<p>I was looking up the interview feedback for Northwestern, a school that’s known for asking unusual/indirect questions during their med school interviews (questions like “what’s your favorite color” or “how many fire hydrants are there in the US”). There are two questions/scenarios I’m unsure about:</p>
<li>“You are an emergency physician and an 8 year old child comes in bleeding profusely. The parents are Jehovah’s Witnesses and refuse to let their child have a blood transfusion. What would you do?”</li>
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<p>This would be simpler if we were only talking about the parents. However, since we’re talking about a minor here, I assume the parents have the right to decide or refuse treatment for their child. Anyone know about the physician’s rights in this scenario?</p>
<li>“You are an intern at a hospital and a patient comes in with acute cerebral bleeding. You call the attending physician and when he arrives he is intoxicated. He or she is the only one in the hospital that can perform this surgery. What do you do?”</li>
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<p>If anyone has any ideas about how they would answer these two questions, please post Any knowledge of what the laws say about these two situations would be great also.</p>
<p>The second question is probably a pretty straightforward question of airlifting. Obviously you can’t let him do the surgery, and you can’t let anybody else do it.</p>
<p>In all cases you will resuscitate with crystalloid, non-human derived colloid (e.g., hetastarch) before considering allogenic blood. Some JW will allow cell saver blood.</p>
<p>The bind of course comes when you believe a blood transfusion is necessary to save a life. Transfusions of minor children of JW parents have been considered carefully by the courts.</p>
<p>You may not, of course, give a transfusion without consent. The usual procedure is to obtain a judicial order to give the transfusion as a life saving measure against the wishes of the parents. This sounds awkward and time consuming, but every judge is familiar with the procedure and able to give the order at any time of day or night.</p>
<p>For an eight year old, the case law is clear: document the indication, get the order, give the transfusion, save a life. For older minors who might be able to give or refuse to give informed consent, the scenario is trickier.</p>
<p>The second question is really a question about knowing your limits, rather than clinical acumen.</p>
<p>Identifying possible resources (airlifting, alternative surgeons, phone consults) will be necessary to answer the question, but the likely scenario will deny that any of these resources are available.</p>
<p>A reasonable answer will include immediate supportive care, marshalling any resources available, seeking direction/supervision from more experienced physicians, discussing real options with the family (as well as discussing why other desirable options are not available) and providing care within the limits of your ability.</p>
<p>Remember also that every hospital has supervisory mechanisms for attending physicians including the medical director the the attending group, the chief of the department and the chief of staff.</p>
<p>The failing answer involves diving in without supervsion.</p>
<p>You may also be interested the AMA’s virtual mentor site which discusses all aspects of medical ethics. The full text of current and past issues is available for free online.</p>
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<li>How easy would be it be obtain a judicial order to force the transfusion in this case? Is it common to see a physician go over the head of the parents in order to save a life?</li>
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<li>If we take this scenario to the extreme: that the patient will die soon w/o surgery, that the only person who knows how to perform the surgery is an intoxicated surgeon, what would you do? </li>
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<p>Obviously, it’s a stretch to suggest that you would cut the guy’s head open yourself w/o supervision. But, in this case, would you let the surgeon just perform the surgery or would you suggest that you perform the surgery w/ assistance/advice from the drunk surgeon? Are either of these choices even legal? I understand obviously that you should alert the supervisor of the attending and try to keep the patient alive as long as possible within your limits. But, basically in such a scenario, you would not perform the surgery yourself nor will you permit the surgeon to perform?</p>
<p>For question #1 - the frequency of judicial orders probably depends on what type of physician you are (ER docs probably face this more often) and in the specific example given, the size of the JW population in your city…
But as .02 has said already, judges are aware of these sorts of duties, and generally will accept that, with all acceptable avenues pursued, and medical necessity still remaining, that you know what you are talking about. It’s only when lawyers get elected that they start thinking they went to medical school…</p>
<p>Both questions are the sort of thing to pop up on Step 1. I think I had two or three ethics questions when I took it.</p>
<p>Remember there are no absolutely right answers, and only a couple which are absolutely wrong. The questions are designed to make you think and present multiple opportunities for the interviewers to question your line of thinking. They want to make you flustered (and it’s better than the infamous “open the window” challenge) - so be confidant, acknowledge the complexity, and do your best to stick to your guns within reason.</p>
<p>Judicial orders for this specific scenario common, but naturally will vary according the JW population at your hospital. Most cases where a judicial order is sought do not make the news. All hospitals have policy and procedures for this eventuality. </p>
<p>Here are a few examples turned up by google:</p>
<p>As BRM noted, these questions are intended to make you think and weigh all options. An answer that identifies reasonable options; considers pros and cons with respect to patient safety, patient autonomy, and parental wishes; and then makes a supported decision will serve you well.</p>
<p>There are several things that have come out time and time again as common med school tactics during interviews. How common they remain is debatable, but they’re designed to fluster you, much in the same way as the ethical questions could be used.</p>
<p>The first is to tell you that your LOR’s are great, except for one. And that one is AWFUL. Occasionally they’ll tell you which one, sometimes they won’t. But they want to know why you could have gotten such an awful LOR from someone you solicited the favor from.
This did happen to me during my interview at UMKC’s 6 year program when I was a HS senior (I must have done a good job explaining it away, b/c I got accepted, though obviously turned it down - thank God).</p>
<p>The other “classic” is that they have the heat up high, or AC turned off, so the room is stuffy, and ask you to open the window - but it has been nailed shut…so no matter how hard you try, you’ll never get it open. Part of it is a test of your habits of observation, part of it is again to make you flustered (as if you needed more nerves during a med school interview). This trick is likely no longer used, because it’s pointless and really adds nothing to the interview. More an “old-school” relic of a time when medicine was all male, and admissions decisions not so highly scrutinized.</p>
<p>I think BDM and Shades and others will agree that interviews are nerve-wracking but they can also be fun and a great experience. In one of my interviews, the interviewer was so laid back that he had a leg swung over the arm of his chair and we got to talking about so many other things that he didn’t get all his questions in he was supposed to ask. That was my best interview by far. I pretty much walked out of that one feeling like he was going to do his damnedest to get me in that year’s class.</p>
<p>The admissions director at Michigan said they no longer ask questions like “if you could only save one person, who’d you save? your mother or your wife?” haha (I’m sure he meant it as a joke)</p>
<p>Generally, I haven’t been asked any tough questions but Northwestern’s known for asking weird questions during the panel interview (which is stressful in itself).</p>
This would not be the result in all jurisdictions. Competent testimony about the ability of a 14 year old boy to make these types of decisions (based upon the maturation of the brain) would likely sway some judges to the opposite conclusion. In the jurisdiction I live in , this decision would have likely gone the other way.</p>
Any knowledge of what the laws say about these two situations would be great also.</p>