Palaniappan
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A girl at first describes her love with her boyfriend as 'best in earth' till their first disagreement where she says that their love is the 'worst on earth'.What type of dfense mechanism?
A.Splitting
B.Reaction formation
C.Displacement
D.Projection
E.Sublimation
Please explain your answer
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| Ancylostoma
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Classic splitting, this is a narcissistic behavioral defense mechanism. These mechanism occurs in people with a poor sense of self, or like the steven daughtery explains it, " A tissue paper ego" A mnemonic I made for narcissistic defense mechanism is as follows " Narcissistic Dan Denied his Stupendous Problems".
Narcissistic defences , distortion, denial , splitting , projection
splitting is commonly used with people in love. They view the world in terms of all good or all bad. There is no grey area(middle), there is no in between. This defense is commonly used by borderline personality disorders, and stereotypes. " all blacks are criminals, all muslims are terrorists " these are examples of splitting . Rememeber if you see splitting and they ask you about a personality disorder , the answer is borderline!!
I wish I knew everything as well as I do defense mechanisms. I hope this helps everyone who reads it . Killed it 
Edited by Ancylostoma on 01/20/07 - 06:33 PM
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| Palaniappan
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That was a nice one....Few more questions on ethics....
A child is in need of a life-saving blood transfusion..His father is refusing due to religious reasons.What is th best response by the physician?
The same case with a husband in need of a life-saving transfusiona nd wifw denies it....Wat should be the response??
Different scenario :
Child/husband can be treated with crystalloid solutions till they succumb...Will the response by the physician change or be the same as above??
Thanx
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| Palaniappan
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Let me make it more clear...
A 6 year old child presents to the ER after a RTA, requiring urgent blood transfusion,by her father.But,father refuses to transfuse blood..What should be the correct respose??
Go ahead and give blood or a court order..When does a court order exactly apply?
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| Ancylostoma
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child
It depends on the urgency fo the need. If the patient requires a blood transfusion, but it is not an emergency, then you must obtain a court order. If it is a emergency, you do not have to listen to the wishes of the father or anyone else. Transfuse. Parents cannot withold life or limb saving treatment from a child the child. The only known case which this was done was in case to infant doe(refer to kaplan chapter on eithicS). I forgot the full name of the case. In this case an infant was born with severe birth defects that required correction. If correction was done the chance of success would still be about 50 %. even if successful the childs prognosis was poor. In this case they rule that it was in the best interest not to do anything. This is not such a case .
Edited by Ancylostoma on 01/20/07 - 07:22 PM
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| Ancylostoma
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it is different for adults, if the wife denies treatment to the husband on religuos grounds you listen to the wife. Only in case of a will, or someone with health power attorney would you or could you override her wishes. In that case you would do what the will or heath power of attorney said.
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| Ancylostoma
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crystalod solutions ? I think this refers to assisted suicide. You cannot under any cicumstance actively help someone die. You can however passively soothe there pain and make them comfortable while they are dying. What that means is that if you have a terminal patient, you can provide morphine to relieve the pain, other drugs to help other ailments, but you cannot provide so much morphine that you cause resp depression and death . The court assumes that you know what you are doing, screwing up here can lead to criminal charges.
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| Palaniappan
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Thanx anky..So in exam..Which should be given more importance...best outcome of the patient or legal ethics..As in infant doe's case...Should we chose to treat the condition or leave it as it is if treatment doesn't going to change the condition much?
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| Ancylostoma
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infant doe case is very special, the out come of the surgery might of killed him, even if he lived he had poor porgnosis, and even if he some how lived through all that, he would have a extremely poor quality of life. I doubt you would get such an extreme situation in the exam, instead, i would tell you to follow this rule. " Life or limb saving treatment cannot be refused in a child , period." Remeber the key is it has to be life saving, if its not an emergency, then you have to get a court order.
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| Clozapine
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I`m afraid I have a different answer for the " hubby requiring life-saving Rx, wife denying it on religious ground" ...
I guess I read in Kaplan, in this situation we are supposed to treat, since it`s a life-saving Rx and there`s no time to assess substituted judgement .... (ofcourse, provided the hubby is unconscius and 18+  )
Only execption is when he has some kind of advanced directive (living will or power of attorney)
Correct me if I`m wrong Ancylostoma
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| Ancylostoma
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your wrong (not trying to be an ass), it is an emergency, and therefore technically you dont need any type of consent. However, if prior to doing anything the wife informs you that their religous beliefs are against transfusion then you by all means do not transfuse. If it is an emergency, and the wife isnt there, or is there but hasnt told you otherwise then you can transfuse. But whenever possible you should get substituted judgment. Its a fine line that you walk but you must be careful in these situations.
This falls under the rule that an adult patient can withold life or limb saving treatment for themselves. Even if they are pregnant up until the first trimester. (roe vs wade) The second and third trimester are governed by state law and will not be tested because it varies from state to state.
The shiavo case(last year), a quadraplegic, who was being kept alive via a feeding tube. The husband had the feeding tube removed. On her last couple of days she was in need of emergency nutrition or she would die. Why couldnt the physician use the emergency to treat her? he couldnt because the courts later upheld that her husband was making a decision that shiavo would have made if she was to have a sudden lucid interval and tell her doctor. Not exacly the same but it is close.
Edited by Ancylostoma on 01/20/07 - 08:59 PM
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| Clozapine
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Thanks.
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| Clozapine
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I hate to bother you again with my stupid question.... but in shiavo case... it wasn`t an emergency, court was involved.. i mean they had time for all those judgment stuff .... and an adult patient can withold Rx for THEMSELVES .... for other halves too ?
Anyways... will go with the answer "do not treat"
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| Ancylostoma
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you right, the thing is your not assesing substituted jugdment, you given her substituted judment. Upon entering the wife clearly says they do not believe in transfusions while the patient is being admitted. If she wasnt saying that when he was admitted then you would not have an obligation to call immediately and find out. The fact that she is there and she is saying prior means you should listen to her. She is not there and doesnt say anything Just treat unless there is a will or health power of attorny( #1 beats everything ) saying otherwise. It is not the physician responsibility to find the will, the institution must provide it. No matter what, if someone comes with health power of attorney, even in the presence of a will, you do what that person says .
emergency, court was involved.. i mean they had time for all those judgment stuff .... and an adult patient can withold Rx for THEMSELVES .... for other halves too ?
response, for this you have to remember what substituded judment is, substituded judments is what the unconcious person would have done if alive. Its a technical way of saying that he is actually picking his own method, she is just voicing it.
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| Clozapine
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Thanks so much for taking the time to exlpain !!!
I was taking the 'substituted judgment' too literally, b/c to get a substituted judgement we sometimes need to find out who best represents the patient / who is entitled to be a surrogate.... but then I found this ... have a look if you get time
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| Ancylostoma
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This article also states that the surrogate cannot withold life sustaining treatement in a non vegatative state person. But this is maine state law only. I have done many questions . one on usmel world was that a father and daughter get into an car accident and the mother requests that transfusions not be given though both require to live. the answer was tanfuse the child, respect her wishes for the father.
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| Clozapine
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You Rule
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| unique1
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Very enlightening discussion !!!!
I would have thought the same way as Clozapine but Ancylostoma's explanations make sense
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