[MMI prompt] Unprofessional colleague + tips for acting stations

I helped out at a practice interview session organized by a friend of mine tonight. It was a great success! I hope to replicate the organization and success with those of you who signed up in time, but we shall see how it turns out :)

I wrote this scenario for the acting station of tonight's practice:

You are a 3rd year medical student doing hospital rotations. A fellow medical student who is doing rounds with you often show up to these sessions tired, messy, hungover, or even drunk. One day you found him in the lunch room unaccompanied, so you decided to talk to him. Please enter the lunch room.

As we discussed earlier, the key to success for this type of stations is to go in with an open mind and let the troubled character in the situation tell his/her story first before you move onto. As I acted, I was looking for some "right questions" such as "I've noticed that you are often really tired, are you stressed?" or "is there a reason why you started drinking so heavily?" from the interviewees for me to go on to reveal the back story:

On the surface, he is a party-goer who risks patients' safety for his personal enjoyment/intoxication. When questioned, he initially provides irresponsible answers such as: "I just like to get drunk", "I like meeting girls at clubs and telling them I'm going to be a doctor", "I can perform in the hospital just fine even if I had a few drinks". And he can get defensive "what do you care?"

But upon persistent and nonjudgmental questioning (otherwise stay defensive till the end), he reveals that he is unsure of the career in medicine and doesn't want to quit but really isn't enjoying what he is doing. Lots of stress resulted from this internal conflict, which pushed him to escape by going to parties and forgetting about his worries. His grades, relationship with family and friends, and health are all suffering.

Some people started on the wrong foot and began to lecture too early ("You shouldn't be drinking so much, it's bad for the patients"), but most people were able to suspend their judgment and focus on helping the colleague. Some did better and invited him to share the reasons behind his drinking problems. This requires some empathy skills (watching out for the colleagues' posture, emotions, key words like "drinking takes my worries away"), and some listening skills.

Some things that were well-done by the participants tonight, in point form:

• suggested career counselling. Never offer advise that you are not trained to give like "maybe you should drop out of med school"


• encouraged colleague to reflect on what brought him into medicine in the first place,


• listed motivations to get help with drinking problems, such as a better controlled life-style, patients' safety, and the public impression of the medical profession,


• opening with "do you have a minute? I have something I'd like to talk to you about",

Some things I would suggest to everyone facing questions like this:

• ask lots of questions, don't rush to provide answers before you get the complete picture;


• referral when appropriate;


• relax!


• some lecturing is called for in this situation.

Even the best participants tonight could do better with the last point: there is a hard message that you should give your colleague -- drinking is not acceptable when you are acting as a health professional in a hospital. The key is to build understanding and trust with the colleague first before you deliver this message, through listening, empathy, and the above-mentioned good stuff.

Once you've shown that you understand your colleague and is interested in helping him with his concerns, you can say something like this:

"As your colleague, I have to tell you that you really need to address the drinking issue. This is for your own benefit as well as everyone around you, because this will help you find a lifestyle that you can enjoy and help your patients receive the care that they need."

[MMI prompt] Public health

Do you think general practitioners have an obligation to report their patients' health status to a public health agency, if their patients have active infectious diseases?

[MMI prompt] Non-paternity

You are a genetic counselor.  One of  your clients, Linda, had a boy with a genetic defect that may have a high recurrence risk, meaning her subsequent pregnancies has a high chance of being affected by the same defect. You offered genetic testing of Linda, her husband, and their son to find out  more about their disease, to which everyone agreed. The result showed that neither Linda nor her husband carry the mutation, while the boy inherited the mutation on a paternal chromosome that did not come from Linda's husband. In other words, the boy's biological father is someone else, who is unaware that he carries the mutation.

You suspect that Linda nor her husband are aware of this non-paternity. How would you disclose the results of this genetic analysis to Linda and her family? What principles and who do you have to take into consideration in this case?

[MMI prompt] Health care

In a particular socialist society, the health care system is set up as follows: the public shares the cost of health care, and everyone who needs it enters a line-up. Because the public funding is limited, the health care system does not operate to its full capacity (in other words, some doctors want to work more hours but can't get paid for extra hours), and the line up for health care is long.

It has been proposed that in order to reduce the burden on health care, we allow some patients to pay for their medical services and receive them faster. It is argued that the rest of the public will not have to wait any longer, because the doctors and surgeons have unused hours, and the private funding goes to pay for these hours instead of jumping the public line.

Discuss the pros and cons of the introduction of this two-tier system (ie. coexisting public and private funding sources for health care).

[MMI prompt] Doctor's obligation

You are an ER resident who specializes in trauma. One day, a martial arts sportsman is sent to your ER with an apparently throat injury. His coach said he was hit by the opponent in the throat during the semi-finals match. You are aware that in this type of martial arts, attacking unprotected areas of the head such as the throat is ground for disqualification.

Your attending physician (your boss in the hospital) told you that the opponent of the injured player is your countryman, whereas the injured player is a foreign contender of the champion title that your country values highly. He wants you to "examine the injury carefully" right after he remarks how important the match is for the country.

How would you handle this situation?

[MMI prompt] time management

You are a cardiologist at a local hospital, who just finished a shift and has a tight run to your daughter's high school graduation ceremony. As you headed off to the door, Mark, a patient who knew you well, saw you from the waiting room and grabbed your attention. "Doctor! I have a bad chest pain. Please stay for a bit. I'll feel much better if you were here."

Enter the waiting room and talk to Mark.