Answering an Ethical Scenario | Medicine MMI Interviews | Kenji & KharmaMedic

all right what's going on guys my name is Kenji you can welcome back to my channel I'm here today with calm medic again what's up guys I'm not gonna introduce them again because I did in my last video if you have a check that out going back to my last video to have a look to see who comedy is but basically it's youtuber he's my friend and we're gonna be making some videos in the near future we thought that we'd sit down we know the end mine tears coming up so we thought we'd sit down and answer a few questions to kind of give you guys an idea of what a model answer would be like in an MRI today we'll be talking about ethical and ethical scenario and how we might tackle that in MMI we had a lot of fun making the last video so we decided to do a little bit of a series about the MMI and today we're gonna be covering an ethical question they're likely to get at least one of these in your MMI it almost definitely make up one of the stations so you should prepare for them you should know what's coming up so yeah let's get straight into it alright so question is you have the patient home visit and begin talking to a patient who has a history of cardiac and mental health problems she mentions that she'd like to speak to the GP about signing a do not attempt resuscitation form and also you to pass this information on to him before you leave she suddenly collapses being trained in basic life support which is a CPR you assess her and ascertain that she requires CPR do you continue with CPR and if so Watson with potential complications Basic Instinct required tough question I think the reading operation and every one of my angles to cover definitely and the reason why I chose this is on I was at my patient home visit around two weeks ago okay and one of the patients asked to speak to the GP about it do not attempt resuscitation form right so happy thinking like if she does right collapse like something like that happens you know what exactly I do in that situation alright so starting off patrol he mentioned what an advanced refusal is dude you wanna start off I thought you know if I give me a sign yes so an advanced refusal or an advanced directive is basically having said beforehand before and it then happens that what action you want taken so a lot of people will sign it DNA are which do not attempt to resuscitate so if you were found to be unconscious or if there was complications in like a surgery let's say then you wouldn't want to be attempted Horace's station so yeah so what do you want for the initial thoughts on yeah about this matter so my initial thoughts are why haven't you called an ambulance yet if we've already realized that she needs life support I think maybe we should have alerted someone first or called an ambulance yeah before having done that because you know in the process of you assessing she might be hypoxic and losing some function she's had a stroke anything else before his time is very important so I guess in the situation we have to like kind of think should we go for CPR not and she you know she mentioned she mentioned to us that she might be wanting to do yeah I might be her wish yeah you think we should you know go for CT Australia what do you think think about in that situation yeah so although the patient's told us very directly that she wants do not resuscitate yeah and there's still a lot of factors that we need to take into account because she hasn't discussed this with her GP to start with we don't know if this patient has full capacity would be making a decision like that for themselves yeah we don't know even if they have autonomy maybe they're being forced to say this by someone else but there's a lot of factors to consider yeah so I don't think that we can do I don't think that we can resuscitate yeah sorry I don't think that we can not resuscitate based on just having yeah she could change your mind as well like she could speak to GP you know what's going on or the processes yeah I should actually realize that she doesn't want to do that that's true there's no sense though but I Stephanie something we would have to consider yeah a patient might not even understand what do not resuscitate means they might have heard about it from their friend or family member and just thought it would be a good idea without actually fully understanding the full extent of it definitely and in the in the Nexus said that she has mental health problem so she could have like dementia she could have another - no problem wish good yeah that's her ability to give us you know decision so she max you might lack capacity yeah you know so capacity is the ability to make a decision on her treatments yeah decision your treatment exactly and she might you know she might not have capacity in my past as well person I would definitely have to be exactly so while talking to her GP and the chica would definitely want to GP would want to give the patient as much information as possible and she would want to cheer he would want to check that the patient understands that information and is able to make a decision based upon it yeah and obviously like before we have a tree a patient we don't see any consent but if she's you know she's on the floor she she's in a heart attack or something you have you can't you know get consent patients best interests would come in to that point yeah so like right now what we want to do for her is you know where this in her best interest so she's on the floor and you know we don't know what she's like I think we definitely dress which is basically so the when answering a question like this you're gonna want to consider the pillars of medical ethics and that can actually help you structure cancer as well and so we've already talked a little bit about autonomy we've talked about beneficence as well there's non malevolence and justice as well yeah yeah so one of me the patient has a right to decide what they want to happen in their life and in their health so the patient if she was to speak to a GP she has the ability to refuse treatment and in medicine you don't necessarily have the ability to request treatment so she can't say like oh I want this particular treatment I don't want a cesarean section like if you pregnant they can only refuse treatment and even if that means that the market be ended so if that was - if she ever became in a position where she couldn't eat for example she couldn't speak she doctor actively say that she doesn't want to have a nasogastric tube and says there's only to keep her alive that's one thing I definitely would have to consider the situation as well so part of the question talks about being trained in basic life support and we thought we'd talk a bit a little bit about what basically I support is as part of basic life support when you're assessing the patient whether they are unconscious if they need compressions and anything like that you run through what's called ABCD and there's also a F G H I but the main ones are ABC so those stands for airway breathing and circulation alright so specially gonna do is to survey the area so make sure there's nobody need to danger and the next thing is to secure the airway so as to do it as a jaw thrust in there call it according your sections your first is if it's like really mmm blocked okay but otherwise you want to take a look inside the mouth see if there any objects obstructing it take those on with your finger and then you do what's called a chin lift head tilt and so you kind of cut them back like this and it's the most optimal way to have their we open definite and if you do a pop if you have a partner with you try and get them to do that because that secure it for the whole time there are conscious yeah yeah if you're one person is quite difficult to hold there we have been and also assess breathing the next thing will be to check breathing so you know having of the chat asleep is any signs of movements yeah listen to the you know cirno's amounts if there's any you know any sound as well from that yeah I think it's no breaths within 10 seconds confirmed if they're not breathing something like that yeah and obviously you know if you're looking at someone's chest and you see that they're not breathing don't be looking at your stopwatch to check the ten seconds pass yeah you want to make a bit of a judgment call definitely and the last thing for us as much use is seen which is active circulation yeah so if they don't if they're not breathing you can assume that occasion because completely you know the hot Sun meeting basically because the harlot stops before breathing right so you can dance that the the heart stops before the breathing does okay so soon as their breathing stops you can assume the highs also stopped as well which is why we do see last and if that's not you know the heart's not beating then you can go straight away to do compressions directions and as part of circulation as well you want to check if there's any major bleeding if there's any blood loss so if it's not visible - usually you'll be able to see if there's any if there's a lot of blood loss but you can also check behind their back and with circulation the compressions is 30 compressions and then two breaths you don't have to give the best if you don't want to but it's normally a ratio of 30:2 - yeah and it's out of beat of 110 BPM which equates to something like the song of stayin alive oh yeah all right so it's kind of wrap this question up I think we were conclude that we would attend resuscitation simply because you know we it's not an official form yeah we don't entirely know if she you know that's exactly what she was your chest capacity yeah it could be you know it sounds like it is I wish but we have to wait till the GP decides to go forth with giving her the DNA our form yeah I wanted to say that yeah in these questions you should never assume and you should always try and find out as much information as you can and so we shouldn't assume that this is fair final wish this is exactly what she wants for sure exactly like we said before she might still want to talk to her GP about it my one she might change your mind in the future and anything like that yeah so yeah we can't assume that this is exactly what you want yeah and you'd always do what's best location and then situation like this which you know would be to say that I suspect what we conclude so in most dear questions if you finish within a reasonable amount of time the interviewer would like to ask people follow-up question and so one that I thought of for this scenario was how would your actions change or how would your thoughts change if the patient definitely had do not resuscitate if he knew that she had signed that form and that was something that she did want yeah so I guess in situation like that you would have no choice button you know to not resuscitate her and that might be quite hard you know I found these in the room or you know husbands there it might be really hard to not go to that especially if that's what her husband wants but the end there you have to respect their autonomy yeah you have to respect decision and they want to and you know I'll be really hard but it's just thought you'd have to do as no you have to do yeah yeah so Kenji touched on two important points there the first one was autonomy respecting patient autonomy the patient had signed a do not resuscitate that was what they wanted that's what you have to respect and the second thing he touched upon may be live noticing was empathy so he talked about how it would be difficult if the husband was in the room and how it would be difficult for you as a medical student anyway going through this experience so being able to show empathy or show the ability to have empathy in your interview response is also very important yeah and of course you know you're called an ambulance anyways your clergy doesn't know what happens no staff you defecate games kind of situation yeah yeah that was something else quite a hard question I think I'm not an astronaut I just sat here thinking about what we do is you know we struggle with that as well yeah and if you didn't get X or question in the airline it would be so hard to answer and I thank God we didn't get that because if I gonna in there that I did should walk out like I think that they gave them a harder question yeah so yeah don't worry too much about it we chose a hard question by purpose because there's so many different aspects I mean yeah talk about and everything's we can include in our answer yeah so go over these things that we mention my autonomy competence get a feel for them maybe come back to video and see if you can present it you know model answer yourself yeah yeah definitely cover the five pillars of medical ethics it's gonna come up in multiple questions and you want to know what they are for this of it yeah four pillars fund me justice beneficence and non malevolence yeah so yeah I think note as well and they'll play a role in a lot of questions yeah but obvious giving you guys a bit of an idea about how to go about answering ethical questions yeah we wanted to be like mobile discussion we didn't want to like you know make it very structured we want to stay here like with our laptops and stuff and just give you guys and yes pigs think about so hopefully this helped you guys out please yeah please phone NASA on his social media on the huge shoes well I'll put all the links on the screen give him a thumbs up show him some love show me some love as well if you like video and and just give us some comments and suggestions about what you guys might see in the future it's really enjoyed making these videos and hopefully helps you guys out as well yeah all the best in your prep guys I know it's interview season coming up soon so work hard do us practice and hopefully you do well yeah thank you so much for watching guys and we'll see you next one peace [Music]

Channel: Kenji Tomita

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Keywords: medicine mmi, medicine, mmi, medicine interview tips, medicine interview, king's college london, med school, ukcat, a-levels, how I got into medical school, medicine mmi help, medical school vlogs, medical school london, medical school vlog uk, medical school application, medicine mmi ethical questions, medicine mmi ethical scenario, kenji medicine, kharmamedic

Id: NIcizHNGz5Q

Length: 12min 33sec (753 seconds)

Published: Thu Nov 08 2018