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Interesting Q...invite Answers

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10 Posts

SMALLFIDGET
Forum Junior

Topics: 9
Posts: 72

08/17/04 - 11:41 AM

Guys, I found this Q elsewhere...thought it wud be worth discussing!

A 10 year old kid brought in by parents for routine check up .while parents r waiting outside . the doctors conversation with the kid reveals that he smokes. On asking the kid as to where he gets the cigerets from he answers that he gets it out of the fathers pocket . On hearing this what the doctor should advise the patient.
1) tell him about lung cancer & diseases he can get.
2)send the kid for smoking counseling .
3) send the parents for counseling
4) tell the kid not to do it again.

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Ahab
Forum Elite

Topics: 9
Posts: 228

08/17/04 - 11:59 AM

Sounds silly but I would probably go with

4)Tell the kid not to do it again.

They are too young to understand the consequences of smoking and scare tactics would not work, likewise smoking counselling for the kid I would not think would have an effect.
It seems that the USMLE does not like any answer that does not directly involve the doctor/pt (i.e never refer to a specialist etc), ruling out sending the parents for counselling.

If the problem continues then further exploration of options are necessary but with the options given I would stick with the direction of the patient not to do it again

SMALLFIDGET
Forum Junior

Topics: 9
Posts: 72

08/18/04 - 01:42 AM

"It seems that the USMLE does not like any answer that does not directly involve the doctor/pt (i.e never refer to a specialist etc), ruling out sending the parents for counselling. "

That's a nice point there Ahab!

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Angie
Forum Newbie

Topics: 0
Posts: 21

08/18/04 - 11:02 AM

What if the "tell the pt's parents" is one of the options?

mjl1717
Forum Hero
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08/18/04 - 07:31 PM

I like answer 1- because you are discussing smoking with him and telling him the problems he can get. ( scare tactics may be good in the case if you can curtail smoking)
As far as answer 4 the minute you tella child not to do something the next minute he is likely to do it out of spite especially if you do not explain the danger in his action. (Also a lot of doctors do not communicate enough to anyone whether for time reasons or whatever) Thats my reasoning in the ambiguous area!
As far as tell the parents- you lose all trust with the patient.

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docofthebigapple
Forum Senior
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Topics: 23
Posts: 174

08/20/04 - 10:40 PM

There are many points to be considered here. the patient is onlly 10 yrs old, so he doesn't know what lung cancer feels like/ probably doesn't understand that. Too young to comply to 1.

#4 choice is properly explained above....ie. simply telling not to do would sound uninteresting to the child and would not yield compliance.

sending the parents for counselling is not in the frame of the picture, coz they are not patients. they have a right to make their own chioces whether they like to smoke or not.

Sending the child for counselling seems the the "most appropriate" option for me, coz the doctor doesn't have that much time or the councellor knows how to do the job better.

I would pick choice #2 in the exam and add a little bit of advise to parents in my practice.

I think its like the tarasoff thing where the patient is about to harm him/herself and it becomes the duty of the physician to do the requisite job to prevent injury to the patient.

Please sumit revies and mail me at dr_jot@yahoo.com

nsh_00
Forum Junior

Topics: 2
Posts: 48

09/03/04 - 01:41 PM

Tell him how harmful smoking is.

Parents don't need counseling.
The kid doesn't need counseling.
Don't tell him not to do it...that doesn't explain to him WHY he shouldn't do it

Ahab
Forum Elite

Topics: 9
Posts: 228

09/03/04 - 04:45 PM

"docofthebigapple" wrote:

I think its like the tarasoff thing where the patient is about to harm him/herself and it becomes the duty of the physician to do the requisite job to prevent injury to the patient.

The tarasoff case involved the victim of a murder in california sueing the psychiatrist who was treating the accused and failed to warn the victim in advance. It resulted in the decision that psychiatrists who are aware of danger that their patient poses to others has a duty to warn the possible victims and the authorities of such a threat if they believe the threat to be real (harming OTHERS). The backside of this decision is that some people will no longer report everything to their psychiatrists for this fear and lose out on valuable treatmet. Sometimes it sucks being a physician sad

I still would go with answer 4, but really another option would be nice. I just dont buy that telling a 10 year old about lung, bladder, stomach cancer, atherosclerosis etc is going to persuade him to stop. Now telling him that it will stain his fingers, make him unable to taste candy, smelly breath and the girls wont look at him might be a nice alternative smiling face

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bluedusk
Forum Elite

Topics: 35
Posts: 217

09/03/04 - 05:04 PM

i gotta go with nsh here - i don't think you're supposed to outsource this one. between telling a kid to just stop or telling him why he should stop, the latter seems like the no-brainer usmle answer.

btw, i realized looking at this that the q is actually a test of child development. kid's ability to reason logically is done by 6-11. that's why it's cool to tell him why he should stop.

SMALLFIDGET
Forum Junior

Topics: 9
Posts: 72

09/04/04 - 12:38 AM

#10

Bluedusk...that was gr8 - i too agree with you...that this might be a Q testing logic and then it follows what to choose.
Thx Buddy.

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