<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>A 2005 NEJM article entitled, “Disciplinary Action by Medical Boards and Prior Behavior in Medical School” found disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school. For this reason, medical schools try to weed out loose canons early on.
<a href=“http://content.nejm.org/cgi/content/abstract/353/25/2673[/url]”>http://content.nejm.org/cgi/content/abstract/353/25/2673</a></p>