Title: Usmle Step 1 MCQ's # 20
Subject: Behavioral Science
Q NO 20: A 36-year-old married woman complains to her physician that she is having trouble sleeping. A detailed history shows that her insomnia is sporadic and seems to be connected to cyclical stressors related to her working environment. The physician prescribes alprazolam to be taken “as needed.” The next day, the physician receives a distressed call from the patient. With anger in her voice, she tells the physician that the “pharmacist said that taking this medication might cancel out the effects of my birth control pills.” At this point the physician’s next response should be which of the following?
A. “I’m sorry. This is my fault. The problem is not yew likely given the dose level I prescribed and your only occasional use, but I should have discussed this issue with you before.”
B. “It’s not the pharmacist’s job to be tinkering with your medications. I suggest you have the prescription filled somewhere else.”
C. “Its really such a small chance that it is not worth woring about.”
D, “Really, its nothing to worry about. I’ll call the pharmacist and work it out.”
E. “Really, there is no problem here .Pharmacists just like to show what they know.”
F. “The pharmacist is being overly cautious. As long as you take both medications as I prescribed them for you, you will have no problem.”
G. “Well, if you don’t like the drug I prescribed, what would you rather have?”
H. “You seem angry about this. Tell me more about what you are feeling right now.”
Explanation:
The correct answer is A. Always admit a mistake. In this case the physician erred in not discussing the interaction of the new prescription with other drugs the patient was taking. The right answer starts by admitting the mistake, moves on to provide the necessary information to the patient, and closes by admitting the mistake again. Physicians are only human. Mistakes do unfortunately happen. Within the context of a good relationship with the patient, most mistakes can be openly discussed and corrected. By this discussion, the physician-patient relationship is strengthened.
Choices B, E, and F are defensive. Worse, they do not even acknowledge the mistake, and miss the opportunity’ to educate the patient. Denigrating the pharmacist, who is correctly doing his job, seeks to hide the mistake rather than correcting it.
Choice C provides an explanation without admitting any mistake was made. If the physician wants honesty from the patient, he must provide it in turn. Admit the error and then correct it.
Choice D suggests both that there is no problem, and that the physician will talk with the pharmacist and solve it. It is deceitful. No mistake is admitted, and the chance to educate the patient is lost.
In choice G again, no mistake is admitted. FR at her than educating the patient the physician asks the patient to prescribe for herself. The physician is the one with the expertise, and must lay out options from which the patient can choose. Ideally this should have been done before the alprazolam was prescribed.
Discussing the patient’s feelings (choice H) is off the point, and avoids dealing with the mistake. The error not the patient’s feelings about it, should be the first focus of the discussion.
Subject: Behavioral Science
Q NO 20: A 36-year-old married woman complains to her physician that she is having trouble sleeping. A detailed history shows that her insomnia is sporadic and seems to be connected to cyclical stressors related to her working environment. The physician prescribes alprazolam to be taken “as needed.” The next day, the physician receives a distressed call from the patient. With anger in her voice, she tells the physician that the “pharmacist said that taking this medication might cancel out the effects of my birth control pills.” At this point the physician’s next response should be which of the following?
A. “I’m sorry. This is my fault. The problem is not yew likely given the dose level I prescribed and your only occasional use, but I should have discussed this issue with you before.”
B. “It’s not the pharmacist’s job to be tinkering with your medications. I suggest you have the prescription filled somewhere else.”
C. “Its really such a small chance that it is not worth woring about.”
D, “Really, its nothing to worry about. I’ll call the pharmacist and work it out.”
E. “Really, there is no problem here .Pharmacists just like to show what they know.”
F. “The pharmacist is being overly cautious. As long as you take both medications as I prescribed them for you, you will have no problem.”
G. “Well, if you don’t like the drug I prescribed, what would you rather have?”
H. “You seem angry about this. Tell me more about what you are feeling right now.”
Explanation:
The correct answer is A. Always admit a mistake. In this case the physician erred in not discussing the interaction of the new prescription with other drugs the patient was taking. The right answer starts by admitting the mistake, moves on to provide the necessary information to the patient, and closes by admitting the mistake again. Physicians are only human. Mistakes do unfortunately happen. Within the context of a good relationship with the patient, most mistakes can be openly discussed and corrected. By this discussion, the physician-patient relationship is strengthened.
Choices B, E, and F are defensive. Worse, they do not even acknowledge the mistake, and miss the opportunity’ to educate the patient. Denigrating the pharmacist, who is correctly doing his job, seeks to hide the mistake rather than correcting it.
Choice C provides an explanation without admitting any mistake was made. If the physician wants honesty from the patient, he must provide it in turn. Admit the error and then correct it.
Choice D suggests both that there is no problem, and that the physician will talk with the pharmacist and solve it. It is deceitful. No mistake is admitted, and the chance to educate the patient is lost.
In choice G again, no mistake is admitted. FR at her than educating the patient the physician asks the patient to prescribe for herself. The physician is the one with the expertise, and must lay out options from which the patient can choose. Ideally this should have been done before the alprazolam was prescribed.
Discussing the patient’s feelings (choice H) is off the point, and avoids dealing with the mistake. The error not the patient’s feelings about it, should be the first focus of the discussion.
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