NBME 23 "Thank you for telling me this. Your friend's previous statements to you can be helpful in making decisions for him." (NBME Answers)

Retired NBME 23 Answers

nbme23/Block 2/Question#38 (reveal difficulty score)
A 78-year-old man is found unresponsive in ...
"Thank you for telling me this. Your friend's previous statements to you can be helpful in making decisions for him." 🔍 / 📺 / 🌳 / 📖
tags: ethics

+9 upvote downvote
submitted by ∗stinkysulfaeggs(125)

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Key words: "at this time" and "can be helpful"

The answer to this question isn't: great - now we're going to take him off the vent because you told us that's what he wanted.

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nbmehelp ^^^ exactly +

handsome do you know any great reference for communication questions like these? +

+0 upvote downvote
submitted by ∗nlkrueger(51)

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.... would we really take the word of a friend who definitely can't be confirmed? I feel like this is misleading

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lispectedwumbologist All the other answer choices make you come across as an asshole. Easy way to ace ethics questions is to just not be an asshole +12

seagull I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +37

dr.xx The patient has no wife, children, or close relatives... +4

nwinkelmann @lispectedwumbologist this is going to be my technique, because I've gotten a couple of these wrong, but I completely agree with everyone else's sentiments of suspicion of going off what a friend said without any confirmation about state of advance directives, etc. It's really dumb. +3

paulkarr With these questions; you have to take what NBME says at face value. If it says no family, he really does have no family. This friend is also claiming that the 78 y/o said this about himself, so we know it's the patients wishes rather than someone else's wishes for him. (A son saying he can't let go of his father yet despite the patient's DNR type of situation). +1

suckitnbme I think the point here isn't that we would take the patient off the ventilator because the friend said so. The answer is saying "Thank you for your input, we will take that into consideration." It's completely non-committal. +9

vivijujubebe they say no close relatives, which means he could have remote relatives, relatives must be asked before listening to a stranger/friend's words..... +

handsome can you recommend any great reference for communication questions like these? +

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submitted by ∗syoung07(58)

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YUUUUUUUGE key here- patient wife has been dead for 5 years and he has no children or close relatives. This "friend" has been taking care of our guy here like a relative would. So based on NBME that close enough.

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madamestep People don't lie on USMLE. Obviously, there are exceptions like child abuse or anytime they put quotes around something. But the assumption is that they are telling the truth. If not, it'll be REALLY obvious. +

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submitted by ∗rockodude(39)

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not sure if this is right but the way I thought about it was that after family a surrogate decision maker can be a close friend and the neighbor has cooking for him and running errands for the last 5 years since his wife died so I believe that the close friend surrogate designation may apply

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-1 upvote downvote
submitted by ∗bmilt34(1)

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Some things ive noticed for these types of questions? 1) dont be a dick (b, d, e) 2) dont differ to some other person (a)

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-3 upvote downvote
submitted by ∗tinydoc(276)

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116089/#!po=56.2500

I've had a uworld q where the correct response was to remove the life support if the patient is determined not to be an organ donor.even if the family is actively against this decision. In my experience the answer that is most honest (and likely makes you sounds like a tactless asshole) is usually the correct one on NBMEs. I picked E and I don't see how this friends opinion on his advanced care directives are at all relevant if the patient by all acounts medically and legally is considered dead.

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-4 upvote downvote
submitted by ∗usmleuser007(464)

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So as a physician per this question you will go of some neighbor's words and not confirm if the patient has an advanced directive... seems like the doc and the neighbor are in some kind of a deal here ....

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