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July 13, 2005

Ethical Question of the Day


The question below is taken from Kaplan’s “Q-Bank”, which is a collection of over 2,000 USMLE Step 1-type questions. Among the topics that the boards test on, medical ethics comprises a significant portion of the questions. I found this one particularly fascinating…


A male physician enters an examining room to find a new patient. The patient is a Muslim woman, wearing a head scarf, sitting with a man. The man stands up and introduces himself to the physician. He indicates that the woman is his wife, whom he has brought for treatment. He recounts her symptoms as a persistent cough, nausea, and some difficulty breathing, and that she has had these symptoms for the past four days. Looking directly at the physician, he asks what can be done to help his wife. As he recounts her symptoms, the woman says nothing and makes no eye contact. At this point, the best thing for the physician to do is thank the husband for his account and do which of the following?


A. Ask him to lift the woman’s clothing so that the physician can listen to her lungs.
B. Ask him to wait outside while the physician examines the woman in private.
C. Ask the woman directly to describe her symptoms.
D. Ask the woman to disrobe so she can be examined.
E. Ask the woman if she wishes to have her husband present during the examination.
F. Suggest that the husband and wife might be more comfortable with a female physician.
G. Tell the husband that the best information comes directly from the patient, and question the woman directly about her symptoms.


Which would you do? And why? The “correct” answer may surprise you…


If you have Q-Bank and/or know the “correct” answer… don’t spoil it.


Note: This officially is my last post until August 1st. Until then, I will post guest entries if anyone wishes to write one up and email it to me.


 

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41 Comments
  1. Anonymous permalink

    aww thats so cute that the USMLE has that kinda question 🙂
    AND I’M WRITING YOUR ENTRIES FROM HERE ON OUT!! I CALLED IT FIRST!
    I would do F…

  2. Anonymous permalink

    muahahaha and i’m the first one to comment.. cuz i’m cool like that

  3. Anonymous permalink

    my friend says B

  4. I would either choose E or F

  5. F seems like the logical thing, but you said the right answer may be surprising.  and the answer that would surprise me would be A.  the others would just baffle me, well except G. hehehe. asalamu alaikum!

  6. I don’t know the answer…but whenever I need to see my doctor (who’s male) he ALWAYS listens to my lungs through my abaya…hehehe and checks my lymph nodes through my scarf. When I was married, my husband insisted on a female doctor. “F” sounds like the best answer, but that was probably not written by a muslim, so they probably think that one of the other answers is best.

  7. Anonymous permalink

    i say its B…because if the husband is in the room while you’re questioning the wife…although she might be telling you her symptoms…he might interfere by adding other information…and since the wife is your patient…and not the husband…you need to only focus and concentrate on the wife’s testimony…and not the husband…
    geez i could probably do better on the USMLE then the stupid mkuttas…
    back to studyin…
    nigger-ul-haq

  8. i would say F ..isnt there a clinic whihc does that for muslims?

  9. I would choose option F; and try to help the couple find a female physician, who could perhaps examine the woman more closely-and also see if there are any addt’l symptoms that maybe the husband doesn’t know yet.  I’m not a doctor, nor do I aspire to be, but that is just what I would do!  (Any clinic is willing to do provide you with a female physician if one is on staff) 

  10. Anonymous permalink

    Asalamualaikum,Well the logical answer would be F laykin since you said its surprising, its probably D.

  11. Anonymous permalink

    I would say E

  12. I know House would kick the husband out of the exam room so that he can get the symptoms from the source instead of through her husband. So whatever House would do is probably correct. So B.

  13. its interesting how the usmle are putting such questions in the medical ethics, just from all the ppl answering here, you can tell there is no one answer

  14. Anonymous permalink

    From a Muslim standpoint, we would logically go with F, but yeah we’ll see what happens.

  15. so wait..whats the answer???

  16. given the way power dynamics that seem to be in play with the marriage, I say the doc hush up the hubby (choice G.)  and send the hubby out (choice B.) suggestin a female doc seems nice…uff. final answer: B. trickay trickay trickay-IJB

  17. Anonymous permalink

    probably…b……..or g.

  18. The culturally competent doc would choose F.  Good to see they’re training docs to be aware of the Muslim culture. 
    Good luck on your boards!

  19. Anonymous permalink

    I think E because to make her feel comfortable.

  20. Def not B. Docs not playing marriage counselor. F seems most appropriate but C seems to be the most reasonable and logical decision enabling doc to respect whatever the “power dynamics” are and at the same time not delaying a more direct and immediate diagnosis in the event of an emergency…blech. Stupid Med School :::shaking fist:::

  21. I choose G, but I know Kamran won’t even read my answer like he did to mein his last post. (that was broke as hell kr!)
    -Mohd 

  22. I’d pick Gwell I wouldn’t pick any others because it wouldn’t be comfortable for either or both of them…

  23. im gonna say G.

  24. Anonymous permalink

    In this world there is no such thing as not talking to a man or looking at him, especially under such circumstances. The husband sounds like the typical overprotective “im in the jamaat” type of guy. The question is why would the husband even bring his wife to a male physician you can easily call ahead. The woman does not even HAVE to look at the doctor to talk to him, I think somethings fishy so as stated numerous times most logical answer F or G, but  I would probably go with C just because all the rest can happen after it
     
     
    props on the post, really intuitive.

  25. F is what a muslim doctor would do, but from the veiwpoint of a non-muslim who has limited fimiliarity with islamic culture, G sounds like the right choice because that’s taking the steps in the right order….but of course I’m ready to be surprised.

  26. HIPAA….that’s all I have to say…well there more actually:HIPAA basically is gives the right to privacy to a patient so that if he/she wants their spouse out of the room, the spouse has to oblige, no questions asked…therefore, I do believe (but still could be wrong) that the doctor would be inclined to ask if the patient would like her husband to leave so to keep the entire examination private and confidential. Then you just go from there…and choose the safe answer ‘F’. 🙂

  27. I’m guessing E or G…eh, I should just ask Omar, you guys study together, right?

  28. i am guessing B considering what kabri just wrote about hipaa, and with addition of alti’s explanation of how the husband would be pressuring his wife with his presence.  heck, how do we know he hasnt been beating her? i mean, of course we hope not since they are muslim, but your job as a doctor isnt to assume. otherwise, c, or the less provocative g.  why do they leave so many choices? jerks.
    salaamalaikum. yay.

  29. Anonymous permalink

    If she has shortness of breath, wouldn’t it be hard for her to tell the doctor what her symptoms are when she can hardly breathe. I change my answer to D because he said that the answer will be surprising.  This will definitely be surprising though it would be wrong but if its necessary and the availability of female doctors are not there what else would they do. It’s a life and death situation.

  30. Anonymous permalink

    Asalamu alaykum wrwb,
    reminds me of medical ethics class..ahh hard! I guess C, and I’m claiming Kant as my backup. ha.

  31. Anonymous permalink

    oops, you know, my intent of using the word “infamous,” was for it’s colloquial definition: idolized, rare, etc. Sorry haha I definately did not mean in a negative sense =)

  32. salamz kamrann, kool postt. i would do F. but whats the “correct” answerr??!! are u gonan tell us?!

  33. heh heh, i know the answer…but I got it wrong the first time! 

  34. Anonymous permalink

    I’m saying A. Only because so far the husband seems to be running the show. The woman has not communicated with the doc. The husband has. Once the doc asks the husband to lift the clothing, the husband will either do it or he will provide for an alternative. The answer, surely, has to be A.

  35. Anonymous permalink

    The answer has to be A. The husband is the one doing the talking. He is in command and is familiar with his culture. Thus the doctor asks the husband to lift the clothing. The husband will either oblige, or will offer a more suitable alternative. My choice would probably be A.

  36. Anonymous permalink

    Oh dang, i posted twice…i guess make that thrice.

  37. C it is folks….I go with C…..and brother CubWrig…you need to read my latest post..especially point number 2….

  38. Anonymous permalink

    C and G are similar. Probabaly G, if not then, F.

  39. It could be G as well, but then, if the guy’s a typical desi uncle, he’ll probably think: so you tink i am lier!!!…hence I chose C….like just get on with it..and ignore the husband…

  40. the answers B i tell u B. lol kr im goni to lay the smack down on ur candy ass remember that. its baqi by the way.

  41. I would choose G. But of course, being a medical student myself, I kinda have some background. E would be my next choice.
    http://www.thealo.com/maloblog Malo’ Doctoring Adventures

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