NBME 21 “The two of you seem to have a very important relationship. Of course you may stay together.” (NBME Answers)

NBME 21 Answers

nbme21/Block 4/Question#27 (reveal difficulty score)
A 65-year-old woman is being treated in the ...
“The two of you seem to have a very important relationship. Of course you may stay together.” 🔍 / 📺 / 🌳 / 📖
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+6 upvote downvote
submitted by ∗imaginarybanana(30)

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don't be a dick? not really sure what more there is to it. The patient doesn't have any other family so this woman should be considered family

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aesalmon Questions like this usually hinge on asking if you're going to follow the rules or not though, obviously the one asking her to lie and say she was her sister is wrong, but the correct answer is obviously breaking the hospice center's "policy" - presumably if the physician is sending her to hospice then they don't work there so why would the Dr. be able to just tell her its fine? +6

hungrybox Yeah, I got this one wrong with the same logic as you, aesalmon. +1

emmy2k21 I genuinely interpreted this question as though the two women were in a relationship because of the quotes "my close friend". I figured significant others would be allowed to visit simply. Ha seems like I'm the only one who read too far in between the lines! +9

dr_jan_itor @emmy2k21 I also thought the quotes implied a lesbian relationship and that the patient was afraid to share this (they grew up at a time when it was heavily stigmatized). So i was thinking, of course you and your "special friend" can stay together. I know this is not just a phase +10

et-tu-bromocriptine Anything particularly wrong with A (Don't worry. I'll call you right away...")? It seemed like the most professional yet considerate answer choice. Are we supposed to imply that they're partners based on those quotation marks around "close friend"? Because otherwise it seems like too casual and less professional than A, almost as if it's breaking policy. +5

lilmonkey I can swear that I saw this exact same question in UWORLD before. The only reason I got it right this time. +1

docshrek @lilmonkey can you please give the QID for the UWorld question? +2

jakeperalta Can someone explain to me why following hospital policy is the wrong answer? I'm so lost.And essentially how is this option any different from the last option where he asks her to say its her sister? Both go against hospital policy. Would greatly appreciate some insight yall. +

drschmoctor @jakeperalta Following the hospital policy is wrong because it would be cruel and unnecessarily rigid to deny a dying woman the comfort of her closest companion. Also, It would be inappropriate to ask the Pt to lie. What's the point of becoming a doctor if you have to follow some BS corporate policy instead of calling the shots and doing right by your patients? +1

peridot Ya kinda dumb that usually NBME usually tells us to never break the rules, yet here it's suddenly ok. But here the reason for this exception is that while only "family" is allowed, a lesbian relationship qualifies the "friend" as family (they just were never officially acknowledged as family/married due to stigma or state laws, which society recognizes today is dumb and outdated). It's a stupid technicality that her significant other isn't allowed to visit as a family member, so while we usually never want to break rules, this scenario follows the "spirit" of the rule. Plus it's a really extreme scenario where the woman is dying and just wants to spend her last moments with her loved one and it would be too cruel to deny someone that. There is no lie involved, which kinda leaves open the chance for the situation to be cleared up if worse comes to worst. This is different from E which is a straight up lie. Hope that helped. +1

kavarthapuanusha Well i am writing this after getting the answer wrong and after know the right answer , i kinda think its justified. Coz they mentioned its hospice, if in hospice any amount of pain medication is allowed , then this also should be allowed , afterall main aim is to comfort the patient! If it were may be elsewhere then following hospital policy may be right , but hospice always patients comfort first so makes sense! Also its there in nbme 17 , so dont worry if you get it wrong . +1

+6 upvote downvote
submitted by ∗pg32(218)

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The only way to get this question correct is to break the rules of the hospice center because you assumed there was a romantic relationship between the women. Couldn't be more straightforward.

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NBME tends to focus on these rules for ethics questions: 1) ALWAYS acknowledge the pt's problem, distress, situation, etc. 2) NEVER ask the pt to lie 3) NEVER be a dick. The answer may sound robotic, but should never be mean. 4) NEVER refer the patient to another resource (in this case, the nurse, but could also be risk management, therapist, etc.) 5) COMMUNICATE with other clinicians/experts, etc. to resolve issues. Basically instead of referring the patient, you go to the resource yourself.

Is this how it works in real life? Am I ever going to need to need the TCA cycle after Step 1? Probs not.

+5/- anjum(36)

+0 upvote downvote
submitted by ∗syoung07(58)

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This more or less relies on what you determine the definition of "family" to be. Whether the pt and her friend are in a romantic relationship or not they arguably rely on each other as family members would.

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+0 upvote downvote
submitted by ∗beetbox(6)

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Well they are not legally a family yet (and yes it is very upsetting and unfair) and the doctor arbitrarily overruling the hospice facility rules according to his/her own judgment sounded wrong to me... I don't know... In case anything happens and the facility finds out about this, wouldn't the doctor's ass be on the first line on lawsuits? Does Don't-Be-A-Dick rule also apply where you may potentially clash with rules and laws as well? :(

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-1 upvote downvote
submitted by ∗zevvyt(45)

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Of all the things they can test us on, they're testing our fucking Gadar??

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peridot Don't mean to be an eager beaver but I thought it was pretty cool to get tested on our gaydar! I think that's an important thing to pick up on. As for their answer choices, I'm not always the biggest fan of those since I think there's more than one right way to do something... +4

yesa @zevvyt I really don't think they are. I've done my internal medicine rotation and spent two weeks on solid onc where all my patients were terminal. It doesn't matter if the relationship is romantic or not, and the reason the friend should get to stay with the patient isn't so the friend can be updated on the patient's care/condition more easily--it's to provide comfort and companionship to the patient as she faces a constant uphill battle with her disease. The quality of the patient's life is contingent on such experiences/support if these are important to her. +1

sunnyside Yikes... it's disconcerting reading this from a potential future colleague. Terrible joke if that's what you were going for. Boooo +

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