abarusmle
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A 51-year-old man who was previously a successful businessman and devoted husband and father now neglects and abuses his family. At his last visit, he confided to the physician that he abuses alcohol. His wife tells the physician that her husband’s drinking is destroying their family. Of the following responses, which is likely to be the most effective in initiating a discussion about his use of alcohol and its effect on his family?
A) “Did you know most patients who drink as much as you do lose their families?”
B) “Do you feel guilty about what you’re doing to your children?”
C) “Do you realize the damage your use of alcohol is doing to your relationships?”
D) “What do you think is the impact of your drinking on your family?”
E) “Your wife says your use of alcohol is destroying your family.”
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| mani
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D) “What do you think is the impact of your drinking on your family?”
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| MLF
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Agree with D
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| abarusmle
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I understand your logic.....option D being open ended question.
But remember the "CAGE" for alcohol abuse screening questioniarre.
C- Did you think of Cut down
A- Does it make you Annoyed
G- Do you feel Guilty for what you do
E- Do you need an Eye opener
So, I thought “Do you feel guilty about what you’re doing to your children?” would be the answer.
What do you say?
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| mani
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i overlooked the option. correct ans is B
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| MLF
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yea I forgot about CAGE, thanx for reminding me.
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| amitjosh
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great reasoning ABARUSMLE
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| musiclover
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g'day
I also thought about CAGE but decided the option "what is impact on family" is better because CAGE is a screening tool designed to determine who abused alcohol. But our patient has already admitted he abuses alcohol - therefore wouldn't it be better to open discussion?
But I dunno...these questions are so hard! and I always get them wrong. :roll:
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| bhallaji
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Exactly, musiclover is right. I would still go for D.
CAGE is only a screening tool, and not a grading tool. C, A, G, E have equal importance. It has a cutoff score of 2. In this case, meaning two "yes" answers will identify dependence/abuse.
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| abarusmle
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Physican's role is to fix the physical, psychosocial problem, if any, within the professional boundary.
Let's assume answer to the question, "What do you think is the impact of your drinking on your family?” (option D) is " I know it is bad".
what do you confer at this point?
Where as with option B, if answer is 'Yes" you can document that the patient abuses alchol and now you can detox or rehab the patient.
Anyway, I think questions on doctor- patient relationships are very subjective and somewhat relative......it's how one looks at it.
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| amitjosh
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Sorry for the doublespeak, but I think musiclover and Bhallaji have a point since the question already informs us that the patient has admitted that he abused alcohol.
If that statement had not been given, I think B would have been the best choice. But since that part of the problem is already solved, the best choice could be D.
But again, I am eternally confused about such questions.
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| Dr. Hussam
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I go with answer D.
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| FreshDebu
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I say B due to it being a classic CAGE question.
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| Snood
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I would go with D. Using choice B in the context of his children would imply that he is a bad father and would create resentment between the Pt. & Physician. Choice B would not put the Physician in a condition to help the Pt. Choice B is part of CAGE, but choice B implies he is hurting his children & could disrupt the Pt. Physician Bond.
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| bantik
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Do you know the correct answer?
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| adeelmd
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b is NOT cage.. cage would be "have you ever felt guilty about drinking".. and if it was stated like that it might be the correct answer. but it specifically asked about children which I couldn't imagine asking someone right off the bat. also, cage is used as a screening tool, it is not used to open a conversation!! (think about it, if you were doing glucose screening, would you finger stick the patient before you at least opened a conversation about diabetes? )
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| ramo7
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i agree with adeelmd...my vote is for D
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| KEROCHI
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I have encountered this q can't remember the source but the correct answer is D...
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| KEROCHI
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I think D was chosen bec. it allows effective discussion about his alcohol abuse & it's effect to his family.
CAGE is a diagnostic test for alcohol abuse... Pt. in the q already admitted alcohol abuse..
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| netlover
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"KEROCHI" wrote:
I have encountered this q can't remember the source but the correct answer is D...
Probably in Kaplan QBANK
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| mjl1717
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definitely answer d its:
1)calls for intrinsic inspection
2)its not a leading q
3)it gets to one of the ills of this disease
4) its not threatening.
5)since he is consulting with the physician, the q should not be annoying.
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| zubr
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Q:Of the following responses, which is likely to be the most effective in initiating a discussion about his use of alcohol and its effect on his family?
Just idea, soon he confided to the physician that he abuses alcohol, he has to be helped/treated and maybe this Q about AA 12-step program as a most effective treatment.
Step1: We admitted we were powerless over alcohol - that our lives had become unmanageable.
…lives had become unmanageable.
D) “What do you think is the impact of your drinking on your family?”
The answer should be projected from the patient about whole life and whole family: relationship with wife + children???
Answers A) and E) projection of someone else.
B) only about children
C) only about wife
It’s just my guess. I do not understand why one question is so important. Have a talk with a patient! He admitted. He is ready. He seeks help. Cover all bases.
Is this Q from actual USMLE or NBME?
A) “Did you know most patients who drink as much as you do lose their families?”
B) “Do you feel guilty about what you’re doing to your children?”
C) “Do you realize the damage your use of alcohol is doing to your relationships?”
D) “What do you think is the impact of your drinking on your family?”
E) “Your wife says your use of alcohol is destroying your family.”
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| deupak
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me to agree with adeelmd
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| jaide
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D......
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| abarbaryan
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D
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