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NBME 21 Answers

nbme21/Block 1/Question#8

A 52-year-old woman is admitted to the hospital ...

Speak with the two gynecologists to attempt to coordinate care

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submitted by taway(7),

Does anybody understand why we are allowed to interfere with the clinical decisionmaking of two other specialists directly? Wouldn't that muddy the waters even more by adding our opinion? I don't see the underlying principle that explains the rationale in this answer.

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 +4  
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. +2  




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submitted by temmy(24),

I agree with what has been said but also note that the patient called her internist to help her address the conflict between the two physicians which has gotten her worried. That is her desire. And from what i have gathered, where possible, the patients wishes should be met.