01/22/05 12:47:30 Roxanita Joins Subroom USMLE_Step_1
01/22/05 12:49:13 [USMLE_Step_1] Roxanita: Hi
01/22/05 12:49:36 [USMLE_Step_1] Roxanita: let's see this color
01/22/05 12:49:39 [USMLE_Step_1] Roxanita: ok
01/22/05 12:50:23 [USMLE_Step_1] Roxanita: *choochoo*
01/22/05 13:05:37 usmle_guy Logs in
01/22/05 13:05:38 usmle_guy Joins Subroom USMLE_Step_1
01/22/05 13:06:29 mick Logs in
01/22/05 13:06:29 mick Joins Subroom USMLE_Step_1
01/22/05 13:06:48 [USMLE_Step_1] usmle_guy: hi roxanita and mick
01/22/05 13:06:58 [USMLE_Step_1] mick: hi
01/22/05 13:07:05 clover Logs in
01/22/05 13:07:05 clover Joins Subroom USMLE_Step_1
01/22/05 13:07:07 [USMLE_Step_1] Roxanita: Hi mick and usmle_guy
01/22/05 13:07:13 [USMLE_Step_1] Roxanita: hi Clever
01/22/05 13:07:24 [USMLE_Step_1] Roxanita: wow so punctual huh ?
01/22/05 13:07:25 [USMLE_Step_1] clover: hello
01/22/05 13:07:48 [USMLE_Step_1] mick: hey everyone
01/22/05 13:08:13 [USMLE_Step_1] Roxanita: ok we are 4 so far
01/22/05 13:08:58 [USMLE_Step_1] Roxanita: Did you finish readin, to be honest this can be confusing by the type of questions :/
01/22/05 13:08:59 [USMLE_Step_1] mick: i'm just observing today because didnt get through the material
01/22/05 13:09:23 [USMLE_Step_1] Roxanita: Let's do some questions to warm up ok?
01/22/05 13:09:30 [USMLE_Step_1] clover: i read through some, but didnt finish
01/22/05 13:10:09 [USMLE_Step_1] Roxanita: A 34 y.o. woman with SLE gives instructions to her attorney about how her care should be in the event that she becomes incompetent, this is an example of?
01/22/05 13:10:09 saghar Logs in
01/22/05 13:10:29 saghar Joins Subroom USMLE_Step_1
01/22/05 13:10:41 [USMLE_Step_1] saghar: Hi everybody
01/22/05 13:10:56 [USMLE_Step_1] Roxanita: a) living will b) power of attorney c) willful living d) just want to mess up doctors
01/22/05 13:10:56 [USMLE_Step_1] usmle_guy: hi saghar. good to see you again
01/22/05 13:11:06 [USMLE_Step_1] clover: hello saghar
01/22/05 13:11:10 [USMLE_Step_1] Roxanita: Hi Saghar *welcome*
01/22/05 13:11:12 [USMLE_Step_1] saghar: Hi there
01/22/05 13:11:19 zoya Logs in
01/22/05 13:11:20 [USMLE_Step_1] mick: hi
01/22/05 13:11:24 [USMLE_Step_1] saghar: would u pls repeat the q?
01/22/05 13:11:26 zoya Joins Subroom USMLE_Step_1
01/22/05 13:12:01 [USMLE_Step_1] usmle_guy: living will i think
01/22/05 13:12:07 [USMLE_Step_1] zoya: hi
01/22/05 13:12:17 [USMLE_Step_1] clover: sounds like a
01/22/05 13:12:36 [USMLE_Step_1] mick: living will
01/22/05 13:13:06 [USMLE_Step_1] mick: A 34 y.o. woman with SLE gives instructions to her attorney about how her care should be in the event that she becomes incompetent, this is an example of?
01/22/05 13:13:15 [USMLE_Step_1] Roxanita: 34 y.o. woman with SLE gives instructions to her attorney about how her care should be in the event that she becomes incompetent. This is an example of?
01/22/05 13:13:15 [USMLE_Step_1] mick: that was the question saghar
01/22/05 13:13:21 [USMLE_Step_1] saghar: thanks
01/22/05 13:13:25 [USMLE_Step_1] Roxanita: I can't copy and paste it from my pc
01/22/05 13:13:56 [USMLE_Step_1] saghar: living will
01/22/05 13:14:00 [USMLE_Step_1] mick: you can click on the transcript button which is to the right of the sound button
01/22/05 13:14:15 [USMLE_Step_1] zoya: hi , roxanita,good to see you; how is your dad doing?
01/22/05 13:14:19 [USMLE_Step_1] Roxanita: right guys
01/22/05 13:14:30 [USMLE_Step_1] usmle_guy: hi zoya
01/22/05 13:14:37 [USMLE_Step_1] clover: hello zoya
01/22/05 13:14:44 [USMLE_Step_1] saghar: hi zoya
01/22/05 13:14:50 [USMLE_Step_1] Roxanita: thank you mick
01/22/05 13:14:52 [USMLE_Step_1] mick: hi zoya
01/22/05 13:15:02 [USMLE_Step_1] Roxanita: Hi ZOYA *welcome*
01/22/05 13:16:11 [USMLE_Step_1] Roxanita: ok so Living will are instruments created when a pt is able to make decisions about his or her end-of-life treatment which detail what extraordinary and ordinary treatments the pt wishes to have or not
01/22/05 13:16:22 [USMLE_Step_1] Roxanita: is that correct?
01/22/05 13:16:45 [USMLE_Step_1] usmle_guy: agree
01/22/05 13:16:47 [USMLE_Step_1] saghar: yes
01/22/05 13:16:48 [USMLE_Step_1] Roxanita: What is a DNR?
01/22/05 13:16:52 [USMLE_Step_1] clover: yes
01/22/05 13:16:57 [USMLE_Step_1] mick: yes
01/22/05 13:17:00 [USMLE_Step_1] saghar: do not resucitate
01/22/05 13:17:07 [USMLE_Step_1] usmle_guy: do not resucitate
01/22/05 13:17:12 [USMLE_Step_1] clover: agree
01/22/05 13:17:20 [USMLE_Step_1] mick: do not resucitate
01/22/05 13:18:08 [USMLE_Step_1] Roxanita: right and should it be in the medical chart of this pt?
01/22/05 13:18:21 [USMLE_Step_1] zoya: onlly cardiopulmonary resuscitaion
01/22/05 13:18:35 [USMLE_Step_1] saghar: if that's px wish, yes
01/22/05 13:18:35 [USMLE_Step_1] usmle_guy: yes, but can be given verbally
01/22/05 13:18:49 [USMLE_Step_1] clover: yep
01/22/05 13:18:50 [USMLE_Step_1] Roxanita: Do Narcotics go against this DNR?
01/22/05 13:18:59 [USMLE_Step_1] zoya: yes
01/22/05 13:19:01 [USMLE_Step_1] clover: no, different matter
01/22/05 13:19:03 [USMLE_Step_1] saghar: no
01/22/05 13:19:07 [USMLE_Step_1] usmle_guy: no
01/22/05 13:19:44 [USMLE_Step_1] Roxanita: Dosages of Narcotics, which may hasten death, may be appropriate for pain control if a pt is "DNR"
01/22/05 13:20:03 [USMLE_Step_1] zoya: it doesn't include pain medication
01/22/05 13:20:08 [USMLE_Step_1] Roxanita: this question was from Exam Master nice right?
01/22/05 13:20:16 [USMLE_Step_1] zoya: yep
01/22/05 13:20:19 [USMLE_Step_1] clover: good question
01/22/05 13:20:22 [USMLE_Step_1] saghar: yes. thanks
01/22/05 13:20:36 [USMLE_Step_1] mick: important in real world too because happens all the time
01/22/05 13:20:40 [USMLE_Step_1] usmle_guy: in ethical issues determining who makes decisions for incompetant pt, is it more important to use the next of kin, or the person who is most likely to represent pts own wishes, regardless of relation to patient?
01/22/05 13:21:17 [USMLE_Step_1] clover: person who is most likely to represent patients wishes is more important
01/22/05 13:21:24 [USMLE_Step_1] saghar: the person who knows pt more and represent px wishes is more important
01/22/05 13:21:32 [USMLE_Step_1] saghar: regardless of relation
01/22/05 13:21:40 [USMLE_Step_1] zoya: most likely to represent
01/22/05 13:21:55 [USMLE_Step_1] mick: again, in real life this comes up all the time. it should be the person who represent wishes, but often it ends up being the family's wishes instead ;(
01/22/05 13:22:14 [USMLE_Step_1] usmle_guy: yes all correct
01/22/05 13:22:23 [USMLE_Step_1] saghar: that's true
01/22/05 13:23:24 [USMLE_Step_1] Roxanita: A schizophrenic outpatient comes to visit his doctor to ask for advice. He states that he has been experiencing many negative side effects from the Haloperidol he is taking. He is experiencing tardive dyskinesia.
01/22/05 13:23:30 [USMLE_Step_1] mick: in real life, try to get the wishes from your patient while still competant and document it in case the person ever becomes incompetant
01/22/05 13:25:17 [USMLE_Step_1] Roxanita: He asks his doctor if it would be all right if he entered a double blind study on the effects of a new schizophrenic drug. One group would not receive any treatment and the other group would receive the experimental drug.
01/22/05 13:25:29 [USMLE_Step_1] Roxanita: What would you do?
01/22/05 13:26:25 [USMLE_Step_1] Roxanita: any ideas, can he qualify for the study?
01/22/05 13:26:38 [USMLE_Step_1] usmle_guy: can he be in the study if he has already taken the drug?
01/22/05 13:27:02 [USMLE_Step_1] Roxanita: this study will try a new drug
01/22/05 13:27:12 [USMLE_Step_1] zoya: he can,
01/22/05 13:27:16 [USMLE_Step_1] saghar: tough one, rox..
01/22/05 13:27:42 [USMLE_Step_1] Roxanita: well in this case remember, first the pt and second the patient, and third ...again the patient
01/22/05 13:27:52 [USMLE_Step_1] usmle_guy: sounds like there might be a little selection bias since he already has that reaction to a similar drug
01/22/05 13:27:59 [USMLE_Step_1] Roxanita: The study would be too risky considering his current condition. Look at alternative drugs with less side effects until the new drug has been tested.
01/22/05 13:28:23 [USMLE_Step_1] saghar: good q!
01/22/05 13:28:26 [USMLE_Step_1] Roxanita: ok Guys that was a little warm up, let's discuss
01/22/05 13:28:46 [USMLE_Step_1] Roxanita: ETHICAL & LEGAL ISSUES
01/22/05 13:28:52 [USMLE_Step_1] usmle_guy: that was warm up? those were very good questions rox
01/22/05 13:28:58 [USMLE_Step_1] Roxanita: very important point in the exam huh
01/22/05 13:29:18 [USMLE_Step_1] Roxanita: warm up because it made me sweat *)
01/22/05 13:29:29 [USMLE_Step_1] saghar: lol
01/22/05 13:29:46 [USMLE_Step_1] zoya:
01/22/05 13:30:01 [USMLE_Step_1] Roxanita: who can say something about Infant Doe case?
01/22/05 13:30:38 [USMLE_Step_1] usmle_guy: parents withholding treatment
01/22/05 13:30:54 [USMLE_Step_1] Roxanita: This fatal error in the past left the general rule: Parents can not withhold life from their children
01/22/05 13:31:01 [USMLE_Step_1] Roxanita: Right usmle_guy
01/22/05 13:31:06 [USMLE_Step_1] clover: parents cant withhold treatment if life or limb saving
01/22/05 13:31:06 thomda Logs in
01/22/05 13:31:10 [USMLE_Step_1] zoya: i am haven't read today, so most of my answers are wrong , sorry for that.
01/22/05 13:31:26 [USMLE_Step_1] Roxanita: poor down baby, what if he had just a mild M.R. you never know
01/22/05 13:31:37 [USMLE_Step_1] mick: i haven't read it either, so sorry in advance
01/22/05 13:31:55 [USMLE_Step_1] saghar: if a mother of 15 mo/o baby says she does not want her baby to vaccinate what you should do?
01/22/05 13:31:57 [USMLE_Step_1] usmle_guy: no prob, as long as we're all learning
01/22/05 13:32:00 [USMLE_Step_1] Roxanita: Guys don't worry about it, this questions will help us so much, just stay
01/22/05 13:32:18 [USMLE_Step_1] zoya: thanks
01/22/05 13:32:40 [USMLE_Step_1] usmle_guy: do not vaccinate, but ask why
01/22/05 13:32:53 [USMLE_Step_1] Roxanita: to bridge the vaccine wont kill the baby
01/22/05 13:33:10 [USMLE_Step_1] saghar: yes, first explain the outcome to mother and if she still refuses, DO NOT VACCINATE but write down in her chart....
01/22/05 13:33:21 thomda Logs Out
01/22/05 13:33:32 [USMLE_Step_1] usmle_guy: as far as tarasoff decision (duty to warn and protect), what should the doctor/conselor do. try to detain person making threat, call police, notify and warn potential victim, none of above, all of above, 2 of above?
01/22/05 13:33:50 [USMLE_Step_1] Roxanita: In the case of Roe vs Wade: The pt decides.... as everybody knows Abortion is legal in US but
01/22/05 13:33:57 [USMLE_Step_1] clover: all of above and in that order
01/22/05 13:34:06 [USMLE_Step_1] Roxanita: ABortion is not a exam issue
01/22/05 13:34:14 [USMLE_Step_1] Roxanita: so, let's skip it
01/22/05 13:34:33 [USMLE_Step_1] mick: good thats one less thing to worry about studying for exam
01/22/05 13:34:34 [USMLE_Step_1] Roxanita: all above
01/22/05 13:34:41 [USMLE_Step_1] zoya: all
01/22/05 13:34:46 [USMLE_Step_1] Roxanita: yeah
01/22/05 13:34:49 [USMLE_Step_1] saghar: all the above
01/22/05 13:34:53 [USMLE_Step_1] mick: you need to detain the person too?
01/22/05 13:34:58 [USMLE_Step_1] Roxanita: and right in that order
01/22/05 13:35:09 [USMLE_Step_1] zoya: yes
01/22/05 13:35:11 [USMLE_Step_1] Roxanita: but don't say like "somebody is going to kill you"
01/22/05 13:35:19 [USMLE_Step_1] usmle_guy: yes, all of the above you are responsible to do to protect and warn potential victims
01/22/05 13:35:50 [USMLE_Step_1] Roxanita: just tell the possible victim to get away from the place and go to a safe place, maybe the police station?
01/22/05 13:36:14 [USMLE_Step_1] Roxanita: I remember Daugherty said that :/
01/22/05 13:36:48 [USMLE_Step_1] Roxanita: And now the Rules:............. *)
01/22/05 13:37:21 [USMLE_Step_1] Roxanita: RULE 1 : "Competent patients have the right to refuse medical treatment"
01/22/05 13:37:34 [USMLE_Step_1] clover: is a convicted criminal competent for his/her own medical treatment?
01/22/05 13:38:04 [USMLE_Step_1] usmle_guy: yes assuming nothing else preventing competence
01/22/05 13:38:07 [USMLE_Step_1] saghar: yes
01/22/05 13:38:09 [USMLE_Step_1] zoya: yes
01/22/05 13:38:14 [USMLE_Step_1] mick: yes
01/22/05 13:38:23 [USMLE_Step_1] clover: yep, good
01/22/05 13:38:28 [USMLE_Step_1] Roxanita: yes
01/22/05 13:39:51 [USMLE_Step_1] Roxanita: that's a good question clever
01/22/05 13:40:18 [USMLE_Step_1] saghar: competency can only be decided by court of law
01/22/05 13:40:27 [USMLE_Step_1] Roxanita: Competent is a legal decision, but if a suicidal comes to the emg you got to help him even if he refuses
01/22/05 13:40:28 [USMLE_Step_1] usmle_guy: what about a pt who comes in after trying to commit suicide and then insists that she wants to leave the hospital right away. is she competant to make this decision?
01/22/05 13:40:52 [USMLE_Step_1] Roxanita: you read my mind
01/22/05 13:40:53 [USMLE_Step_1] usmle_guy: you gave away the answer rox
01/22/05 13:41:01 [USMLE_Step_1] usmle_guy: lol
01/22/05 13:41:11 [USMLE_Step_1] Roxanita: Good guys
01/22/05 13:41:34 [USMLE_Step_1] mick: i didnt know the answer before, but now i will "guess" the person is not competent
01/22/05 13:41:43 [USMLE_Step_1] Roxanita: RULE 2 : Assume that the pt is competent unless clear behavior evidence indicates otherwise.
01/22/05 13:41:47 [USMLE_Step_1] usmle_guy: good guess mick
01/22/05 13:42:11 [USMLE_Step_1] saghar: yes attempted suicide considered incompetent.
01/22/05 13:42:48 [USMLE_Step_1] usmle_guy: yes saghar, thats correct
01/22/05 13:43:21 [USMLE_Step_1] Roxanita: just remember if you have doubt about it just assume is competent ok
01/22/05 13:43:30 [USMLE_Step_1] saghar: also a px who is grossly dysfunctional and psychotic.
01/22/05 13:44:10 [USMLE_Step_1] Roxanita: RULE 3 : AVOID GOING TO COURT
01/22/05 13:44:41 [USMLE_Step_1] clover: if a patient refuses life saving treatment on religious grounds, what should you do?
01/22/05 13:44:50 [USMLE_Step_1] Roxanita: one issue would be to decide the competence of a pt
01/22/05 13:44:57 [USMLE_Step_1] usmle_guy: don't treat
01/22/05 13:45:11 [USMLE_Step_1] Roxanita: yea, don't treat
01/22/05 13:45:18 [USMLE_Step_1] mick: agree, dont treat
01/22/05 13:45:21 [USMLE_Step_1] saghar: if you have a writing from px then u have to foolow px's wishes
01/22/05 13:45:31 [USMLE_Step_1] zoya: don't treat
01/22/05 13:45:43 [USMLE_Step_1] clover: yep, assuming competent, dont treat
01/22/05 13:45:53 [USMLE_Step_1] Roxanita: Remember, in the exam answers you don't go to court
01/22/05 13:45:57 [USMLE_Step_1] saghar: it's the case of blood transfusion in jehovah's withness person
01/22/05 13:45:59 [USMLE_Step_1] Roxanita: all the time
01/22/05 13:46:35 [USMLE_Step_1] clover: what about if wife refuses consent to emergency life saving treatment for unconscious husband citing religious grounds?
01/22/05 13:46:53 [USMLE_Step_1] Roxanita: x.e. what if a child in the emg is really sick and his parents ask your permission to take him to pray?
01/22/05 13:47:02 [USMLE_Step_1] saghar: if they have it in writing, do not treat, if no, treat the px
01/22/05 13:47:22 [USMLE_Step_1] usmle_guy: in emergency situation, i think you need to treat
01/22/05 13:47:25 [USMLE_Step_1] zoya: it's emergency situation,so treat
01/22/05 13:47:35 [USMLE_Step_1] Roxanita: I am not sure clever :/
01/22/05 13:47:59 [USMLE_Step_1] clover: treat because no time to assess substituted judgement
01/22/05 13:48:15 rsandhu Logs in
01/22/05 13:48:15 rsandhu Joins Subroom USMLE_Step_1
01/22/05 13:48:16 rsandhu Logs Out
01/22/05 13:48:19 [USMLE_Step_1] saghar: praying is good but not when child's life is in danger
01/22/05 13:48:29 [USMLE_Step_1] Roxanita: in the case of the child you can contact the court asap and treat the child
01/22/05 13:48:30 [USMLE_Step_1] usmle_guy: take him where to pray. is the child in danger
01/22/05 13:48:37 [USMLE_Step_1] saghar: so treat the child first.
01/22/05 13:49:15 [USMLE_Step_1] Roxanita: that's when we should go to court but other than that remember ..in the exam we don't go to court all the time
01/22/05 13:50:20 [USMLE_Step_1] Roxanita: RULE 4: When surrogates make decisions for a pt
01/22/05 13:50:24 rsandhu Logs in
01/22/05 13:50:25 rsandhu Logs Out
01/22/05 13:50:30 [USMLE_Step_1] clover: what if same wife produces card stating unconscious husbands wishes to not be treated on religious grounds?
01/22/05 13:50:35 [USMLE_Step_1] Roxanita: the criteria remember?
01/22/05 13:50:57 [USMLE_Step_1] zoya: don't treat
01/22/05 13:50:57 [USMLE_Step_1] usmle_guy: if produces written statement, dont treat
01/22/05 13:51:05 [USMLE_Step_1] mick: do not treat
01/22/05 13:51:08 saghar Logs Out
01/22/05 13:51:17 [USMLE_Step_1] Roxanita: this stuff with religion make me nuts
01/22/05 13:51:24 saghar Logs in
01/22/05 13:51:30 saghar Joins Subroom USMLE_Step_1
01/22/05 13:51:43 [USMLE_Step_1] saghar: sorry I got disconnected.
01/22/05 13:51:52 [USMLE_Step_1] clover: thats the way the questions were written
01/22/05 13:52:09 [USMLE_Step_1] clover: thats right, dont treat
01/22/05 13:52:30 [USMLE_Step_1] Roxanita: in the case of this wife that drives me nuts if it's not an emg we can't intervene, we need the court's permission
01/22/05 13:53:12 rsandhu Logs in
01/22/05 13:53:21 rsandhu Joins Subroom USMLE_Step_1
01/22/05 13:53:29 [USMLE_Step_1] Roxanita: RULE 5 : If Patient is incompetent, physician may rely on advance directives
01/22/05 13:53:29 [USMLE_Step_1] rsandhu: hi
01/22/05 13:53:31 [USMLE_Step_1] clover: but even if emg and she produces a card stating his wishes, you are not supposed to treat
01/22/05 13:53:40 [USMLE_Step_1] clover: hi rsandhu
01/22/05 13:53:41 [USMLE_Step_1] saghar: but if it signs by px, we have to follow, it's like a will... but rather than I agree if it's not emergency go to court.
01/22/05 13:54:23 [USMLE_Step_1] usmle_guy: hi rsandhu, *welcome*
01/22/05 13:54:26 [USMLE_Step_1] zoya: hi,rsandhu
01/22/05 13:54:29 [USMLE_Step_1] rsandhu: i am new to this.....today is first time
01/22/05 13:54:37 [USMLE_Step_1] rsandhu: hi
01/22/05 13:54:38 [USMLE_Step_1] saghar: Hi rsandhu
01/22/05 13:54:41 [USMLE_Step_1] mick: hi rsandu
01/22/05 13:54:49 [USMLE_Step_1] Roxanita: Hi rsandhu *welcome*
01/22/05 13:54:54 [USMLE_Step_1] rsandhu: thx
01/22/05 13:55:10 [USMLE_Step_1] Roxanita: hey clever I have doubts now
01/22/05 13:55:16 [USMLE_Step_1] usmle_guy: we're discussing the ethical issues in behavioral science. feel free to join in or observe
01/22/05 13:55:27 [USMLE_Step_1] rsandhu: oh k..thx
01/22/05 13:55:40 [USMLE_Step_1] clover: what doubts rox?
01/22/05 13:56:33 [USMLE_Step_1] Roxanita: let's see this: A 75 y.o. man with chronic renal disease designates his wife of 45y to make the decisions about his care in the event that he becomes incompetent, this is an example of?
01/22/05 13:57:00 [USMLE_Step_1] saghar: serogate
01/22/05 13:57:03 [USMLE_Step_1] usmle_guy: basically, in emergency treatment, unless very clear evidence like a written will or DNR, etc, give treatment because no time to decide. but if clear evidence, do not treat if that was the patients wishes and its well documented
01/22/05 13:57:08 [USMLE_Step_1] Roxanita: a)Living will b) Durable power of attorney
01/22/05 13:57:50 [USMLE_Step_1] usmle_guy: durable power of attorney i think
01/22/05 13:57:52 [USMLE_Step_1] saghar: pawer of attorney
01/22/05 13:58:01 [USMLE_Step_1] clover: power of attorney
01/22/05 13:58:07 [USMLE_Step_1] mick: agree
01/22/05 13:58:12 [USMLE_Step_1] rsandhu: yup
01/22/05 13:58:15 [USMLE_Step_1] Roxanita: things are so easy like this but with this wife's stuff
01/22/05 13:58:47 [USMLE_Step_1] Roxanita: I don't understand that card state or something?
01/22/05 13:59:07 [USMLE_Step_1] Roxanita: can anybody explain that please?
01/22/05 13:59:11 [USMLE_Step_1] mick: as i said, in real life this is a big issue because the family's wishes often gets in the way. but for exam, you must figure out the patients wishes, not the family's, and abide by them
01/22/05 13:59:44 [USMLE_Step_1] Roxanita: and what about that card ?
01/22/05 14:00:05 [USMLE_Step_1] clover: the card stating something means that it is an official document by the patient stating his/her wishes. it should be treated as patients own words
01/22/05 14:00:56 [USMLE_Step_1] saghar: now I have a q, if you as a px physician see that the person with power of attorney's decision is not the best px interest what you should do?
01/22/05 14:01:04 [USMLE_Step_1] Roxanita: even in a situation of EMG?
01/22/05 14:01:04 [USMLE_Step_1] usmle_guy: a DNR can be presented on a "card" signed by the pt beforehand
01/22/05 14:01:17 [USMLE_Step_1] zoya: yes ,rox
01/22/05 14:01:27 [USMLE_Step_1] Roxanita: go to court?
01/22/05 14:01:48 [USMLE_Step_1] saghar: I don't have the answer, I am just asking..
01/22/05 14:01:51 [USMLE_Step_1] usmle_guy: its the patients wishes when he or she was competant to make them, so it takes priority over everything else that the wife or anyone else wants
01/22/05 14:01:59 [USMLE_Step_1] Roxanita: it's great to have you guys, I clarify my doubts
01/22/05 14:02:06 [USMLE_Step_1] zoya: you can go to courrt
01/22/05 14:02:58 [USMLE_Step_1] Roxanita: the rule 3 says "avoid going to court" but for these cases when you have conflicts about what's best for the pt you should go
01/22/05 14:03:05 [USMLE_Step_1] usmle_guy: its not about best interest of patient, its about the the patients wishes. if he wishes to not be treated, that is clearly not in the best interest, but it is the pts wish
01/22/05 14:03:38 [USMLE_Step_1] Roxanita: I mean when we don't have something documented
01/22/05 14:04:23 [USMLE_Step_1] Roxanita: In fact 2 are the situations when we should go to court:
01/22/05 14:04:28 [USMLE_Step_1] mick: we deal with this all the time. our attending always ask "what does the family want?
01/22/05 14:04:28 [USMLE_Step_1] rsandhu: then u treat the patient
01/22/05 14:04:43 [USMLE_Step_1] mick: that is not correct. you should ask "what does the pt want"
01/22/05 14:05:10 [USMLE_Step_1] Roxanita: 1)to determine Competence 2) conflict of interests between surrogate and pt's interests
01/22/05 14:05:16 [USMLE_Step_1] mick: the family's input should be based on knowing the pt best and communicating the pts wishes, not their own
01/22/05 14:05:57 [USMLE_Step_1] usmle_guy: agree with mick
01/22/05 14:06:03 [USMLE_Step_1] Roxanita: This kind of questions drive me nuts
01/22/05 14:06:11 [USMLE_Step_1] saghar: yeah... me too..
01/22/05 14:06:21 [USMLE_Step_1] saghar: ok, let's move on...
01/22/05 14:06:25 [USMLE_Step_1] usmle_guy: ethics questions are heavily tested and not always clearly defined
01/22/05 14:06:29 [USMLE_Step_1] zoya: :<
01/22/05 14:07:28 [USMLE_Step_1] saghar: in the case of anorexia nervosa, what you do if: 1- px is minor 2- px is an adult?
01/22/05 14:07:29 [USMLE_Step_1] Roxanita: if anybody has a question about this I would appreciate it
01/22/05 14:07:37 [USMLE_Step_1] Roxanita: treat both
01/22/05 14:08:03 [USMLE_Step_1] clover: treat
01/22/05 14:08:26 [USMLE_Step_1] usmle_guy: is pt or parents refusing treatment?
01/22/05 14:08:42 [USMLE_Step_1] saghar: px refuses
01/22/05 14:08:59 [USMLE_Step_1] usmle_guy: is it emergency?
01/22/05 14:09:16 [USMLE_Step_1] saghar: 1- px is not legally competent --> treat.... 2- go to court
01/22/05 14:09:35 [USMLE_Step_1] zoya: rt
01/22/05 14:09:53 [USMLE_Step_1] usmle_guy: if patient is minor and refuses treatment, but parents want treatment, then treat
01/22/05 14:10:09 [USMLE_Step_1] saghar: yes, that's right usmle_guy
01/22/05 14:10:09 [USMLE_Step_1] zoya: in emergency even if adult treat
01/22/05 14:10:44 [USMLE_Step_1] zoya: am i right?
01/22/05 14:11:15 [USMLE_Step_1] usmle_guy: there are many factors that can change the answer. for example, 17 year old living alone vs living with parents, emergency vs non emergency, etc
01/22/05 14:11:23 [USMLE_Step_1] saghar: yes, in case of emergeny you should treat I guess
01/22/05 14:11:55 [USMLE_Step_1] rsandhu: mother refuses to consent to emergency lifesaving tx for her daughter on religious grounds? wht should u do?
01/22/05 14:12:09 [USMLE_Step_1] clover: treat
01/22/05 14:12:14 [USMLE_Step_1] usmle_guy: treat
01/22/05 14:12:15 [USMLE_Step_1] zoya: treat
01/22/05 14:12:18 [USMLE_Step_1] mick: treat
01/22/05 14:12:21 [USMLE_Step_1] saghar: treat for sure
01/22/05 14:13:06 [USMLE_Step_1] Roxanita: I will post some questions about this in the forum for behav sci ok?
01/22/05 14:13:17 [USMLE_Step_1] rsandhu: kool thx
01/22/05 14:13:17 [USMLE_Step_1] zoya: great
01/22/05 14:13:24 [USMLE_Step_1] usmle_guy: ok, good idea to post in forum
01/22/05 14:13:44 [USMLE_Step_1] rsandhu: wht is partial emancipation?
01/22/05 14:14:53 [USMLE_Step_1] Roxanita: RULE 5 : If pt is incompetent, phys may rely on advance directives
01/22/05 14:15:14 [USMLE_Step_1] Roxanita: we did it already: This can be Oral, Living will, Health power of attorney
01/22/05 14:15:15 [USMLE_Step_1] usmle_guy: i think that has to do with having legal independence to make decisions for people in gray areas like the 17 year old who lives alone or is married, etc
01/22/05 14:15:43 [USMLE_Step_1] usmle_guy: but not sure
01/22/05 14:15:54 [USMLE_Step_1] rsandhu: that is emancipated minor
01/22/05 14:16:01 [USMLE_Step_1] Roxanita: RULE 6: FEEDING TUBE IS A MEDICAL TREATMENT AND CAN BE WITHDRAWN AT THE Pt REQUEST
01/22/05 14:16:26 [USMLE_Step_1] Roxanita: SO this pt can refuse nutrition or hydration
01/22/05 14:16:56 [USMLE_Step_1] Roxanita: SO....they can refuse Nutrition
01/22/05 14:16:56 [USMLE_Step_1] saghar: right
01/22/05 14:17:01 [USMLE_Step_1] usmle_guy: a child is free to make his own decisions about himself, but is still entitled to financial support from his parents.
01/22/05 14:17:02 [USMLE_Step_1] rsandhu: turn off life support..... ethical? or legal?
01/22/05 14:17:14 [USMLE_Step_1] zoya: applicable for sub drug tx ,prenatal care,std tx, birth control.
01/22/05 14:17:31 [USMLE_Step_1] rsandhu: ok
01/22/05 14:18:07 [USMLE_Step_1] usmle_guy: that is the definition of partial emancipation....right?
01/22/05 14:18:20 [USMLE_Step_1] saghar: right
01/22/05 14:18:37 [USMLE_Step_1] clover: legal rsandhu
01/22/05 14:18:40 [USMLE_Step_1] Roxanita: RULE 7: DO NOTHING TO ACTIVELY ASSIST THE PATIENT TO DIE SOONER
01/22/05 14:18:50 [USMLE_Step_1] zoya: rt, usmle and also in many states it's 16 or older
01/22/05 14:19:11 [USMLE_Step_1] saghar: guys just wanted to mention that military service is counted as emanicipated minor also...
01/22/05 14:19:29 [USMLE_Step_1] Roxanita: that's right
01/22/05 14:19:30 [USMLE_Step_1] usmle_guy: thanks
01/22/05 14:19:58 [USMLE_Step_1] zoya: yes but these are groud for partial emancipation
01/22/05 14:20:05 [USMLE_Step_1] rsandhu: u can give something to relieve pain, but cant add something to end their life quick
01/22/05 14:20:09 [USMLE_Step_1] Roxanita: RULE 8 : The physician decides when the pt is dead
01/22/05 14:20:52 [USMLE_Step_1] Roxanita: cortically dead, treatment must stop
01/22/05 14:21:05 [USMLE_Step_1] Roxanita: even if the family insist
01/22/05 14:21:17 [USMLE_Step_1] saghar: in the case of clear cortical death, even if family still hoping for another specialist --> call the death.
01/22/05 14:21:17 [USMLE_Step_1] Roxanita: RULE 9: NEVER ABANDON A PT
01/22/05 14:21:38 [USMLE_Step_1] Roxanita: You can't say "I can't be your doctor"
01/22/05 14:21:48 [USMLE_Step_1] zoya: but if the surrogate insists
01/22/05 14:22:03 [USMLE_Step_1] Roxanita: remember "once they are your pt they will always be
01/22/05 14:22:18 [USMLE_Step_1] Roxanita: yes, call the death
01/22/05 14:22:36 [USMLE_Step_1] Roxanita: RULE 10: ALWAYS OBTAIN INFORMED CONSENT
01/22/05 14:22:50 [USMLE_Step_1] saghar: but if u can't continue to be her/his doctor u have to make arrengement and make sure he/she will be taken care of...
01/22/05 14:22:56 [USMLE_Step_1] Roxanita: Full informed consent requires??? *choochoo*
01/22/05 14:23:25 [USMLE_Step_1] saghar: that px understood these:
01/22/05 14:23:31 [USMLE_Step_1] Roxanita: yes x.e if you move be sure that they will be taken care
01/22/05 14:23:32 [USMLE_Step_1] rsandhu: benefits
01/22/05 14:23:37 [USMLE_Step_1] Roxanita: ok
01/22/05 14:23:38 [USMLE_Step_1] rsandhu: risks
01/22/05 14:23:41 [USMLE_Step_1] Roxanita: ok
01/22/05 14:23:50 [USMLE_Step_1] saghar: 1- nature 2- purpose 3- benefits 4- riskd 5- availability
01/22/05 14:23:53 [USMLE_Step_1] usmle_guy: received and UNDERSTOOD info....nature of procedure, purpose, benefits, risks, availability of alternatives
01/22/05 14:24:16 [USMLE_Step_1] Roxanita: We have 4 exceptions to informed consent: which are??? *choochoo*
01/22/05 14:24:26 [USMLE_Step_1] rsandhu: emergency
01/22/05 14:24:27 [USMLE_Step_1] Roxanita: that was right saghar
01/22/05 14:24:29 [USMLE_Step_1] usmle_guy: emergency
01/22/05 14:24:33 [USMLE_Step_1] rsandhu: waiver by pt
01/22/05 14:24:51 [USMLE_Step_1] saghar: emergency, waiver by px, px is incompetent and theraputic privilage
01/22/05 14:24:54 [USMLE_Step_1] clover: emergency, waiver by pt, incompetence, therapeutic privilege
01/22/05 14:24:54 [USMLE_Step_1] Roxanita: x.e in research right?
01/22/05 14:25:15 [USMLE_Step_1] usmle_guy: agree
01/22/05 14:25:29 [USMLE_Step_1] Roxanita: they agree not to sign the paper b/c they don't really know the results
01/22/05 14:25:33 [USMLE_Step_1] rsandhu: consent can be oral
01/22/05 14:25:39 [USMLE_Step_1] Roxanita: yes
01/22/05 14:25:52 [USMLE_Step_1] Roxanita: another exception to informed consent?
01/22/05 14:25:55 [USMLE_Step_1] usmle_guy: agree, consent can be oral
01/22/05 14:26:20 [USMLE_Step_1] rsandhu: can be revoked orally
01/22/05 14:26:52 [USMLE_Step_1] Roxanita: also when *)pt is incompetent 8) Therapeutic privilege (unconscious)
01/22/05 14:27:03 rsandhu Logs Out
01/22/05 14:27:06 [USMLE_Step_1] Roxanita: right
01/22/05 14:27:13 rsandhu Logs in
01/22/05 14:27:24 rsandhu Joins Subroom USMLE_Step_1
01/22/05 14:27:29 [USMLE_Step_1] Roxanita: RULE 11: SPECIAL RULES APPLY FOR CHILDREN
01/22/05 14:28:02 [USMLE_Step_1] Roxanita: we talked about this already: < 18y.o. ; Exceptions: emancipated minors ; partial emancipation
01/22/05 14:28:15 [USMLE_Step_1] saghar: right
01/22/05 14:28:36 [USMLE_Step_1] Roxanita: RULE 12: PARENTS CAN NOT WHITHHOLD LIFE - or LIMB-SAVING TREATMENT FROM THEIR CHILDREN
01/22/05 14:29:03 [USMLE_Step_1] Roxanita: What is parents refuse Treatment in an emg ?
01/22/05 14:29:12 [USMLE_Step_1] Roxanita: if is immediate EMG?
01/22/05 14:29:18 [USMLE_Step_1] clover: treat
01/22/05 14:29:20 [USMLE_Step_1] zoya: treat
01/22/05 14:29:23 [USMLE_Step_1] rsandhu: treat
01/22/05 14:29:29 [USMLE_Step_1] saghar: treat
01/22/05 14:29:32 [USMLE_Step_1] Roxanita: yup.GO AHEAD AND TREAT THE POOR CHILD
01/22/05 14:29:35 [USMLE_Step_1] clover: if life or limb saving emergency
01/22/05 14:29:53 [USMLE_Step_1] Roxanita: If not immediate but critical?
01/22/05 14:30:03 [USMLE_Step_1] zoya: go to court
01/22/05 14:30:07 [USMLE_Step_1] rsandhu: get court permission
01/22/05 14:30:08 [USMLE_Step_1] Roxanita: We need the court
01/22/05 14:30:08 [USMLE_Step_1] usmle_guy: court
01/22/05 14:30:15 [USMLE_Step_1] Roxanita: All Right
01/22/05 14:30:15 [USMLE_Step_1] clover: go to court
01/22/05 14:30:17 [USMLE_Step_1] saghar: court
01/22/05 14:30:30 [USMLE_Step_1] Roxanita: If not life threatening?
01/22/05 14:30:41 [USMLE_Step_1] saghar: listen to parent
01/22/05 14:30:42 [USMLE_Step_1] usmle_guy: do not treat
01/22/05 14:30:48 [USMLE_Step_1] clover: dont treat
01/22/05 14:30:51 [USMLE_Step_1] rsandhu: do wht parents say
01/22/05 14:30:53 [USMLE_Step_1] Roxanita: yes, listen to the parents...right!
01/22/05 14:30:59 [USMLE_Step_1] mick: listen to parent
01/22/05 14:31:03 [USMLE_Step_1] Roxanita: Do children decide to take or not the treatment?
01/22/05 14:31:09 [USMLE_Step_1] zoya: no
01/22/05 14:31:20 [USMLE_Step_1] mick: no
01/22/05 14:31:21 [USMLE_Step_1] saghar: no
01/22/05 14:31:24 [USMLE_Step_1] usmle_guy: no
01/22/05 14:31:28 [USMLE_Step_1] clover: no
01/22/05 14:31:37 [USMLE_Step_1] saghar: they can't give permission
01/22/05 14:31:48 [USMLE_Step_1] Roxanita: RULE 13: FOR USMLE: ISSUES GOVERNED BY LAWS THAT VARY WIDELY ACROSS STATES CAN NOT BE TESTES
01/22/05 14:32:01 [USMLE_Step_1] Roxanita: TESTED I mean
01/22/05 14:32:09 [USMLE_Step_1] usmle_guy: lol
01/22/05 14:32:15 [USMLE_Step_1] Roxanita: sorry
01/22/05 14:32:22 [USMLE_Step_1] saghar: lol
01/22/05 14:32:28 [USMLE_Step_1] Roxanita: ok..enough
01/22/05 14:32:49 [USMLE_Step_1] Roxanita: that was just to wake up everybody *choochoo*
01/22/05 14:33:12 [USMLE_Step_1] Roxanita: ok. so difference between states we don't care for the exam
01/22/05 14:33:39 [USMLE_Step_1] Roxanita: RULE !$: GOOD SAMARITAN LAWS LINIT LIABILITY IN NONMEDICAL SETTINGS
01/22/05 14:33:46 [USMLE_Step_1] mick: like abortion or legal drinking age
01/22/05 14:33:49 [USMLE_Step_1] saghar: good, I wish we had more like this...
01/22/05 14:33:49 [USMLE_Step_1] Roxanita: that was RULE 15
01/22/05 14:33:57 [USMLE_Step_1] Roxanita: right mick
01/22/05 14:34:23 [USMLE_Step_1] Roxanita: RULE 15: GOOD SAMARITAN,...somebody?
01/22/05 14:34:47 [USMLE_Step_1] Roxanita: ok. they say: You are not required to stop to help..........BUT
01/22/05 14:34:51 [USMLE_Step_1] usmle_guy: are you required to stop and help at the scene of an accident?
01/22/05 14:34:58 [USMLE_Step_1] zoya: not requiered
01/22/05 14:35:05 [USMLE_Step_1] Roxanita: USMLE like you to stop
01/22/05 14:35:09 [USMLE_Step_1] saghar: no
01/22/05 14:35:13 [USMLE_Step_1] Roxanita: Daugherty words
01/22/05 14:35:17 [USMLE_Step_1] usmle_guy: did it again lol
01/22/05 14:35:19 [USMLE_Step_1] saghar: but you don't have to..
01/22/05 14:35:36 [USMLE_Step_1] clover: not required
01/22/05 14:36:08 [USMLE_Step_1] Roxanita: But your good samaritan spirit makes you stop...immediately you will be protected from?
01/22/05 14:36:58 [USMLE_Step_1] saghar: liability
01/22/05 14:37:06 [USMLE_Step_1] Roxanita: well....You will be protected if:
01/22/05 14:37:12 [USMLE_Step_1] clover: protected from liability assuming you dont take any money, only do what is within your training, stay until relief arrives, only accepted procedures
01/22/05 14:37:22 [USMLE_Step_1] Roxanita: 1) your actions are within physician's competence
01/22/05 14:37:23 [USMLE_Step_1] usmle_guy: agree
01/22/05 14:37:30 [USMLE_Step_1] zoya: yes
01/22/05 14:37:34 [USMLE_Step_1] Roxanita: 2) Only accepeted procedure are performed
01/22/05 14:37:38 [USMLE_Step_1] saghar: yes, whithin your abilities and competence..
01/22/05 14:38:03 [USMLE_Step_1] Roxanita: not even accept gifts no matter how small or big they are
01/22/05 14:38:19 tmt33 Logs in
01/22/05 14:38:19 [USMLE_Step_1] clover: only 30 mins left and we sill have another chapter
01/22/05 14:38:47 [USMLE_Step_1] Roxanita: can you guys stay 30 more min?
01/22/05 14:38:50 [USMLE_Step_1] saghar: the other chapter is small...
01/22/05 14:38:56 tmt33 Logs Out
01/22/05 14:39:01 [USMLE_Step_1] saghar: yes, I can
01/22/05 14:39:04 [USMLE_Step_1] Roxanita: consider this is a must in the exam
01/22/05 14:39:21 [USMLE_Step_1] clover: true, other chapter is small, but still need some time to cover
01/22/05 14:39:35 [USMLE_Step_1] Roxanita: RULE 15 : CONFIDENTIALITY IS ABSOLUTE
01/22/05 14:39:38 [USMLE_Step_1] saghar: I know, I mean we can make it in time...
01/22/05 14:40:00 [USMLE_Step_1] clover: ok, just wanted to bring it up so that we are aware of time
01/22/05 14:40:08 [USMLE_Step_1] saghar: thanks..
01/22/05 14:40:10 [USMLE_Step_1] Roxanita: when the physician can bridge confidentiality?
01/22/05 14:40:20 [USMLE_Step_1] Roxanita: thanks clever
01/22/05 14:40:40 [USMLE_Step_1] saghar: when px is a treat to self or another.
01/22/05 14:40:55 [USMLE_Step_1] zoya: duty to warn and duty to protect
01/22/05 14:41:22 [USMLE_Step_1] Roxanita: we bring back Tarasoff case here
01/22/05 14:41:44 [USMLE_Step_1] Roxanita: STD's
01/22/05 14:41:51 [USMLE_Step_1] saghar: infectious dis.. suicide, homicide...
01/22/05 14:41:56 [USMLE_Step_1] zoya: suicide , homicide
01/22/05 14:42:00 [USMLE_Step_1] Roxanita: have your pt and sx partner with you to inform
01/22/05 14:42:09 [USMLE_Step_1] zoya: abuse
01/22/05 14:42:50 zoya Logs Out
01/22/05 14:43:05 [USMLE_Step_1] saghar: specially child and elderly abuse..
01/22/05 14:43:12 [USMLE_Step_1] Roxanita: RULE 16: PATIENTS SHOULD BE GIVEN THE CHANCE TO STATE DNR ORDERS AND PHYSICIAN SHOULD FOLLOW THEM
01/22/05 14:43:20 [USMLE_Step_1] Roxanita: we talked about it already
01/22/05 14:43:43 [USMLE_Step_1] Roxanita: DNR refers only to CPR
01/22/05 14:44:10 [USMLE_Step_1] Roxanita: RULE 17: COMMITTED MENTALLY ILL PATIENTS RETAIN THEIR RIGHTS
01/22/05 14:44:55 [USMLE_Step_1] Roxanita: can anybody explain this?
01/22/05 14:44:59 [USMLE_Step_1] Roxanita: please
01/22/05 14:45:35 [USMLE_Step_1] usmle_guy: the commited only lose civil liberty to come and go, but still have ability to make decisions about their health....assuming they are competent
01/22/05 14:45:59 [USMLE_Step_1] Roxanita: uhm... :/
01/22/05 14:46:08 [USMLE_Step_1] saghar: like they can accept or refuse Tx..
01/22/05 14:46:13 [USMLE_Step_1] Roxanita: ok
01/22/05 14:46:22 [USMLE_Step_1] saghar: but they have to have Tx available
01/22/05 14:46:33 [USMLE_Step_1] Roxanita: Thanks to both
01/22/05 14:46:41 [USMLE_Step_1] usmle_guy: no prob
01/22/05 14:46:51 [USMLE_Step_1] Roxanita: RULE 18: DETAIN PATIENTS TO PROTECT THEM OR OTHERS
01/22/05 14:46:52 [USMLE_Step_1] saghar: u r welcome
01/22/05 14:47:23 [USMLE_Step_1] Roxanita: detention can be from 48h to 72 h
01/22/05 14:47:39 [USMLE_Step_1] Roxanita: with children:
01/22/05 14:47:48 [USMLE_Step_1] saghar: only judgs can commit but physician can detain
01/22/05 14:48:32 [USMLE_Step_1] Roxanita: what if your little pt come to your office bb/c a flu but you fin bruises all over
01/22/05 14:48:40 [USMLE_Step_1] Roxanita: what to do next?
01/22/05 14:48:49 tmt33 Logs in
01/22/05 14:49:14 tmt33 Logs Out
01/22/05 14:49:31 [USMLE_Step_1] usmle_guy: call child protective services
01/22/05 14:49:34 [USMLE_Step_1] saghar: report the child abuse to social service ..
01/22/05 14:49:43 [USMLE_Step_1] Roxanita: but what to do first?
01/22/05 14:49:54 [USMLE_Step_1] usmle_guy: ask how they got bruises?
01/22/05 14:50:02 [USMLE_Step_1] saghar: so they can put them in foter's home or somewhere safe
01/22/05 14:50:16 [USMLE_Step_1] Roxanita: but if you start asking the father will grab the child and it will be a mess
01/22/05 14:50:26 [USMLE_Step_1] saghar: yes, first make sure it's an abuse
01/22/05 14:50:28 [USMLE_Step_1] Roxanita: the steps are:
01/22/05 14:50:39 [USMLE_Step_1] saghar: talk to the child in private?
01/22/05 14:50:42 [USMLE_Step_1] Roxanita: Carry the child to some other safe place, room
01/22/05 14:51:17 [USMLE_Step_1] Roxanita: then away from the parent call the Child Protective service in the hospital and then confront the father
01/22/05 14:51:47 [USMLE_Step_1] saghar: thanks...
01/22/05 14:51:47 [USMLE_Step_1] Roxanita: be sure your patient is safe first and then act
01/22/05 14:51:52 [USMLE_Step_1] usmle_guy: thanks
01/22/05 14:52:04 [USMLE_Step_1] Roxanita: that was a question in the exam but with an elderly
01/22/05 14:52:25 tmt33 Logs in
01/22/05 14:52:37 tmt33 Logs Out
01/22/05 14:53:01 [USMLE_Step_1] Roxanita: RULE 19: REMOVE FROM PT CONTACT HEALTH CARE PROFESSIONAL WHO POSE RISK TO PATS
01/22/05 14:53:18 [USMLE_Step_1] Roxanita: Risks like??? Guys? *choochoo*
01/22/05 14:53:27 zoya Logs in
01/22/05 14:53:32 [USMLE_Step_1] saghar: infectious dis., drug abuse
01/22/05 14:53:33 zoya Joins Subroom USMLE_Step_1
01/22/05 14:53:37 [USMLE_Step_1] usmle_guy: infectous disease
01/22/05 14:53:38 [USMLE_Step_1] saghar: depression
01/22/05 14:53:44 [USMLE_Step_1] usmle_guy: depression
01/22/05 14:53:50 [USMLE_Step_1] saghar: incompetence
01/22/05 14:53:51 [USMLE_Step_1] mick: incompetence
01/22/05 14:54:01 [USMLE_Step_1] zoya: sorry ,i had a phone call
01/22/05 14:54:10 [USMLE_Step_1] Roxanita: here the pt comes first and not your colleague
01/22/05 14:54:46 [USMLE_Step_1] Roxanita: welcome back Zoya *welcome*
01/22/05 14:54:51 [USMLE_Step_1] zoya: tx
01/22/05 14:55:01 [USMLE_Step_1] Roxanita: remember your obligation is with the pt
01/22/05 14:55:07 [USMLE_Step_1] Roxanita: and now..
01/22/05 14:55:33 [USMLE_Step_1] Roxanita: RULE 20: FOCUS ON WHAT IS THE BEST ETHICAL CONDUCT, NOT SIMPLY THE LETTER OF THE LAW
01/22/05 14:55:50 [USMLE_Step_1] Roxanita: the best answer on these kind of questions would be....
01/22/05 14:56:00 [USMLE_Step_1] mick: both legal AND ethical
01/22/05 14:56:10 [USMLE_Step_1] Roxanita: What would MOTHER TERESA would do?
01/22/05 14:56:14 [USMLE_Step_1] usmle_guy: legal and ethical
01/22/05 14:56:28 [USMLE_Step_1] saghar: both legal and ethical
01/22/05 14:57:02 [USMLE_Step_1] Roxanita: Always we should follow this steps: 1) ISSUE 2) RULE 3)PICK CLEAN, the correct answer
01/22/05 14:57:22 [USMLE_Step_1] Roxanita: ok Guys we are done with ETHICS
01/22/05 14:57:24 [USMLE_Step_1] rsandhu: Can a competent pregnant women refuse a C- section delivery even though she knows without it fetus will die....
01/22/05 14:57:33 [USMLE_Step_1] saghar: yes...
01/22/05 14:57:35 [USMLE_Step_1] zoya: yes
01/22/05 14:57:39 [USMLE_Step_1] mick: yes
01/22/05 14:57:45 [USMLE_Step_1] clover: yep
01/22/05 14:57:49 [USMLE_Step_1] usmle_guy: yes
01/22/05 14:57:54 [USMLE_Step_1] Roxanita: yes
01/22/05 14:57:58 [USMLE_Step_1] rsandhu: thxxxx
01/22/05 14:58:04 [USMLE_Step_1] saghar: she's in charge of her body, but make sure she understands the riskd and outcomes
01/22/05 14:58:15 [USMLE_Step_1] Roxanita: Who makes the medical decision in US?
01/22/05 14:58:26 [USMLE_Step_1] usmle_guy: the pt
01/22/05 14:58:28 [USMLE_Step_1] Roxanita: ....THE PATIENT
01/22/05 14:58:33 [USMLE_Step_1] saghar: px
01/22/05 14:58:34 [USMLE_Step_1] zoya: pt
01/22/05 14:58:35 [USMLE_Step_1] clover: the patient always
01/22/05 14:58:41 [USMLE_Step_1] mick: agree
01/22/05 14:58:56 [USMLE_Step_1] rsandhu: yup
01/22/05 14:58:57 [USMLE_Step_1] Roxanita: Right!!! *whip*
01/22/05 14:59:21 [USMLE_Step_1] Roxanita: "PHYSICIAN-PATIENT RELATIONSHIPS"
01/22/05 14:59:37 [USMLE_Step_1] zoya: ok ,before we move on to the next chapter can i ask one thing?
01/22/05 14:59:53 [USMLE_Step_1] rsandhu: yup
01/22/05 14:59:54 [USMLE_Step_1] usmle_guy: srue
01/22/05 15:00:03 [USMLE_Step_1] clover: yep
01/22/05 15:00:19 [USMLE_Step_1] zoya: is it possible to give 1or 2 more days for gross anatomy.
01/22/05 15:00:23 [USMLE_Step_1] Roxanita: You have your desk at your office where your patient should sit?
01/22/05 15:00:29 [USMLE_Step_1] Roxanita: sure
01/22/05 15:01:00 [USMLE_Step_1] mick: at your side??
01/22/05 15:01:03 [USMLE_Step_1] Roxanita: 1)in front of you 2) beside you right 3)beside you left
01/22/05 15:01:23 [USMLE_Step_1] saghar: in front of you, so u can make eye contact
01/22/05 15:01:30 [USMLE_Step_1] Roxanita: infront of you=authoritarian physician
01/22/05 15:01:46 [USMLE_Step_1] Roxanita: this question is for the first interview
01/22/05 15:01:54 [USMLE_Step_1] rsandhu: never put anything between u and pt.
01/22/05 15:02:00 [USMLE_Step_1] zoya: rt
01/22/05 15:02:01 [USMLE_Step_1] usmle_guy: sounds like a trick question
01/22/05 15:02:21 [USMLE_Step_1] Roxanita: daugherty said some years ago it was a question
01/22/05 15:02:22 [USMLE_Step_1] usmle_guy: what is the difference between right and left of patient?
01/22/05 15:02:37 [USMLE_Step_1] Roxanita: and for him the answer was: right beside you to your right
01/22/05 15:03:15 [USMLE_Step_1] usmle_guy: why right?
01/22/05 15:03:16 [USMLE_Step_1] Roxanita: people are more comfortable turning head to the right
01/22/05 15:03:28 [USMLE_Step_1] usmle_guy: interesting
01/22/05 15:03:34 [USMLE_Step_1] saghar: did not know that... thanks..
01/22/05 15:03:50 [USMLE_Step_1] Roxanita: Daugherty always makes me think :/
01/22/05 15:03:57 [USMLE_Step_1] zoya: tx
01/22/05 15:03:57 [USMLE_Step_1] zoya: tx
01/22/05 15:04:11 [USMLE_Step_1] clover: thanks
01/22/05 15:04:27 [USMLE_Step_1] Roxanita: ok Guys the following rules are about what makes the right answer in the physician-pt relationship
01/22/05 15:04:59 [USMLE_Step_1] Roxanita: The rules always apply, so we better learn all of them
01/22/05 15:05:00 [USMLE_Step_1] zoya: sorry, i meant thanks
01/22/05 15:05:19 [USMLE_Step_1] Roxanita:
01/22/05 15:05:31 [USMLE_Step_1] Roxanita: RULE 1 ???
01/22/05 15:05:36 [USMLE_Step_1] Roxanita: SOmebody?
01/22/05 15:05:45 [USMLE_Step_1] zoya: pt is no1
01/22/05 15:05:56 [USMLE_Step_1] usmle_guy: pt is #1
01/22/05 15:05:58 [USMLE_Step_1] Roxanita: that's right Zoya
01/22/05 15:06:05 [USMLE_Step_1] mick: pt comes first
01/22/05 15:06:45 [USMLE_Step_1] zoya: pt's safety and comfort over anyone elses
01/22/05 15:06:50 [USMLE_Step_1] Roxanita: remember in the exam, don't be aware of how do you protect yourself but what is best for your patient
01/22/05 15:07:26 [USMLE_Step_1] Roxanita: RULE 2: ALWAYS RESPOND TO THE PATIENT
01/22/05 15:07:31 [USMLE_Step_1] rsandhu: always respond to pt.( answer any ques. that pt. asks)
01/22/05 15:07:53 [USMLE_Step_1] Roxanita: If the pt asks a question? what do you do, even if you had a terrible day and just want to go home?
01/22/05 15:08:07 [USMLE_Step_1] zoya: answer it
01/22/05 15:08:14 [USMLE_Step_1] rsandhu: answer the question
01/22/05 15:08:14 [USMLE_Step_1] saghar: u have to answer
01/22/05 15:08:19 [USMLE_Step_1] Roxanita: right always reply
01/22/05 15:08:40 [USMLE_Step_1] usmle_guy: answer
01/22/05 15:08:54 [USMLE_Step_1] Roxanita: and also as soon as you know any test result the pt should know
01/22/05 15:09:14 [USMLE_Step_1] Roxanita: even if he says "doc if the results are bad I don't want to know"
01/22/05 15:09:23 [USMLE_Step_1] Roxanita: what do you do?
01/22/05 15:09:25 [USMLE_Step_1] saghar: yes, px should know everything but ask them how much they want to know
01/22/05 15:09:56 [USMLE_Step_1] Roxanita: just find out, talk to him "why you don't want to know?" right saghar
01/22/05 15:10:17 [USMLE_Step_1] saghar: yep..
01/22/05 15:10:27 [USMLE_Step_1] usmle_guy: agree
01/22/05 15:10:34 [USMLE_Step_1] Roxanita: RULE 3: TELL THE PT EVERYTHING
01/22/05 15:10:50 [USMLE_Step_1] zoya: don't force at that moment but try to dicuss it with them
01/22/05 15:11:08 [USMLE_Step_1] Roxanita: remember the information should go from the pt to the family and not the other way
01/22/05 15:11:20 [USMLE_Step_1] saghar: if u have partial info tell them that it's partial
01/22/05 15:11:28 [USMLE_Step_1] Roxanita: that's right
01/22/05 15:12:08 [USMLE_Step_1] Roxanita: RULE 4 : WORK ON LONG TERM RELATIONSHIPS WITH YOUR PATIENTS
01/22/05 15:12:24 [USMLE_Step_1] Roxanita: which specialists are most sued?
01/22/05 15:13:01 [USMLE_Step_1] usmle_guy: ones with bad patient physician skills
01/22/05 15:13:06 [USMLE_Step_1] saghar: surgeons?
01/22/05 15:13:17 [USMLE_Step_1] Roxanita: a) psychiatrists b)anesthesiologists c) family practice d) surgeons
01/22/05 15:13:26 [USMLE_Step_1] Roxanita: there are 2 answers
01/22/05 15:13:26 [USMLE_Step_1] zoya: anesthesiologists,surgeons,
01/22/05 15:13:44 [USMLE_Step_1] saghar: b and d
01/22/05 15:13:47 [USMLE_Step_1] Roxanita: allright !!! *choochoo*
01/22/05 15:13:51 [USMLE_Step_1] usmle_guy: i agree
01/22/05 15:13:54 [USMLE_Step_1] Roxanita: why?
01/22/05 15:14:16 [USMLE_Step_1] usmle_guy: they spend least time with patients building repor
01/22/05 15:14:26 [USMLE_Step_1] usmle_guy: rapport
01/22/05 15:14:30 [USMLE_Step_1] Roxanita: cause they don't really comunicate with their patients as much as psichiatrists and family doctors do
01/22/05 15:14:50 [USMLE_Step_1] saghar: right..
01/22/05 15:15:00 [USMLE_Step_1] Roxanita: Rapport? could you remind me please usmle_guy ?
01/22/05 15:15:29 [USMLE_Step_1] usmle_guy: rapport is another word for the relationship
01/22/05 15:15:40 [USMLE_Step_1] Roxanita: ok
01/22/05 15:15:59 [USMLE_Step_1] usmle_guy: surgeons also do not know what that word is lol
01/22/05 15:16:05 [USMLE_Step_1] Roxanita: RULE 5 : LISTENING IS BETTER THAN TALKING
01/22/05 15:16:31 [USMLE_Step_1] Roxanita: Let the pt talk... best answer
01/22/05 15:16:38 [USMLE_Step_1] saghar: talk to the px even if other px are waiting
01/22/05 15:16:48 [USMLE_Step_1] saghar: take your time
01/22/05 15:16:53 [USMLE_Step_1] Roxanita: ideally the pt should talk 75% and the doc 25%
01/22/05 15:17:02 [USMLE_Step_1] Roxanita: that's right saghar
01/22/05 15:17:23 [USMLE_Step_1] saghar: what's the average time spending with px? do u know?
01/22/05 15:17:24 [USMLE_Step_1] Roxanita: RULE 6: NEGOTIATE RATHER THAN ORDER
01/22/05 15:17:45 [USMLE_Step_1] Roxanita: is there any limit?
01/22/05 15:18:12 [USMLE_Step_1] usmle_guy: dont know saghar, but getting shorter and shorter
01/22/05 15:18:18 [USMLE_Step_1] saghar: I am not sure, I heard average 15 min, but do not know the ref..
01/22/05 15:18:28 [USMLE_Step_1] Roxanita: Don't be a general with your pt, be a partner, negotiate with them
01/22/05 15:19:08 [USMLE_Step_1] Roxanita: help them to understand and then come to a consence of agreement on how to proceed
01/22/05 15:19:11 [USMLE_Step_1] mick: in residency, you start out 1st yr seeing 1 pt per hour, 2nd yr 30 mins, 3rd yr 15 mins.....not sure if thats any indication
01/22/05 15:19:18 [USMLE_Step_1] Roxanita: all this sound so nice right guys?
01/22/05 15:19:47 [USMLE_Step_1] usmle_guy: yes rox
01/22/05 15:19:48 [USMLE_Step_1] saghar: yeah..........
01/22/05 15:19:48 [USMLE_Step_1] Roxanita: but in the CSA is just 13min right ?
01/22/05 15:20:12 [USMLE_Step_1] saghar: 13 or 15??
01/22/05 15:20:21 [USMLE_Step_1] Roxanita: RULE 7: TRUST MUST BE BUILT, NOT ASSUMED
01/22/05 15:20:40 [USMLE_Step_1] Roxanita: don't assume the patient likes you
01/22/05 15:21:00 [USMLE_Step_1] saghar: Iand treat suspicious px with friendly manner
01/22/05 15:21:03 [USMLE_Step_1] Roxanita: don't assume they are going to follow you
01/22/05 15:21:18 [USMLE_Step_1] Roxanita: we built the right to that trust guys
01/22/05 15:21:41 [USMLE_Step_1] Roxanita: right saghar
01/22/05 15:21:55 [USMLE_Step_1] Roxanita: RULE 8 : ADMIT TO THE PATIENT WHEN YOU MAKE A MISTAKE
01/22/05 15:22:18 [USMLE_Step_1] saghar: yes, always even if px is fine
01/22/05 15:22:26 [USMLE_Step_1] Roxanita: If we make a mistake, those things happen, we are humans and mistakes are made.
01/22/05 15:22:42 [USMLE_Step_1] Roxanita: In the exam tell the pt when a mistake is made
01/22/05 15:23:07 [USMLE_Step_1] Roxanita: surgeons...we cut the wrong things
01/22/05 15:23:31 [USMLE_Step_1] Roxanita: because patients should know everything, remember that
01/22/05 15:23:43 [USMLE_Step_1] mick: of course your lawyers and risk management people will tell you differently *evil*
01/22/05 15:23:46 [USMLE_Step_1] Roxanita: RULE 9 : NEVER PASS OFF
01/22/05 15:24:14 [USMLE_Step_1] Roxanita: Ja Ja but this is a chat for the step 1, remember we are mother teresa
01/22/05 15:24:33 [USMLE_Step_1] Roxanita: what is Never Pass off?
01/22/05 15:24:48 [USMLE_Step_1] Roxanita: *choochoo*
01/22/05 15:24:50 [USMLE_Step_1] zoya: your pt
01/22/05 15:24:59 [USMLE_Step_1] saghar: never refer your px to someone else
01/22/05 15:25:12 [USMLE_Step_1] usmle_guy: never refer
01/22/05 15:25:17 [USMLE_Step_1] saghar: refer only to ophthalmologist
01/22/05 15:25:24 [USMLE_Step_1] Roxanita: what if your patient has depression and you are family physician?
01/22/05 15:25:25 [USMLE_Step_1] clover: referals
01/22/05 15:25:30 [USMLE_Step_1] saghar: but usually is not the answer in usmle
01/22/05 15:25:42 [USMLE_Step_1] usmle_guy: treat depression
01/22/05 15:25:43 [USMLE_Step_1] Roxanita: Great Guys!!! *choochoo*
01/22/05 15:25:56 [USMLE_Step_1] zoya: refer only when it is beyond your expertise
01/22/05 15:25:57 [USMLE_Step_1] Roxanita: RULE 10: EXPRESS EMPATHY, THEN GIVE CONTROL
01/22/05 15:26:33 [USMLE_Step_1] Roxanita: we should deal with Hostility and angry patients
01/22/05 15:26:36 [USMLE_Step_1] saghar: in case of angry or upset px or family..
01/22/05 15:26:44 [USMLE_Step_1] Roxanita: always we have to express empathy
01/22/05 15:26:59 [USMLE_Step_1] Roxanita: Help the pt to feel better
01/22/05 15:27:12 [USMLE_Step_1] Roxanita: "I am sorry , what would you like to do?"
01/22/05 15:27:17 [USMLE_Step_1] zoya: a 42 yr old male pt snaps at you about the time he had to wait
01/22/05 15:27:26 [USMLE_Step_1] Roxanita: Never panic
01/22/05 15:27:31 [USMLE_Step_1] saghar: I rememebr a q, which the px was crying and answer was offering tissue and wait
01/22/05 15:27:32 [USMLE_Step_1] zoya: what is your respond
01/22/05 15:27:42 [USMLE_Step_1] zoya: response
01/22/05 15:27:45 [USMLE_Step_1] Roxanita: oh thanks saghar
01/22/05 15:28:04 [USMLE_Step_1] Roxanita: :<
01/22/05 15:28:31 [USMLE_Step_1] Roxanita: ok I am mother teresa .... wait until he gets calmed?
01/22/05 15:28:32 [USMLE_Step_1] usmle_guy: any choices zoya....lots of ways to respond as long as its calm and polite
01/22/05 15:28:36 [USMLE_Step_1] saghar: try to calm him down
01/22/05 15:29:11 [USMLE_Step_1] Roxanita: do you have options zoya?
01/22/05 15:29:35 [USMLE_Step_1] Roxanita: RULE 11: AGREE ON PROBLEM BEFORE MOVING TO SOLUTION
01/22/05 15:29:39 [USMLE_Step_1] zoya: yes ,show support like'i am sorry.it must be hard to havet to wait solong"
01/22/05 15:30:00 [USMLE_Step_1] zoya: don't take his anger personally
01/22/05 15:30:03 [USMLE_Step_1] Roxanita: ..and it's ok that you snapped me
01/22/05 15:30:10 [USMLE_Step_1] Roxanita: ok
01/22/05 15:30:25 [USMLE_Step_1] mick: hey all, i have to go. see everyone on monday. have a great weekend.
01/22/05 15:30:35 [USMLE_Step_1] zoya: did i /
01/22/05 15:30:52 [USMLE_Step_1] zoya: bye mick
01/22/05 15:30:53 [USMLE_Step_1] saghar: thanks.. and see ya
01/22/05 15:30:56 [USMLE_Step_1] Roxanita: on rule 11, we have to agree with the pt about what the problem is. You have a pt. Dx is clear, what physician should do next?
01/22/05 15:30:58 [USMLE_Step_1] usmle_guy: bye mick
01/22/05 15:31:01 [USMLE_Step_1] Roxanita: those questions come...
01/22/05 15:31:14 [USMLE_Step_1] Roxanita: Thanks Mick, sorry for the delay
01/22/05 15:31:17 [USMLE_Step_1] clover: i have to go soon also. bye mick
01/22/05 15:31:44 [USMLE_Step_1] saghar: bye clover and mick
01/22/05 15:31:49 [USMLE_Step_1] saghar: see ya later..
01/22/05 15:31:52 [USMLE_Step_1] mick: no problem roxanita. you're doing a great job. thanks. bye.
01/22/05 15:31:58 [USMLE_Step_1] Roxanita: so, always we should agree on what the problem is and then move
01/22/05 15:32:15 mick Logs Out
01/22/05 15:32:17 [USMLE_Step_1] Roxanita: RULE 12: BE SURE YOU UNDERSTAND WHAT THE PT IS TALKING ABOUT
01/22/05 15:32:37 [USMLE_Step_1] Roxanita: "Doc my treatment is not working?"
01/22/05 15:32:37 [USMLE_Step_1] zoya: bye clover
01/22/05 15:32:52 [USMLE_Step_1] Roxanita: what do you do?
01/22/05 15:32:54 [USMLE_Step_1] saghar: start with open ended qs and then move on to close ended
01/22/05 15:33:09 [USMLE_Step_1] saghar: seek info
01/22/05 15:33:21 [USMLE_Step_1] saghar: and details
01/22/05 15:33:26 [USMLE_Step_1] Roxanita: ask the your patient " why is your treatment not working?", or "what is the problem with your treatment"?
01/22/05 15:33:41 [USMLE_Step_1] Roxanita: Right Saghar, alwyas comunicate as more as you can
01/22/05 15:33:43 [USMLE_Step_1] clover: i can stay till 3:30. any chance we'll be done by then?
01/22/05 15:33:51 [USMLE_Step_1] saghar: to see if he's compliance with his medication and if he takes them right
01/22/05 15:34:04 [USMLE_Step_1] Roxanita: Before going to solution understand your patient
01/22/05 15:34:08 [USMLE_Step_1] clover: i guess i can just read the transcript later
01/22/05 15:34:26 [USMLE_Step_1] Roxanita: RULE 13: PATIENTS DO NOT GET TO SELECT INAPPROPRIATE TREATMENTS
01/22/05 15:34:59 [USMLE_Step_1] saghar: this is an example of the schizo px and double blinded trial roxanita....
01/22/05 15:35:20 [USMLE_Step_1] Roxanita: Our job is to give them many options of treatment
01/22/05 15:35:35 [USMLE_Step_1] Roxanita: How is that Saghar, could you explain please?
01/22/05 15:35:36 [USMLE_Step_1] saghar: so explain to him that it's not the right choice...
01/22/05 15:36:05 [USMLE_Step_1] Roxanita:
01/22/05 15:36:18 [USMLE_Step_1] saghar: px select tx from presented appropriate tx
01/22/05 15:36:43 [USMLE_Step_1] Roxanita: Clever it's just 7 rules away but yes we will finish and the transcript will contain everything
01/22/05 15:36:47 [USMLE_Step_1] zoya: a 40 yr old female wants a ct scan even though he has pneumonia and you know he does not need it. what would you do?"
01/22/05 15:37:20 [USMLE_Step_1] saghar: don't order it... but explain why..
01/22/05 15:37:30 [USMLE_Step_1] clover: thanks for great chat. will read transcripts for the rest. bye
01/22/05 15:37:35 [USMLE_Step_1] Roxanita: yes, talk to your patient
01/22/05 15:37:40 [USMLE_Step_1] saghar: bye...
01/22/05 15:37:40 [USMLE_Step_1] usmle_guy: bye clover
01/22/05 15:37:48 [USMLE_Step_1] Roxanita: bye clover
01/22/05 15:38:01 clover Logs Out
01/22/05 15:38:12 [USMLE_Step_1] Roxanita: RULE 14: BE SURE WHO YOUR PATIENT IS
01/22/05 15:38:19 [USMLE_Step_1] zoya: find out why he wants it,try to address that . but don't order it
01/22/05 15:38:38 [USMLE_Step_1] Roxanita: If you think about child abuse...your pt is the child not the parents
01/22/05 15:38:52 [USMLE_Step_1] Roxanita: thanks Zoya
01/22/05 15:39:00 [USMLE_Step_1] Roxanita: x.e.
01/22/05 15:39:19 [USMLE_Step_1] zoya: you are welcome, rox
01/22/05 15:39:45 [USMLE_Step_1] zoya: what does x. e mean?
01/22/05 15:40:27 [USMLE_Step_1] Roxanita: a long term pt in coma. Your pt is still that guy in coma and not the spouse which is representing their own wishes. always focus on your pt
01/22/05 15:40:33 [USMLE_Step_1] Roxanita: this
01/22/05 15:40:47 [USMLE_Step_1] saghar: right
01/22/05 15:40:51 [USMLE_Step_1] Roxanita: for example= x.e.
01/22/05 15:40:58 [USMLE_Step_1] zoya: oh
01/22/05 15:41:03 [USMLE_Step_1] Roxanita: RULE 15 : NEVER LIE
01/22/05 15:41:05 [USMLE_Step_1] zoya:
01/22/05 15:41:25 [USMLE_Step_1] Roxanita: always tell the pt the truth whenever you know it
01/22/05 15:41:35 [USMLE_Step_1] saghar: never lie not in medical field but in everyday life............
01/22/05 15:41:44 [USMLE_Step_1] Roxanita: but what if you discovered cancer with metastasis?
01/22/05 15:41:47 [USMLE_Step_1] saghar:
01/22/05 15:41:57 [USMLE_Step_1] Roxanita:
01/22/05 15:42:10 [USMLE_Step_1] saghar: ask px how much he wants to know and tell them the truth.............
01/22/05 15:42:12 [USMLE_Step_1] Roxanita: do you say it to your pt or relatives?
01/22/05 15:42:19 [USMLE_Step_1] saghar: to the px..
01/22/05 15:42:24 [USMLE_Step_1] Roxanita: right saghar, always your pt first
01/22/05 15:42:44 [USMLE_Step_1] Roxanita: we should just find the way to do it
01/22/05 15:43:05 [USMLE_Step_1] Roxanita: RULE 16 : ACCEPT THE HEALTH BELIEFS OF PATIENTS
01/22/05 15:43:33 [USMLE_Step_1] Roxanita: here we go....what if a pt ask you to pray with him one day before the surgery you are going to do? what do you do?
01/22/05 15:43:35 [USMLE_Step_1] usmle_guy: i'm very sorry everyone, but i have to be somewhere and can't stay for rest of chat. enjoy rest of chat and weekend and i look forward to chatting with everyone on monday at 8
01/22/05 15:43:53 [USMLE_Step_1] zoya: i have to go too,so are we making any changes in anatomy schedule?
01/22/05 15:44:00 [USMLE_Step_1] Roxanita: I am sorry somebody asked to put 2 more days for anatomy?
01/22/05 15:44:13 [USMLE_Step_1] Roxanita: you read my mind?
01/22/05 15:44:19 [USMLE_Step_1] Roxanita: for what part?
01/22/05 15:44:21 [USMLE_Step_1] zoya: yes i did, will it be aproblem?
01/22/05 15:44:22 [USMLE_Step_1] saghar: bye usmle_guy... see u
01/22/05 15:44:36 [USMLE_Step_1] Roxanita: not at all zoya, we are a group
01/22/05 15:44:42 [USMLE_Step_1] zoya: bye usmle
01/22/05 15:44:46 [USMLE_Step_1] Roxanita: bye usmle_guy. Thanks
01/22/05 15:44:58 [USMLE_Step_1] zoya: thanks..rox
01/22/05 15:45:02 [USMLE_Step_1] usmle_guy: bye
01/22/05 15:45:05 usmle_guy Logs Out
01/22/05 15:45:20 [USMLE_Step_1] Roxanita: send me a pm to where do you want to put more days
01/22/05 15:45:21 strug Logs in
01/22/05 15:45:21 strug Joins Subroom USMLE_Step_2
01/22/05 15:45:43 [USMLE_Step_1] Roxanita: what about our pt who asked us to pray with him?
01/22/05 15:45:44 [USMLE_Step_1] zoya: add 1 more day in abdomen and ul.ll
01/22/05 15:45:51 strug Logs Out
01/22/05 15:46:23 [USMLE_Step_1] Roxanita: *choochoo* somebody.....saghar?
01/22/05 15:46:33 [USMLE_Step_1] saghar: pray with him, accept px's religion belief and participate if u can
01/22/05 15:46:33 [USMLE_Step_1] Roxanita: zoya?
01/22/05 15:47:06 [USMLE_Step_1] zoya: i meant imore day in between abdomen and upper limb ,lower limb.head neck
01/22/05 15:47:09 [USMLE_Step_1] Roxanita: that's right it wont hurt us to pray with him and instead the pt will be comfortable and happy with their nice doc
01/22/05 15:47:26 [USMLE_Step_1] zoya: ok i will send you a pm
01/22/05 15:47:35 [USMLE_Step_1] Roxanita: ok zoya your wishes are my comands
01/22/05 15:48:03 [USMLE_Step_1] Roxanita: RULE 18 : ANYTHING THAT INCREASES COMMUNICATION IS GOOD
01/22/05 15:48:23 [USMLE_Step_1] zoya: don't take them as command, request may be
01/22/05 15:48:31 [USMLE_Step_1] saghar: take time to talk and get info from px
01/22/05 15:48:41 [USMLE_Step_1] zoya: thanks rox
01/22/05 15:49:00 [USMLE_Step_1] Roxanita: try to be sure your pt has good information: handouts, discuss with yout pt about his problem
01/22/05 15:49:16 [USMLE_Step_1] Roxanita: it's a joke zoya
01/22/05 15:49:43 [USMLE_Step_1] zoya: yeh..i know
01/22/05 15:50:06 [USMLE_Step_1] Roxanita: RULE 19: BE AN ADVOCATE FOR THE PATIENT
01/22/05 15:50:48 [USMLE_Step_1] Roxanita: It's our job not to simply treat the pt but be sure the pts get what they need
01/22/05 15:50:55 [USMLE_Step_1] saghar: try to get what px want and not to refuse to treat if she/he can't pay
01/22/05 15:51:28 [USMLE_Step_1] Roxanita: for this try to do whatever takes to make the pt comfortable with your care, contact the insurance personally if necessary
01/22/05 15:52:19 [USMLE_Step_1] Roxanita: You are suposse as your primary GOAL on your professional life that your patient gets what you decide they need
01/22/05 15:52:25 [USMLE_Step_1] saghar: but unfortunately you don't see this so often in real life.............
01/22/05 15:52:44 [USMLE_Step_1] Roxanita: RULE 20: THE KEY IS NOT SO MUCH WHAT YOU DO BUT HOW YOU DO IT
01/22/05 15:53:25 [USMLE_Step_1] saghar: put interests of px first
01/22/05 15:53:28 [USMLE_Step_1] Roxanita: here the question is "How do you do them in a way that the pt feels better, feels more comfortable, more taken care of"
01/22/05 15:53:33 [USMLE_Step_1] Roxanita: right saghar
01/22/05 15:53:37 [USMLE_Step_1] saghar: and do it in a right and humane way
01/22/05 15:53:51 [USMLE_Step_1] zoya: and sensitive
01/22/05 15:54:12 [USMLE_Step_1] Roxanita: The Key in all these is not what physicians actually do, but what the most ideal physician should do
01/22/05 15:54:21 [USMLE_Step_1] saghar: yes...
01/22/05 15:54:24 [USMLE_Step_1] zoya: rt
01/22/05 15:54:33 [USMLE_Step_1] Roxanita: rsandhu?
01/22/05 15:54:42 [USMLE_Step_1] saghar: I think we covered it all
01/22/05 15:54:46 [USMLE_Step_1] Roxanita: ok guys
01/22/05 15:54:50 [USMLE_Step_1] zoya: yes
01/22/05 15:55:06 [USMLE_Step_1] saghar: so are we following the schedule for monday?
01/22/05 15:55:15 [USMLE_Step_1] Roxanita: I feel happy cause this is a very important part of behavioral sci, large tested all the time
01/22/05 15:55:29 [USMLE_Step_1] Roxanita: and we did cover it
01/22/05 15:56:02 [USMLE_Step_1] Roxanita: ok guys thanks for being here
01/22/05 15:56:15 [USMLE_Step_1] Roxanita: see you on monday with our new subject Anatomy
01/22/05 15:56:16 [USMLE_Step_1] saghar: thanks rox and all of u guys... see u later... bye
01/22/05 15:56:38 [USMLE_Step_1] zoya: ok ,thanks everyone ..bye