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NBME 21 Answers

nbme21/Block 1/Question#8 (27.8 difficulty score)
A 52-year-old woman is admitted to the ...
Speak with the two gynecologists to attempt to coordinate careπŸ”

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submitted by temmy(130),
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I gerea iwth athw hsa nbee asdi tbu osla neot htat hte itnaept dlecla reh tsintneir to pleh her arsddse het itofccnl eenbwet het owt ahinpiyscs cwhhi sha etogtn reh rrd.ioew aTth si reh sdiere. And rmfo waht i evha rdegtah,e erhwe lisposb,e eht netpasit wihess sdoulh be emt.

mambaforstep  true... i totally missed the part "pt CALLS HER PRIMARY CARE INTERNIST TO HELP ADDRESS THIS CONFLICT BTW THE 2 PHYSICIANS" smh +1  

Some quick rules I've found that apply to 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. Talk to other clinicians/experts, etc. to resolve issues. Often, this is the best option because "speaking" isn't really taking any action so no room for error

+3/- anjum(17),

submitted by taway(31),
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oDse yondbay dreutnasnd wyh we are oldlawe to efiteenrr thiw teh lciclian eokmniscadinig of otw tehor ltessisapci yet?cirdl lWodt'un tath yuddm teh sreawt neve ermo by gaidnd our oipnn?oi I d'tno see eth eiyglnnurd ieilrppcn tath nexilspa eht rnoataiel ni iths .wenrsa

jcrll  I think it's about adding our opinion and more about seeing what the situation is because a patient contacted you in distress. The others are about contacting management off hearsay; that could also "muddy the waters," I Is this question also addressing quaternary prevention? +1  
meningitis  I agree with jcrll. My same thought process but then I changed it to psychiatric consultation in order to first attend the patient's distress and anxiety since it was hindering her decision making. Besides, the whole ordeal about her treatments and ineffectiveness was emotionally and physically exhausting her. +2  
vi_capsule  Referral is NEVER a answer +10  
tsl19  Going straight to the chair of the ethics committee without having spoken to the other physicians would be inappropriate because it would be jumping a bunch of steps in communication first - like jcrll said, you want to get the picture of what's going on from the other physicians first. Maybe the gynecologic oncologist isn't actually as opposed to palliative measures as the patient perceives him to be and thinks he's doing what the patient wants, etc. It could just be miscommunication, which you could help clear up without getting ethics involved ... better to start there. +10  
an_improved_me  Also, to add a little bit: internists on a healthcare team are the care coordinators. For any given problem a patient has, the internist is responsible for managing all the different aspects of a patients treatment. In this case, the intern has to manage the dissenting opinions of her different gynecologists. In other instances, an internist may have to manage the disagreement between a Surgeon vs. IR vs. Onc. +