Ancylostoma
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You are suppose to do what the Ideal physician would do. In this case I would choose rule #1 the patient it always #1. The patiets comfort and safety should come first. I would use that and then choose B. Of course with these type of questions your never completely sure if your right. I'm glad you put it up though, I will do the same the next time I get a physician patient relationship q.
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| Clozapine
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A ? Patient is always # 1, but provided s/he is your patient, aint it? This is a hospital situation where patients are assigned to specific doctors. Also the aim here , I guess, is to teach the residents. B/w A and G, A would take care of both teaching the residents and bringing the patient to hospital authority`s attention to take necessary measures.
what`s the answer me007? 
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| Ancylostoma
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I thought a would be concealing a mistake, in kaplan it says always admit your mistake this guys clearly knew that the patient was allegic to penicillin. Anyway, that was my reasoning, I didnt think we would teach the residents to lie. We will see when mee decides to let us know.
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| me007
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it is not A - allergy to drug is not an adverse drug reaction
It is nbme q, i do not know correct ans.
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| Ancylostoma
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Which NBME is it ? Do you know which block ?
I think cloazpine you are taking the patient thing to literally. Its not your patient but it is a patient. And the patients safety should come before all other legal matters. But since we dont have an answer anyone can choose whatever they want
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| me007
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n1 b3 q22
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| unique1
InGodITrust
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In a hospital setting , a physician cannot go check any patient's chart. So I don't think B is correct option.
I go with A .
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| Luckyall
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i think the rule of thumb in here is discussions about patients should be kept private !!!!! so i 'll strongly go with G
Now the only think that make me reconsider would be the patients safety, is clear that that pt X is not safe, is clear that those PGYs made a huge mistake... so should the attending take over ang save this pt X life ???
I guess if the pt would be in a lifethreatening situation, 1st thing an MD has to do is to save the pts life ...is this a lifethreatening sit ? i'd guess no...so thas why i'd still go with G
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| Luckyall
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A) would be a lie.. so for sure not A
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| Clozapine
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what constitutes adverse drug reaction and what not ? Could it be an adverse drug reaction if the residents didn know that the patient was allergic to penicilln? I thought allergy was also considered as an adverse drug reaction.
Can anyone pls explain to me... I was wavering b/w A and G but didn realize A could be a lie 
What constitutes adverse drug reaction guys?
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| Ancylostoma
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I think an adverse drug reaction would be one that was clearly incidental, here they knew he was allergic and administered the drug anyway. This is physician error. Unique, kaplan clearly states that some of these rules are opposite to what happens in clinical practice. Are respiratory problems in anaphylaxis not life threatening? Would we let a patient possibly die because if a student mistake ? I still pick B
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| Clozapine
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Thanks Ancylostoma ... hope the exam is all epi and bio
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| unique1
InGodITrust
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 I did not mean that they should lie
I was taking it this way. Whether the residents knew it or not , a rash is an averse affect of penicillin. Now they should not hide their mistake and report it as it is.
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| Luckyall
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i think B is wrong... not sure though, b c this is a hospital setting... so there are certain rules, or else it becomes a mess and nobody knows wht MD is in charge of what patient
Generally, if you, as an PGY, see your colleague doing a mistake or even your attending doing a mistake, you were supposed to go and report it to PD or the person in direct charge of your colleague/attending/ floor rather the go ahead and repair yourself other's mistakes... again, not 100% sure, thas why i rather go with G
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| Luckyall
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if there would be an additional option saying " you get off elevator next floor& report it to the person in direct charge of these PGYs, either PD or their supervisor attending" i'd pick that option over G
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| me007
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allergy to penicillin can be type 1,2,3,4.
After having skin rash, is it possible for him to have anaphylaxis or something?
If i go G and next day smb told me that pt died?
And it was chance for me to go B?
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| unique1
InGodITrust
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If the physician advises the residents to report the case, it serves two purposes :
1: It trains the residents that they should not hide their mistakes .
2: The case comes to the notice and concerned attending physician can manage the patient.
What do you think ?
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| Luckyall
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analysing B)..that is not your patient !!! you CANNOT just go and open up the chart regarless whts happening with that pt..oky? for that YOU NEED PERMISSION!!! Dont forget that EVER
The Maximum you can do is to go ahead and report it to the person in direct charge of those PGys/oe person responsible for that floor , only &only that person is entitled to open up the chart and review it and make /correct decisions !
Hope is clear
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| me007
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Luckyall wrote
analysing B)..that is not your patient !!! you CANNOT just go and open up the chart regarless whts happening with that pt..oky? for that YOU NEED PERMISSION!!!
What is the source? I really confused with all that hospital rules.
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| unique1
InGodITrust
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Luckyall , I am not convinced for G or B .
B : for the reason you described above .
G : You advise the residents not to discuss patient related issues in public place . That is a good and correct advice but what about the patient ? When you know that the mistake has been made and that mistake could be life threatening , are you not supposed to do anything about it ?
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| Luckyall
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the source is hospital environment in US, number 1)
Number 2) there is a book "ethic cases" of Kaplan ... with 100 ethical cases for st 2 CK....
These ethic Qs are hard to deal with at the level of st 1, b c one needs hospital environment experience in US in order to deal with these Qs. These Qs ar 1 step ahead theory presented in Kaplan...just my thought
If anything you can always ask a 2 nd opinion of a PGY friend of yours. They will know much more then we do at this level when ics comming to Dr pt relationship
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| Luckyall
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And yes, you are supposed to do more.... like i said, you have to report it to the direct supevisor of thise people to assure that Pt wont die if lifethreating issue, report it to PD/attending supervisor / anybody in charge with that floor, but this ideal option is not AMONG our Qs options, right?
Then you go for best option among those presented in the Qs stem
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| Luckyall
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i cannot be 100% sure...but i'd go with this option 100% if this Qs comes in my exam
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| Ancylostoma
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lol I leave for one sec and there is a huge discussion. Your saying that we should report it to a higher official to prevent the patient from getting harmed, but because thats not there lets just tell the kids to shut up. SHHHHH let him die !!! :-) I cant agree with this
kaplan physician patient relationship, this section lays out a set of rules that seek to orient students as to what constitutes the best answer on the usmle. Apply them to questions on the step. Note that a number of these rules are different than current medical practice.
" The Key is not what physicians actually do, but what the most ideal physician should do"
Word for word kaplan. To me the most Ideal physician, would not tell them to shut up and not check on the patient. He would check on the patient because rule number 1 , Put the patient's comfort and safety over everyone else's . This is the first and most important rule.
In real life when you make a mistake with a patient and you may often talk to an advisor(legal dept) to determine whether you should tell the patient. In physician patient relationships you always tell the patient.
There is difference with what actually happens and what we should answer!
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