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NBME 18 Answers

 +5  upvote downvote
submitted by โˆ—azibird(279)
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Follow-up vs support group?

The only thing that saved me was the ancient Step 1 adage: "Never refer!"

Especially when the answer to another question in the same exam was "Encourage the patient to participate in a support group for persons with her condition"

I mean REALLY! The only difference is that they used the word "encourage" instead of refer. Exact same answer.

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cbreland  Note to self: Never refer, even when that seems like the better answer +
chj7  Take this with a grain of salt but I felt like a treatment plan with goals should be tailored to the patient and would require a physician to assess performance/make modifications. A support group could provide mental support when facing a disease but seems not individually-targeted enough for trying to get a patient to stick to a dietary/exercise treatment plan. I have to admit I did really self-doubt when I saw the 2 questions on the test. +



 +3  upvote downvote
submitted by โˆ—jean_young2019(18)
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Could someone explain why this choice is the best answer? I struggled between A and D, and picked A finally, which is "ascertain educational level and provide publications".

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donttrustmyanswers  It isn't A, because research shows that understanding of information (i.e. eating good and exercising) isn't enough to cause change. Why it is Provide F/U, over support group, IDK. +6
thisshouldbefree  because it says "refer" and u never refer +2
an1  Reading publications is boring and may be beyond the scope of the patient. It's best to explain things in laymen terms and suggest articles if she shows interest @jean_young2019 +
epiglotitties  Random comment but I'm curious, why are some comments pastel orange and others pinkish? What's the difference? +
drdoom  pink = specific question is being posed @epiglotitties +1



 +0  upvote downvote
submitted by geekymle(11)
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okay. i get this question, but what i dont understand is that why cant we inform the patient of the health consequences of not treating her condition?

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submitted by โˆ—leap1608(4)
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While solving Ethics questions, you answer them not as some doctor, but as if some saint. It's not:

  • A. Understanding of a disease doesn't necessarily ensure adherence.

  • B. We typically avoid family/friend involvement in patient care.

  • C. NEVER negatively reinforce!

  • D. Follow ups seem to be the go to option in almost every ethics question. It helps in rapport building, patient-physician relationship, understanding the patients concerns better and direct monitoring of his/her condition.

  • E. You the saint!!! You do the good thing here, an empathetic, humble, honest, overly caring doctor. Please leave practicality out of at your doorsteps while solving ethic questions.

Note : In another question from the same form, we have "refer" in the answer, so refering in itself isn't wrong unless you make sure that the question stem states that you DIRECTLY dealt with and understood all of your "childs" concerns.

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 +0  upvote downvote
submitted by drjmrt26(6)
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In the Kaplan's behavioral science lecture note, they stablish that as a physician, we should foster patient adherence by: - Attend to the amount of imformation; explain its complexity. - Note the patient's affective state. - Explain why a particular treatment is being recommended. - Stress the threat of non-adherence to health. - Stress the effectiveness of the prescribed regimen; give instructions both orally and in writing. - Arrange periodic follow-up visits. - Ask the patient to do less; a long list of instruction is detrimental to adherence.

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drjmrt26  It's actually confusing because one could say that "Stress the threat of non-adherence to health" = inform the patient of the health consequenses of not treating her condition. +1



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