NBME 21 Speak with the two gynecologists to attempt to coordinate care (NBME Answers)

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Retired NBME 21 Answers

nbme21/Block 1/Question#8 (reveal difficulty score)
A 52-year-old woman is admitted to the ...
Speak with the two gynecologists to attempt to coordinate care 🔍 / 📺 / 🌳 / 📖
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submitted by ∗temmy(153)

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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.

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

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

+5/- anjum(36)

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submitted by ∗taway(35)

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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.

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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? +3

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. +4

vi_capsule Referral is NEVER a answer +12

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. +12

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. +2

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