MMI Stations Flashcards
Four people all need a liver and they all have an equal chance of success. One has only
2 weeks left to live without, one is the sole carer for their father, one is a pregnant
lady who would otherwise only have a couple of months with her new-born and one
has taken a large Paracetamol overdose. Assuming there was nothing to medically
differentiate the patients, and considering only the ethical aspects, who would you give
the liver to?
Generally within the NHS, transplants are first prioritised on urgency, which would make me inclined to say the person with a Paracetamol overdose as if they do not receive a liver transplant they will be dead within hours, however I would also like to weigh up the ethics of the situation. Autonomy is not a huge factor assuming they all want the transplant and have had any alternative treatments explained to them and have still drawn the conclusion that they want a transplant. In terms of beneficence, to do good for any of the patients would be to give them the transplant, however when considering the options, the patient who is a sole carer for their father and the pregnant lady seem to have more responsibility and thus it will do good for both them and the others. In terms of non-maleficence you must weigh up any risks of surgery, particularly in the case of the pregnant lady, whether she and the baby can be supported going under general anaesthetic and whether she would be able to manage living on immunosuppressants. Finally in terms of justice, you must consider who would have the best quality of life following the surgery, as it may extend their life, but if it does not improve their quality of life it’s hard to justify it. It is very hard to make a decision on that given the information but it is something to keep in consideration. In conclusion I would probably still give it to the patient with a paracetamol overdose given the information available in hopes that another transplant may become available for the less urgent cases.
You are walking down the street and you see an elderly man walking in his nightgown.
What would you do?
I would start by trying to approach him in a way that was non-threatening, by coming from directly in front of him so he can see me and introducing myself to him to try to make him more comfortable. It is clear from the fact that he is in his nightgown that he may be confused or even sleepwalking so I think trying to set him at ease is a very important first step. At this point if he is responsive I would ask him his name and ask if he knows why he is out here. Given that response I would then ask if he wanted to go home and offer to walk with him. However if he was unresponsive I would probably be inclined to call a non emergency help line like 111 to try and get some guidance on what to do. No matter his response I would stay with him until the issue was resolved to ensure that he didn’t come to any harm.
Talk about the advantages and disadvantages of introducing a new minimum price
for alcohol. How might the public perceive it? Are there any other ways to limit
alcohol consumption?
An advantage of introducing it would be a reduction in drinking which would hopefully reduce incidence of liver cirrhosis, dementia and other issues associated with excessive drinking. Another advantage is that the increased price may encourage alcoholics to quit drinking as the increased price of cigarettes did to smokers.
However it does not consider the complex psychosocial factors which lead people to drinking and how it would disproportionately effect people in lower socioeconomic groups and only grow social divides.
It would also probably be viewed by the public as a reduction of civil liberties and there would be a large amount of backlash due to the popularity of alcohol.
In this way it would be arguably more effective to start more public health and advertising campaigns similar to smoking campaigns to educate people on the dangers of drinking, however without the monetary discouragement there would probably not be a significant decrease as most people already know a lot of the issues presented by alcohol and choose to drink regardless.
How do you think errors are made when prescribing drugs and treatment, and what
can doctors do to avoid these errors?
I think a lot of errors occur when people are overworked and it reduces their concentration which can lead to them making simple errors due to a lapse in judgement. To avoid these there should be sufficient staffing and if doctors feel there is too much pressure on them they should report the issue to the GMC, because this avoids errors like the case of Dr Bawa-Garba which have fatal repercussions.
Other issues arise because of doctors lack of knowledge or lapse in judgement, by failing to consider certain symptoms they may give a false diagnosis which leads to an incorrect prescription or treatment path and the only real thing that can be done to avoid this is to constantly keep clinical knowledge up to date and if you feel you are out of the limits of your competence do not be afraid to admit this and ask somebody else for help because that is much better than having a patient end up with incorrect surgery or a harmful prescription because of your mistake.
You are the leader of a group working on behalf of a charity and £100 that you raised
has gone missing. Discuss with the examiner how would you go about dealing with
this situation?
I would start by raising the issue very openly and in a way that is non-confrontational because in some cases there may be a valid explanation for what happened to the money which may not turn out to be a problem at all. However if nobody offers any kind of explanation I would try to speak to members of the group individually in an environment where they do not feel pressured and hopefully feel comfortable to share any information on the issue. I would make it clear that any information would be kept anonymous and we would try to resolve any issues without any kind of disciplinary action if the money was returned. If people at this point gave any information on an individual I would try to approach them in a non-confrontational manner and see if they are willing to admit to it and if they are I would offer them support and try to understand why they did it and whether they need any support with their home life etc. However if this did not help I would have to raise the issue with somebody more senior within the charity. Finally I would report the incident to the charity regardless of the outcome.
Whilst at medical school you’re placed in a small group for anatomy classes. One
of your group members took a photo during a whole-body dissection class and is
planning on posting it on a chat group with his friends. What would you do and what
are the issues raised?
The first issue is whether they have permission to take a phot of the body in the first place as that has to be given by the lecturer or somebody more senior in the university. However even if he did have permission it is important to explain to him why it is unprofessional to share that kind of image as it is a breach of confidentiality as well as being disrespectful to the individual who had selflessly donated their body for scientific research. If this could not dissuade him from posting it the next step would be to raise the issue with the medical school as it is extremely unprofessional and could cause a serious damage in trust between the public and doctors and would also discourage people from donating their body for scientific research in the future which would impact the education of future doctors and is thus extremely selfish. One of the core principles of Good Medical Practice is maintaining trust and within that it talks about treating all patients with respect and dignity which this student is completely disregarding.
Your and your friend are both applying to medical school. You’ve just had an interview
at what you know is your friend’s top choice university. After your interview, your
friend asks you for a list of the questions. Discuss with the examiner what you would
do and why.
I would have to respectfully decline him as not only do you have a legal obligation from the university not to share the questions but also it would invalidate the whole interview process and disadvantage not only you but all other applicants which would be morally wrong to do. As a doctor one of the key aspects of Good Medical practice is honesty and dignity, so lying to try to increase your odds of getting into medical school would not only be immoral, but also building bad habits which may impact your ability as a clinician and come back to haunt you later on in your career.
A medical student has posted inappropriate photos of themselves and other medical
students, without their consent, at a party on Facebook. The examiner will ask you
a series of questions: What would you do? Do you think he should be punished? Is
what he did considered wrong? If he posted these photos before he came to medical
school, is it still wrong?
The GMC guidelines in Good Medical Practice state that you should communicate on social media just as you should in person, so even if he has posted those before he was at medical school he should still remove them as he should be held to a professional standard. I think you should first approach him and explain why it is inappropriate and ask him politely to remove them, however in the case that he refuses you may have to raise the issue with the medical school, particularly as it is not only impacting him but other students as well.
You are a medical student. Your friend says he is hung over and asks you to sign him
in for a lecture. What would you do? What do you think the GMC would say about
this? What would you advise your friend?
I would explain to him that I couldn’t as it would be fraudulent and we could both get into serious trouble for it. I would try to encourage him to attend as it is required by the university and how vital it is not to miss out topics as it could impact patient care down the line due to gaps in knowledge. If he was unable to make it I would offer to send him the notes and try to help him catch up with the content so he doesn’t fall behind. Within Good Medical Practice it states that doctors must stay up to date with knowledge and that medical students must engage fully with their course so it is vital that he attends all lectures and small group learning. It also states honesty and integrity as key traits of a doctor so this would not only build bad habits but also encroach on both our integrities. Finally I would check that he is alright and there is no underlying issue surrounding his lack of attendance, maybe he was drinking because the pressure was getting to him? In any case I would offer my own support and in more serious cases I would ask him to go and see his GP or mental health support at the university.
A girl you don’t know too well at university has posted online that she has access to
and is selling the questions for an upcoming anatomy exam. She is usually diligent
and hard working. What are the issues for you, her and the university? What would
you do?
The issues for her are that her actions are not in line with a good doctor as she is not acting with integrity and cheating will only harm her down the line in her career. Beyond this you may want to try to understand why she has chosen to do this as she may be facing too much pressure or financial hardship and this is a way to try to support herself. Even in that case it is still wrong ethically, so even if you don’t know if the questions are legitimate you should report her action to the university and they will have policies for dealing with this sort of incident. On the university’s side they may have to rewrite the exam which is a burden and they may also have to seek disciplinary action for the girl which is unfortunate. If the questions have been leaked it also damages the reputation of the medical school which may have serious repercussions. It is important not to jump to judgement without understanding why she did it but it is also vital that it is reported quickly so the university can deal with it accordingly.
An old school friend begins to post worrying messages on his Facebook page, which
are suggestive of mental health problems and the possibility of self-harm/suicide.
Demonstrate how you would approach the situation. When you enter the station,
your friend will be waiting.
I would start by just giving some small talk to try and make him comfortable and settle him down a little. I would just say, look I’m really sorry to have to bring it up but I’ve seen your posts recently and I’ve been wondering if everything’s alright? When he responds I would ask if there’s anything I can do to help him. I would also encourage him to go and see his GP and any mental health services available to him. It’s very important not to underestimate how serious these issues are. Also be willing to help tackle any underlying issues.
Your friend wishes to talk to you as their father has been diagnosed with cancer
and they want to quit medical school to stay with him. His father is in a serious
condition and is bedridden. This has affected your friend heavily, and he doesn’t feel
like studying. His mother has chronic medical conditions and is struggling to look
after herself. Your friend is waiting inside the station.
Start with small talk, try to make him comfortable. Just say ‘I’m so sorry you have to go through this, nobody should ever have to make these decisions’. Try to encourage him not to give up on medical school and not to give up on himself, think of what your parents would want, they would want the best for you and that means finishing your studies and pursuing your dreams. I would ask him if he’s spoken to anybody at the medical school about it and I would discuss whether there was anything that I could do to help with his studies if he needed a break etc.
Your mother asks you to speak to your grandmother and tell her she shouldn’t be
driving anymore, as the family have noticed scratches on her car. Your grandfather
doesn’t drive
Start very informally, hello Nan how are you? Start with some small talk, what’ve you been up to? How’s Grandad? Then I would say look nan, I’m going to be honest, I’ve come to talk about your driving, I know it’s hard because you’re the only one that drives, but I think you really need to think about whether it’s safe for you to still be driving. Mom said she saw some scratches on the side of your car, the last thing we want is for you to get in an accident I don’t think I’d forgive myself. What do you really need the car for these days nan? Could you get your food shop delivered, I could help you to set it up if you’d like? What do you think you’d struggle to do without the car? Could you take a taxi or at the weekends I could give you a lift if you need?
You are working on reception at a restaurant and forgot to write down a reservation
made for 10 people for an important anniversary. They arrive and the restaurant is
fully booked. Explain the situation to the customer.
I would start by apologising to the guests and taking responsibility for the mistake and explain that as the restaurant is full we will not be able to seat them. After this I would try to make up for the error by offering to rearrange the table for another night if they can still make it. I would also explain the situation to a manger or other more senior member of staff and ask if they can offer any compensation or make a special arrangement to try to help make it up to them. I would just end it by apologising for my mistake and for any consequences.
A patient is needle phobic and you have to take bloods for the second time because
the first sample was labelled incorrectly so could not be analysed by the lab. The nurse
looking after the patient put the labels on the first sample bottles. Demonstrate how
you would approach the situation
