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NBME 23 Answers

nbme23/Block 2/Question#38
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."🔍

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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.

nbmehelp  ^^^ exactly +  



 +0  upvote downvote
submitted by nlkrueger(27),

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

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 +6  
seagull  I would be a bigger asshole when the family came I'n after I pulled the plug...opps...but the friend said +13  
dr.xx  The patient has no wife, children, or close relatives... +3  
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). +  
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. +4  



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




 -1  upvote downvote
submitted by tinydoc(157),

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.




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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