rida
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A 70 yeard old widow visits her male doctor as a part of her ongoing treatment for diabetes. Physical exam reveals nothing new. The doc reviews her diet and exercise regiment and encourages her to continue what she is doing. As teh doc rises to leave, she stops him and says that she misses her husband and has been thinking a lot about him. She asksa the doc if she is all right or should seek help. As she is speaking, the door opens and the nurse reminds the doctor that the next patient is waiting. At this point, what is the best thing for the doctor to do?
A) Ask nurse to spend time with the patient and discuss her concernts
B) Offer the patient a referral to a local counselor
C) Reassure the patient that her feelings are natural and that the longing will pass in time
D) Tell the nurse that he is busy and is not to be disturbed
E) Have the patient make an appointment to discuss her concerns at the next visit.
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| mash
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C?
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| rida
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Good guess, but thats not the answer.
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| mash
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A? another guess
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| rida
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[-( nope, i was pretty shocked when i saw the right answer, you might be too #-o
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| piter
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D) Tell the nurse that he is busy and is not to be disturbed
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| suvi21
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E?????? :shock: I've noticed that this is commonly done in practice here!!! A second appointment for a second complaint or concern! Not sure ethically...... :roll:
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| Idiopathic
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I think the USMLE would say B...because they believe that primary care docs are unqualified to handle mst psychiatric problems. She needs to be seen soon, because of the possibility of depression/suicidal ideation, and I dont think 'her next appointment' is good enough (which is way I didnt say E).
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| rida
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Piter is right guys D is the answer. Actually Idiopathic, i was told by one of my professors, that if you ever see a choice that says refer the patient, DON'T EVER CHOOSE IT, even though it might make sense to us. Thats why i hate behavioral questions. :roll:
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| suvi21
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Gosh..... :shock: I would have never got that right!!!
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| mjl1717
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To me it seems that these b.s. qs are sometimes very subjective and can give an indication of how well a person synthesizes info,how they think, do they know the customs, do they know proper etiquette (spelling) are they well rounded or diversified, can the clinician properly interact with pts?,
I even saw a q where the answer might indicate if the clinician is a racist.
Not every one does well socially or does well "dealing" with pts. Most important these qs give an indication how well rounded, tactful, and eclectic a clinician is. [It is a true art having a rapport with people]
Here's my thought:
So hindsight is always 50/50.[even saying that-"answer already given"
1)Here is a 70 year old well controlled diabetic widow
2)The physician must have empathy that she's in her "sunshine years"
3)**Loss of spouse -**Greatest stressor-**one of the greatest things a
physician does is communicate** as Idiopathic mentions "suicide"
must r/o suicidal ideation **Q directly- "HAVE YOU THOUGHT ABOUT
ending it all or commiting SUICIDE?" (most people go to the doctor
before they commit suicide.[It could be malpractice not asking this q
directly.] The slang word for referral is "turfing" this is only done if she
states that she thought of commiting suicide.
4)As far as someone from the "12 hour coffee break club" ( the nurse)
breaking thru the door announcing that he has more patients,he
knows this/so he must diplomatically tell the nurse " give me some time
with this patient and Im busy and Im not to be disturbed! Id sayto
answer B. S. qs correctly one must use every area in their psyche
and not be too much like a methodical robot.
:idea:
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| suvi21
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Thanks for your explanation, after the answer was posted, I went through a similar analysis in my mine, except that I would have expected the physician to deliver the same message in a more polite (or diplomatic, as you mention) way. Don't you guys think that's a part of work ethic too? In addition, the Q probably also emphasize that when you are dealing with a patient, he/she is your priority until done.
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| mjl1717
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Addendum: Yes the pt is the priority until done but most importantly after asking the important q:
HAVE YOU THOUGHT OF ENDING IT ALL OR COMMITING SUICIDE if she says yes- It is considered a psychiatric emergency and she could be admitted to psychiatry ( because she is considered a danger to herself). Once again most people see a doctor in the weeks or months before committing suicide. Also sometimes you have to be firm and direct, but not
rude with the nurses! ( And hope they dont interpet you as being discourtious.)
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