors… what would you do?
Are you f*cking kidding me? There is no right or wrong answer in that situation. You’d have to tailor your response to the patient.
I’m not a doctor, nor do I play one on TV, but I’d go with B every day of the week. It’d also be my preferred response if I *was* a patient (of course, being somewhat un-religious, I’d be unlikely to suggest that god was punishing me to begin with. Not 100% sure what business my religious beliefs are to my doctor anyway, though.)
This depends on so many factors – just the kind of thing that makes a terrible multiple choice question! I think the difference between choosing A & B would be your comfort & preparedness at offering counseling to the patient. I think B could be a good follow-up once you’ve asked A and she lets you know how she’s feeling. But I don’t think going straight to B would be a good idea, given that it basically ignores her statement. I say you write your own answer ;)
I think A might be right if you said something like, “I don’t believe that for a minute. Why would you think that God is punishing you?”
In that way you take the blame off the patient yet you also don’t deny her her beliefs.
Odd question. I think it’s the sign of good bedside manner when you answer the question in a way that’s tailored to the person sitting on the bed. I don’t think you’re ever going to be able to pick the right multiple choice answer to a question like this unless you have an actual body sitting in front of you that is in need of an answer. Where does the human element come into play here?
I haven’t reviewed my “soft” material yet pre-exam, but I always find it helpful to think about what the reaction to your question will be from the patien; this is something that most people don’t take into account and merely think “how would _I_ like the rsponse to be?” or more likely “how would I react to the situation?” without thinking about the patient as a person with completely separate beliefs than you.
In A I think you run the risk of offending the patient’s beliefs. She’s having a baby so assume an adult. At that phase, her religious beliefs are so set (which you can glean from her reaction to the baby’s status) that it would be impossible to change her mind on the matter. I think it’s clear _why_ she thinks God is punishing her – because that is her belief, regardless of what she did in the past. Even if she did something wrong, do you think you’re the best person to speak with her if she tells you what it is she did that was so awful that God punished her by giving her baby Down’s? My vote is with no.
In answer B, yes you seem to be not empathic enough but let’s face it, we’re now straddling a situation in which very little can be done medically – which means there’s very little you can do. Abort is likely the only option, and it strikes me as not a very likely option to be taken by this patient. So refer her – to a spiritual counsellor or social worker, but since there is nothing in your professional capacity that you can do, I’d go with B.
But yes, as many people have said, most ethical issues make terrible multiple-choice questions.
j, is there a formula you use when seeing these in MC? I seem to recall there’s a “quick list” of what to do when faced with an ethics MC but don’t remember where I left it.
that is the dumbest m/c question i’ve ever read! There is obviously no right or wrong answer, but I would definitely go with B myself. You’re not a therapist, you’re her medical doctor. Realistically, an appointment lasts 15-20 minutes…you want to give her the medical facts, not try to reason with her about why God is not punishing her. Anyway, who knows? Maybe God IS punishing her! (just kidding).
B. Leave God out of it…because you have no idea how your patient feels about God. You’re the doctor not the preacher/pastor/rabbi etc.
J, I am also bound to go with B. I do not think it is really necessary or even a doctor’s place to go into religious issues with a patient. 9/10 times the person will be something that you are not in terms of denomination and then where do you go from there. I am not sure about other people, but I know that I do not know enough about being Catholic, Baptist, Mormon, or whatever it may be to give any sort of explanation that would fit with their belief system. Therefore, more information and recommending they talk to their religious leader to reach a decision seems like the best option here. As stated above, medically the options are fairly limited at this point.
(C) Ask, “Would you like to speak to the hospital Chaplain?”
I might go with honesty, along the lines of, “I don’t believe God punishes people like that, but we do get some pretty big challenges thrown at us sometimes. There may be more help available to you than you expect, no matter what you decide to do. Do you want some pamphlets? What kind of support do you have available?”
I’m not a doctor, but some of the most productive conversations I’ve had with health care providers have been honest human to human interactions, when they don’t feel the need to be The Authority.
Of course, test graders might feel differently.
hi! long time no talk! maybe you mentioned this – but did you set up a study schedule? xoxoox m
I opine that to get the loans from creditors you should present a good motivation. But, once I’ve received a bank loan, just because I wanted to buy a car.