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.
In my experience doing these questions, FA has NOT been very useful as a guide because FA has things like surrogate priority, but then NBME writes questions to teach a point.
I get that this answer choice is the most amicable answer.
But honestly the way they asked the question "it is most appropriate for the physician to address the issue of a feeding tube in which of the following manners"
My reasoning was: well...before the family can even begin to argue what do do don't you have to propose a medical treatment/management strategy? which is why I went with "recommend a tube..."
https://www.youtube.com/watch?v=jOOLMHGwCRg
Good explanation
What a GARBAGE question. He was eating breakfast 2 hours ago just fine and now we are supposed to have the family come to a consensus about a feeding tube like he's on his death bed? BULLSHIT
I think the answer was consensus because the "surrogates" aka family members havent deliberated yet. If this was after their deliberation and they disagree, then it goes spouse -> adult children -> parents -> siblings etc. The question doesn't mention any disagreements, hence they need to decide cumulatively and make a decision.
That was just my take on this question.
This is a bullshit question. According to everything we've ever been taught the decision goes to the wife if there's no documentation.
i think the questions is trying to show the importance of unity among family members when there is a patient who is loved by both wife and kids. The duty of the doctor is to ensure the family is united in support of the patient the and in case there is still conflict regarding what to do, you use the hierarchy where wife comes first. i get it was a dumb but this was my logic
submitted by โsbryant6(205)
This question is two-fold. You must know the decision-making hierarchy and also consider autonomy. Making "recommendations" for certain treatments is wrong, because it violates autonomy and informed consent. Physicians should simply explain the RBA's of all treatment options, and allow the family to decide what is best based on informed consent and "their perceptions of the PATIENT'S wishes". If there is no advanced directive, then the decision should be appealed to a surrogate decision-maker. Priority of surrogates is spouse-->adult children-->parents-->siblings. Yes, the spouse would have higher priority, but the family should at least try to reach a consensus first before appealing to "only" the wife. If a consensus, cannot be made, then the wife would have first say in the decision. Therefore, encouraging the family to decide according to the wishes of the PATIENT would be a better first step, especially if the wishes of the wife is contrary to that of the patient. Also, just as a general rule, I typically avoid picking answer options with "absolutes" such as "never, always, only". The purpose of a surrogate is to act in the best interest of the patient.