what i ve realized over the days is that one of the important problem for this exam is doctor patient relationship and ethics . so what i ve planned is to beat them . we will prepare it so well that we can answer any question . there are as many as 10 questions on each exam . so its is really important . so as part of the exercise everyone whose interested should post a Q only from these topics with a simple answer . please post the answer along with the Q . post the questions on this same link so it will be easy for others to read it all together .
PLEASE NUMBER THE QUESTIONS
Q 1
after his spouse dies from malignant melanoma . person comes to the doctor and states that he is feeling a great deal of guilt about his wifes death and thinks that he could have done more to save her . what should be the best response of the doctor
a> dont talk like that
b> i think everyone goes at there appointed time
c> nobody could have saved her
d> tell me more about ur feelings of guilt
e> u did the best u could
ANSWER : WHEN EVER A PERSON LOOSES SOMEONE THE MOST IMPORTANT THING IS THAT THEY WANT TO TALK . SO ALLOW THE PERSON TO SPEAK
good doctorsaheb we must excersice this practice
thanks to illustrate the point
from my exam
a boy who is 13 comes to see you. he says he smokes occasionally but doesnt care for it much. what is the first thing you say
do you know the repercussions from smoking
are you friends making you smoke
how do you feel about smoking
do you want me to show you pics from people with lung cancer
do you mind if i tell your mother that you smoke
is it cool to smoke
i musta got 20 or 30 of them, not 10
so, what do you say first?...how do you feel about smooking ?
the Q what dhruvastill posted is number 2 . please number the questions . next will be Q 3>
the answer to Q 3> may be
do u know the repercussions from smoking
by the way what is the meaning of repercussions
Repercussions of smoking would include all of the the "punishments" that you get for doing it. For example, stained teeth, lung cancer, other cancers, dec exercise tolerance, dec lung capacity, intimal damage etc etc. In Fadem, HY it states that in an adolescent one should focus more on things that someone that age would be more interested in ....such as "stained teeth" rather than lung cancer because an adolescent worries about image and often has the illusion of invincibility and therefore the lung cancer approach would be less likely to impact his decision than bad, ugly looking teeth accompanied by bad breath etc.
For this question:
based on the HY Fadem
and my own instincts
I would
NOT go with
tell mother
nor
pics of lung cancer
for sure
How do you feel about smoking? isn't going to do much good obviously he feels it is ok or he wouldn't be doing it
Are your friends making you? a little too antagonistic and what adolescent would fess up to their dr about this one anyway. the word MAKING is too much here. If they had said INFLUENCE then that would be a better word but overall not going to do much
Is it cool to smoke? I wouldn't pick this one b/c there is a MOCKING tone or a tone of condescension here.
So,
I would pick Do you know the repurcussion of smoking
b/c
it would give the dr an idea of his baseline knowledge
as well
as perhaps further data
at least it OPENS UP THE CONVERSATION
and
is more likely to elicit other details that may be of interest such as (friends, cool or not etc)
baseline knowledge of effects as well as level of maturity will give the dr a better idea of how and what to say or do next.
Just my choice but would like to know the correct answer.
Thank-you
(first post)
For Q1:
Also remember that GRIEF, especially in the ELDERLY, can cause PSEUDODEMENTIA with all the signs and symptoms of DEMENTIA but this would be a reversible form of dementia with treatment. DEMENTIA is typically considered IRREVERSIBLE AND CHRONIC and NOT reversible and acute (right after spouse died)
They will most likely tell you some signs of depression, give you an older person that perhaps lost their spouse,like the pt in Q1, and then continue with signs and symptoms of dementia.
also a big time favorite with regard to dementia and aging is the fact that DEMENTIA IS NOT PART OF THE NORMAL AGING PROCESS
it used to be just a part of old age and it no longer is considered to be the case.
so don't just DISMISS DEMENTIA in the elderly w/o workup and evaluation.
and of course
TALKING IS ALWAYS GOOD FOR DR PT RELATIONSHIPS!
hey jampadrolma gr8 exaplaination...i toatlly agrree with u