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NBME 23 Answers

nbme23/Block 1/Question#36 (29.8 difficulty score)
A medical student is caring for a 72-year-old ...
Let me get the resident physician so we can go over the results.🔍,📺

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submitted by imnotarobotbut(168),
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A mcleadi stdunet todnhul's eb eth neo ivging sooeenm a cancre s.iosagdin iTsh is a llyrea eivssneit eissu dan teh ssturle hsldou eb givne by esooemn whti ihehgr atityurho eikl a netresdi or dn.eanitgt tA het asem ,item oyu o'stludhn ile ot eth ntteapi nad say atht teh uetsrsl rn'tae cabk ety if yeth are. teBs inght to od is ectledf eth eniaorcovnst dan wloflo pu hwti teh e.sied.trn

drdoom  It isn’t so much “someone with higher authority” as it is someone with a license! Without a license, an individual is not permitted legally to provide clinical interpretations, as that would constitute the (unlawful) practice of medicine! +22  
veryhungrycaterpillar  Laughable. 21 upvotes? The legality isn't the issue at all. If you wanna get legal: the student is protected under their preceptor's (resident's) license, as the resident is protected under their attending's, so legality isn't really the issue here. The issue truly is that someone trained in cancer counseling (which involves breaking the news in an appropriate manner) should be the one to break the news. Furthermore, once you tell the patient it is a "carcinoma", the patient is almost certainly going to want to know more details, prognosis, and discuss the management plan-- none of which the resident or the medical student are trained to provide, that's why they're waiting for a specialist (ie the oncologist) and not a filthy internist hospitalist. @imnotarobotbut was correct. +1  
drdoom  Not sure what you're referring to here; a license to practice does not extend to your trainees. It's like you're suggesting if I have a license, I can let my 8th grader deliver the news or administer a test because .. they're under my supervision? What authority or rights does any medical student have? You might be confusing liability coverage with license. +  
skonys  I practice dentistry under my professor's license everyday. I also give diagnoses under their license as well. I'm pretty sure that it's just that as you wont be rendering care you should defer to the person who will be treating them ie: a resident or physician. It has nothing to do with medical liability, it's just clearly above your pay grade as a student. +  
drdoom  @skonys I believe your pay grade, as a student, is zero. Or more accurately, negative. Since you’re paying to be there. You’re not practicing “under your professor’s license”. You’re practicing under their supervision. Which is why you have zero authority to practice OUTSIDE their supervision. Because you are not permitted to practice +  
drdoom  also @skonys: whatever it is you’re doing, it isn’t the lawful practice of anything. You are not a practitioner because you do not hold a license. “You” do not give diagnoses; you might tell a patient what you think, but as a student nothing you say would ever be recognized, legally, as a diagnosis. +  

submitted by snoochi95(3),
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woH ocme uoy outndlc asy "I tdon nk,wo ubt the scogoitlon ilwl eb gseein uoy atrel ?"yaodt Is ti cbsueae inllyhctcae yuo ear ~~nigly to hte ?aptinte

drdoom  Not “technically” but actually! To say “I don’t know” when you *do* know is as lyin’ as it gets! Just remember, before a state issues you a license to practice medicine in their backyard, they look to the National Board of Medical Examiners and ask, “Should we trust this person to practice medicine here?” The NBME is in the business of telling states, “Yes, we believe this person knows enough to practice morally and competently.” Answer ethics questions with this in mind. +7  
pseudo_mona  Besides technically lying, it also probably isn't a good idea to drop the word "oncologist" to a patient before they hear they have cancer, especially as a student who can't answer any further questions about the biopsy results. +12  
usmile1  @pseudo_ shit I just realized that telling them that the oncologist will be seeing them, is essentially telling them they have cancer. Additionally, you can't lie and say you don't know. no Idea what I was thinking when I took this. +9