"Birth Control" - Medical School MMI Interview Practice Question #2 (2015)

this next scenario can be taking a look at its from a set of practice problems available on UBC's website and I think this is great because you're going to be put in some awkward situations they want to see how you respond when things get a little bit awkward so you're going to have to have some experience with these awkward situations before you get into your interview because there's a good chance you're going to have at least one of them may as well know what to expect now so in this scenario you are going to be a doctor so this is you over here you're already a doctor so you equal doctor and you're in your office one day and a patient comes in right when your patience comes in but she comes in alone and she's also a 14 year old girl so automatically you assume what the hell's going to happen she's going to say something weird there's a reason she's here with her parents right so 14 years old now she's going to ask two things first thing she's going to ask for birth control pills the second thing she's going to ask they don't tell her parents what do you do it's awkward right no matter how you want to look at it this is an awkward situation so what are you supposed to do in this case the most important thing the doctor needs to do is make sure he is always acting in the best interest of the patients right you always want to make sure the best interest of the patients is always the first thing that's going to be looked at now they also have to respect the patient autonomy if your patient is making an informed decision or makes ever informed requests as long as they understand the consequences or the parameters of that decision they should be allowed to make that choice as long as also they have to be in you know you educate that they understand you know so that's another thing we'll look at when dealing with patients who cannot make a competent decision or not deemed competent we'll deal with at a different stage but for now we're dealing with a 14 year old girl so what do we do in this situation well look at our pipeline right we go with our checklist we know we start off with what's the problem right what's the problem or what's the decision my do we give a minor birth control pills without parental consent now the two things to consider here right acting the best interest of your patient and respecting patient autonomy so what can we do to accomplish both of those things we want to make sure that we collect a lot of information right the second stage of the solution pipeline where we ask questions is going to be so important you want to just sit there and ask questions for three minutes straight I don't care if it takes up so much time that you have that three minutes of the eight minutes you have just get all the information possible you want to make sure that you cover absolutely everything so that the actor is playing the role this 14 year old girl has pretty much given you all the information to assure you that you understand that she understands what I am with birth control entails so start off right first question you ask it's going to be awkward but you need to ask as doctors ask this all the time to people you know are you or have you been sexually active seems like an awkward question especially when you're saying it to a fourteen-year-old but you have to look at this fourteen-year-old as any other patient right you have to treat her with respect you have to ask these questions you have to make sure that she's going to get the same care that any other adult would receive coming into your your practice facility so you ask her are you or have you been sexually active right now hear about her past experiences and you know mainly here about whether or not she was safe during those situations what types of contraceptives was she using right next you can go ahead and ask something along the lines of you know let's just say this is our first time I'd say this is her first time you asked that question nope this is our first time so you know she doesn't really know what's going on well you know say what do you know about safe sex everybody has sex ed know when they're you know yah when you're young you receive a sex ed course right everything's awkward you don't really know what's going on but you know you retain a little bit of information in some cases you don't retain all the information so there could be a few misconceptions what do you know about safe sex right what does she think you know the birth control pill is going to do and that could be the next question you follow up right after this would you know about the birth control pill because generally when somebody says they want the birth control pill obviously there's going to be exceptions but just generally when somebody requests a birth control pill it's because they plan on having unprotected sex right for the most part you know especially if a 14 year old is approaching you asking for the birth control pill it's not very likely that they're just being extra safe there being other situations where they will use a condom and they'll use the birth control pill normally when someone's talking about the birth control pill they want to have sex without a condom it's just generally what happens normally people who've been in a relationship and they know that both sides do not have any STDs so ask what she knows about safe sex right what does she know about you know the two the two main things you're looking out for when you're talking about sex is you know making sure you don't get pregnant if you don't want to get pregnant or managing your pet your pregnancy and avoiding STDs right those are the two things so while the birth control pill will be successful in removing the pregnancy part of that scare it's not going to reduce or remove the STD part right so she needs to make sure that she understands what the birth control pill is now if she says she understands what the birth control pill is and she understands with safe sex is so she plans to use the pill and the condom she just wants to be extra safe you know you should not you should commend her on you know being knowledgeable of of what's going on and having an idea of you know what should she should do right she's not just going in and she's gonna you know have unprotected sex she's actually going to just be extra safe which is why she came to approach you and you should you know treat her as an adult and say you know it's very mature of you to want to be this safe next thing I want to say is you know you can't really give her something or you know prescribe or something if she doesn't really know what it is right so you say you know what you know about the side effects of the birth control pills do you know about birth control pill side-effects alright se here right because we know that the birth control pill it typically makes women increase a weight while they're on it I know that's a common side effect I think there's mood swings as well related to it so it's just another thing to consider does she know these things right does she know you know she might have read some things up on the internet you want to make sure that she actually understands what they are correctly because there's obviously a lot of they everyone can write anything on the internet you want to make sure she's got the proper information and the same will go for everything else over here so if her reasoning behind you know why she wants this is be based on what she had on the internet make sure she has the correct facts behind it so these are a bunch of great questions we asked why we collected a bunch of information now a fifth question you can ask right I mean you are looking out for the best interests of this person you know you don't want to get too involved in their personal life you don't want to but you can ask this last question down here you know why why don't you want your parents to know why don't you want your parents you you want your parents to know hear reasoning why she doesn't want them to know right you are still going you can tell it you know I am still going to allow you to have these pills right because you've shown me that you are educated in your decision or we have talked this over and after giving you all the information you you know understood the limitations and the the consequences or the side effects and you still want them you know what's the reason why you don't want your parents know right here reasoning out you're there to help her out nurse it in a case if she needs so you know here reasoning but you're still going to give it to her even if she doesn't give you it she doesn't talk about it right this is like an optional question down here you can also ask but not mandatory at all so now we come down to you know stating what the problem is right the problem you can go ahead and actually state out loud you can restate it is that I need to know if I should give you birth control pills without your parents because that so do I give you birth control pills without your parents consent now in most cases right what would be the issue of the parent right because I want to remove religious reasonings of the parents from this situation right because if the child had the same religious beliefs as the parent they probably will not be here asking for that so that's one thing to you know it can bring that up in the questions if you want to discuss that but for the most part I want to just think what's the main concern of a parent and that's going to be is the kids safe right so in whenever we're talking about satisfying both parties in terms of solving a problem normally to appease both sides you want both sides to be happy the main concern of most parents is going to be is the kid safe are as my children save are my children being safe and if we make sure that they know all the dangers and the limitations that we asked up here in the questions part well I think we should be safe in answering that question which is yes they will be safe so what are our options available over here right option number one don't give her the pills don't give her the pills option number two so our solution number two give her the pills do the pills without asking questions do the pills without asking questions or inform her her of the dangers limitations of the birth control pill before giving it to her giving her the prescription there we go so these are the three main pathways we have so don't give it to her don't give her the pills say don't do the pills without parents will consent give her the pills without asking anything and then inform her of the dangers it's pretty clear which with the correct answer is over here right I mean we can go ahead now this is where we go ahead and actually pick which one we want what's the problem with this pathway over here no respect for patient autonomy there's absolutely no respect to patient autonomy over here not looking out for the best interest of the patient for just giving her the pills blindly not looking out for a patient's best interests because this over here you're just going to give her the pills and remember they said right if somebody's asking for birth control pills more times than not the reason why is because they want to have unprotected sex and they don't want to use a condom now remember that will help you the pills will help you with the pregnancy part but not with the STD parts so it's highly recommended that if you plan to have unprotected sex using the birth control pill you'll also have you know both participants will have been checked out to make sure they don't have any sexually transmitted diseases right so you only have to get rid of that idea of just giving her the pills right so this one does not respect your autonomy because you're not requesting her we're accepting a wish but just blindly accepting her wish or a request is also not a good option so it's pretty clear that the good option or the best answer for this scenario is to educate her and you know with the education then if she still wants it after the education then you allow her to have the pills right so this is going to be respecting autonomy respecting patient autonomy while looking out for the best interests now you're going to want to you know go ahead and say what the plan of action is right so the plan of action is I'll give you all this literature you don't do you know I don't have to give her the pills right now right you can actually give her a bunch of information regarding birth control so she can will read it up well you can suggest certain websites that have accurate information so give her information regarding save sex and birth control a bit more space here potentially give her time to think about it and then after if she still wants the pills after being informed give them and as always we want to make sure that the patient is happy with the care that we provided so this is the sample questions over here so when do I got it from up here give them after that being informed give them and then ask her if that's okay is this okay to actually ask that to the interviewer and you know make sure that they are happy with the approach that you got so that's how I would approach the situation it's a very weird situation it's a difficult situation you have to consider two things while you're balancing you know the best interest of your patient and patient autonomy the two things that you need to really consider you're going to see a lot of cases in this series that are going to look out for making sure that we're always looking out for these two things I try to balance them out right do do difficult things to balance out if we can do it successfully we're going to have a great interview so if you have any questions regarding this case leave them below and I'll see you in the next case in the next video

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Id: rNr-KNHD_tU

Length: 15min 46sec (946 seconds)

Published: Wed Apr 01 2015