Interview

UNSW Information Evening
Friday, July 14, 2017

3:00 PM
Be upfront
Definitely avoid trying to say what they want to hear
See if you can ask students what interview questions were like
Insights into Medicine

5:27 PM
In my view, the practical implications of human biology are very relevant to everyday living.
I seek the knowledge-based field of study which requires a human touch in its real-life
applications. From researching and talking with those in the field, my expectations of
Medicine align with my core interests and values. I am interested in an environment in which
I am able to continually apply myself to extend my knowledge and improve my skills, both as
a professional and as a member of the community.
People often make Medicine out to be one of the toughest and most intensive fields. How true
is it in your experience? At what point do most students know what type of medicine they
want to specialise in? What are some things about studying medicine that you only learnt
after you were involved in it? Alternatively, what are some common misconceptions or facts
that most are unaware of about the field of medicine?
Interview:
1. Name a time you've helped someone
2. What do you think a good doctor should be
3. How would you describe yourself
4. What would you do if you don't make it into medicine
5. Be structured, e.g. introduce your main points in a sentence first, then speak in detail
a. If you find yourself rambling for too long, just pull it back
6. Building rapport, a bit of rhetoric can go a long way, e.g. You know when
7. If possible, give examples from recent times
8. If they ask for questions:
a. Building rapport - ask about them, ask about the school
b. Raise a quality which may not have been addressed, I'd imagine it would be an
important quality for doctors to have leadership skills
Be deliberate in your actions, do things when you've set your objective, don't just find
yourself doing something - not just in study, carve our your own path in life
Hold yourself accountable, if you find yourself not getting something done, ask yourself what
you could do to improve
Create a scaffold of a regular weekly study timetable
New experiences to gather between now and interview: convo at clevo, volunteering for
community, tutoring at school and out of school,
Goals should ignite emotions within you
Self-directed learning - self-reflection

Using many opportunities to self-reflect - what is the best for me, what do I want, what
could I have done better there
For example when I realise that this was actually what they were after when they were
asking me something, or when I misread their intentions/emotions - relates to empathy
It's easy to say 'yeah I would have done that' but it's much harder to question yourself
critically
Often when I face challenges I find that a change in perspective or a re-evalutation of
my position/motivations greatly helps in overcoming them
Acknowledging that already I am greatly privileged and lucky enough to be surrounded
by people with similar aspirations, with similarly contemporary values, an inclusive
environment which nurtures success and values education
Mentoring attitude
Leadership
Show maturity, show that I have done research by talking with people and gained an
understanding as to what medicine is really like, and that my interest in it is genuine
Discuss a failure in the last half a year - instead of academic ones, perhaps a personal failure
such as failure to stick to your personal goals
Greatest failure
Proudest moment - year 11 money raising project
Organising the volunteering stuff, participating - describe a time where you had to resolve a
problem/conflict,
Discuss your relationship with your parents, your siblings, your friends
After the careers expo, I went home and wrote a list of things I definitely want in my future -
something which I can wake up to each day, lifelong learning, practical application of
sciences, human touch/interaction. Thought about how I can combine my ability and interest
in math and science into something which I can use to help people. I've considered fields
such as biomedical engineering, working for a company, or even in startups, but after talking
with alex I realised that there was less of a direct effect in helping others, also not as much
human interaction.
Reasearch -
Show that I understand that by pursuing medical degree that I will be essentially be devoting
myself to medicine for life. I know that medicine isn't glamorous, like most work in 'essential'
fields.
Prepare stuff and anecdotes on peer tutoring, tutoring, convo at clevo, volunteering -
teaching, communication
How I overcome challenges, how I
"why not nursing"
Humbling experience
Interview
Thursday, June 29, 2017
4:31 PM
If I cannot respond to any supplementary inquiry with real conviction, then my response will
appear bland, empty, and lacking in substance. Depend on the fact that the interviewers are
skilled at what they do, and they will try to assess how I can handle occasions when my
fluent responses 'dry up'. With regard to eveything I say, or have already submitted (in
application), I must be prepared to justify them by providing detailed examples. For every
viewpoint I have, I must prepare to explain it. I should ask myself "How can I show them
that I really mean what I say?"
Assessing my academic understanding and knowledge is not a priority of the interviewers.

They are more determined to get behind the words of my application and form a view of who
I am like as a person; the interview is much more to do with assessing my suitability for the
course and my personality. However, if the occasion does arise, I should be ready to detail
my past successes, using the principle "Past success is the best predictor of future success".
Some key inquiry threads that they may pursue:

1. Am I passionate about studying medicine?
2. Do I have an understanding of what a career in medicine entails and demands?
3. If I were offered a place, would I complete the course?
4. Will I fit in? Am I suited to a medical career?
Some key principles:

 Selection for Medical School implies selection for the medical profession
o The practice of medicine requires the highest standards of professional and
personal conduct: always, the primary duty of care is to patients.
o It is vital that medical students recognise this from their first day.
o Experience suggests that some applicants will not be suited to a career in
medicine and it is in their best interest, and that of the public, that they are not
submitted to Medical School.
 Candidates should demonstrate an understanding of what a career in medicine involves.
In line with these principles, I must demonstrate:
 Factual understanding and knowledge.
 Interpersonal skills, especially communication skills within teams, the ability to remain
calm under pressure, and to be able to demonstrate initiative and flexibility.
 That I am a determined individual who is able to manage the stress which inevitability
accompanying medical studies.
 Contribute to the broad spectrum of university life. Those who do so are much more
likely to gain a wider experience of working and communicating with people from
different backgrounds.
People see the world not as it is, but as they are. Generous people will see other people as
generous, untrustworthy people will see other people as untrustworthy etc.
To justify the trusts that patients have in doctors, the medical profession has a duty to
maintain a standard of practice and care, and to show respect for human life. In particular,
doctors must:
 Make the care of the patients their first concern.
 Respect patients' dignity and privacy, and listen to and respect their views.
 Give patients information in a way they can understand.
 Respect the right of patients to be fully involved in decisions about care.
 Keep their professional knowledge and skills up to date, as well as recognising the
limits of their professional competence.
 Make sure that their personal beliefs does do not prejudice their patients' care.
 Avoid abusing their position as a doctor.
 Work with colleagues in a way that best serves patients' interests.
Assessment criteria:
1. Evidence of ability to benefit from medical academic rigour.
Don't use too many "I" statements (sounds conceited), don't use jargon, explain
experiences clearly. Be organised and to the point; don't add fluff. Show that you are
an effective communicator.
"Love to read about a personal life story and for the applicant to demonstrate how their
insight saw them through it. Also about how it led them to medicine as a profession.
Humility and honesty about whom they are and what they have to offer medicine."
"What bores you? Mundane accounts of the same things - resume regurtitation.
Name dropping. Applicants who are childrens of doctors and how they followed mom
or dad around in the clinic. Talking about how great our college is or repeating
information found in print or on the Web. Don't try to impress upon us what a genius you
are. Let your experiences and achievements speak for themselves. View it as our
chance to get to know you as a person and a future physician. I want to be a doctor
because I want to help people. I can't think of anything else I would want to do."
"What experience would you like students to talk about more often? Their motivation
for why they want to be in a profession that helps people in the more difficult
circumstances. How will they persist and press on when things are difficult?
Personal/life lessons. Epiphanies they have had about medicine. Some of the
amazing experiences and people they have met so far. Stories about overcoming
adversity."
Medical Application
Tuesday, July 11, 2017
1:52 PM
Think up of events which have strongly influenced or affected your identity - experiences
which have affirmed or challenged your sense of purpose, or led you to reconsider a long-
held opinion. Think about how these moments have shaped you.
Describe challenge or obstacle you have overcome, and what you have learned from the
experience.
Describe an instance where you helped someone in need.
Describe your greatest achievement.
Who has been the biggest influence on your life and your decision to apply to medical
school?
What work experience or extracurricular activity is most meaningful to you? What have you
learned from this activity?
What has been the most disappointing/challenging experience of your life? How has this
experience shaped your medical school readiness and who you are today?
What character trait separates you from the crowd? How did you develop this character trait?
Compassion - a critical part of healing
Advocacy - for your patients and for those without health care
Leadership - in improving health care at the team, hospital and policy level
Lifelong learning - there will always be more to know
Interpersonal skills - communication with patients and among providers is key
Negotiation - to work around bureaucratic restraints
Grasp - of increasing amounts of medical knowledge and of a health care system in flux
UNSW introductory questions

Monday, July 24, 2017
6:44 PM
This is the initial ‘ice-breaker’ period where the panel finds out a bit about you. It
is often used to ‘ease’ you into the interview and help you relax. The aim is to
obtain an insight into who you are – your background, your interests, your
beliefs.
Questions in this section often bring up something that will naturally flow into
another theme, such as personal qualities (eg. leadership skills, teamwork).
This section is a good chance to cover things that you may not be able to bring up
in other parts of the interview.
The UNSW medical interview is unlike any other - it is a highly psychological

interview, and has a strong focus on this theme.
Tell us a bit about yourself.
This looks like a simple question, but it is one that many people find difficult to
answer. You need to think about your identity – what makes you, you? You may
talk about your interests and your key beliefs. The exercise in the "Philosopy
behind Interviews" section will help with this question.
Avoid overusing the words ‘I’ and ‘me’ when answering this question – you do
not want to appear overly self-centred. Try presenting yourself as part of a group
instead of as an individual (eg. ‘My family and I…’, ‘Our basketball team…’).
What are your interests / hobbies?
Here, the interviewers are trying to determine whether you have a life outside
schoolwork and study. They know you are an excellent student – otherwise you
wouldn’t be there. What they want to know is if you are a well-rounded person
with a variety of talents and skills, for example, whether you are involved in
sport, music, drama or debating. They also want to know that you have other
interests and involvements, such as theatre, literature or politics.
What have you learnt from your involvement in extra-curricular
activities?
This question takes the preceding question a step further. It may be used to gauge
the depth of your involvement in a particular activity.
You say you like sport. What does the way you play sport say about
you?
For example: Are you competitive? Do you give up easily? Are you a good loser?
Do you back away from a challenge?
What is your most valued achievement?
This will differ considerably between people. It is important to explain why it is

your ‘most valued achievement’. Is it because it recognised or developed skills
within you? Is it because you worked hard for it? Is it because you learnt about
life or made good friends?
Questions such as this assess personal qualities such as perseverance, self-

reliance and intiative.
What achievements or accomplishments do you take pride in?
Tell us about an event that occurred in your life and how it shaped
you.
Who was your favourite teacher at school and why?
Who in your life has influenced you and how?
The 'who' part of this question may include family, close friends, teachers or
others who have shaped your life. The 'how' part of this question will give the
interviewers greater insight into who you are as a person.
5 Tips for a Panel Interview

5:41 PM
Clipped from: https://www.themedicportal.com/5-top-tips-panel-

interview/
“I’ve always wanted to be a doctor since I experienced A&E as a 5-year-
old” or words along those lines are almost certain to be mentioned by the
clear majority of medical student hopefuls during their interview, amongst
many other well-known phrases, but what can you do to stand out from
the rest? Here I have set out the 5 Top Tips that I believe are key in the
ability to excel at a Panel Interview.
Confidence is key
It might seem obvious and, no doubt, hard enough to do in one of the

biggest moments of your life, but a smile can show to the interviewers
that you’re well prepared or (maybe?) even looking forward to speaking
to the panel about your passion to pursue medicine.
Be aware of the likely structure of the panel interview
The medical school may send lots, little, or absolutely no information to

you regarding your interview. Regardless of the volume of information
given, you should bear in mind the structure of a typical panel interview,
which is generally set out with questions (in no particular order) on:
 Desire to be a doctor (“Why medicine?”, “Why this

university?”, “Tell me about your work experience and which
aspects you found most interesting?”)
 Skills (“Give an example of a time when you used your

leadership/communication skills effectively”, “Tell me about what you
gained from acting as captain of your netball team”)
 Ethics (“What do you think of [x] article in the news recently”, “If
you had £1000.00 to spend on 1 kidney transplant, would you give it
to a 30-year-old lawyer with a history of chronic drug use or a 64-
year-old retired gentleman with no past health problems?)
Ensure that you address everybody on the panel in some way
Some panel interviews will have their own “Good Cop vs Bad Cop” panel
interviewers, who will do their best to intimidate you. The key word here
is positivity – don’t be drawn to the interviewer whose seems to warm to
you the most; it’s key to distribute your concentration across the panel to
give an equally positive impression.
Arm yourself with facts
Medical schools will expect you, as a minimum, to know the basic “pulling
factors” that differentiates them from other schools. If, however, you can
pull together some of the lesser known details, such as specific research
the university carries out, that will go far further than the basics. Having
this depth of knowledge proves your extensive research into your medical
choices, and will only add to the increasing number of tick boxes you will
have next to your name.
Be yourself
One of the major pitfalls I have seen in medical school hopefuls is their
incredible ability to memorise vastly complicated, “model” responses to
questions pitched by the interviewer. However, the interviewer can see
straight through this! Whilst remembering key points of the questions
such as “Why [x] medical school?” is essential, a genuine tone and giving
the impression that you have thought about the question rather than
memorised it will stand you in much better stead.
Background and Motivation Questions - The Medic

Portal
5:43 PM
Clipped from: https://www.themedicportal.com/e-learning/interview/background-

motivation/
Below is a selection of Medical School interview questions on the theme of
‘Background and Motivation to Study Medicine’.
The answer guides have been put together by medics who have successfully navigated
interviews at top Medical Schools.
Remember, though, that an interview is about an individual, so there are no hard and
fast rules. The answer guides are only examples and are not exhaustive. They should
be used to stimulate your thinking — not repeated verbatim at your interview.
Background and Motivation
Why do you want to go to Medical School?
Background and Motivation: why do you want to study Medicine?
Answer Guide:
 This is a common Background and Motivation question, so reflect carefully on
the answer prior to interview
 In order to answer it properly, you will need to first understand what exactly
being a medical student and a doctor entails. This comes from research, work
experience and talking to people ahead of you on the pathway
 Aim to strike a good balance between passion and pragmatism — many people
come across disproportionately one way or the other
 Provide enough detail to be persuasive, but avoid waffling. More than three
points is usually too much and impact will be lost
 Get across your desire to interact with – and ultimately help — people. This is
what being a doctor is all about
 Try to capture why the combination of scientific drive and human engagement
involved in Medicine appeals to you
 Use examples from work experience and your personal life throughout to
personalise and strengthen your answer
Common Mistakes:
 Knowing you want to be a doctor but not being able to articulate why. This is
usually a result of a lack of reflection
 Referring to financial rewards or social status: these are not good motivators
and there are other careers that offer more of both
 Saying that you come from a family of doctors. This is not a mistake in itself, but
you must stress that you have done your own exploration
If you were not offered a place to study Medicine, what would you do?
Answer Guide:
 Saying you would apply again next year, and perhaps try to get a job or
volunteering post in a related area in the meantime, shows commitment
 Stressing that you would remain committed to the pathway in the face of a
setback is a good demonstration of your desire to study Medicine
 Show that you can turn misfortune to your advantage by outlining how you
would make the most of the time – to gain more experience in healthcare for
example
 Perhaps suggest that you could try nursing or a related healthcare degree
because they also involve patient care and that is ultimately what you’re
interested in
Common Mistakes:
 Simply saying ‘I will get in’ shows arrogance, rather than strength — and might
tempt them to prove you wrong!
 Saying straight away that you would do something unrelated suggests a lack of
commitment and resolve
What aspects of the working life of a doctor appeal to you?
Answer Guide:
 Hopefully you find it rewarding to help people who need it, and make a
difference in peoples’ lives. So say so – and don’t be too afraid of sounding
cheesy
 Remember: as a doctor, you have the chance to make a real difference to
peoples’ lives every day that you go to work
 Patient care and disease management, alongside the medical research that takes
place, is intellectually stimulating
 It is a multi-faceted job that presents you with many exciting challenges
 If you enjoy teamwork and problem-solving that will also be a big draw
 Consider the diversity of opportunities available to healthcare professionals
 Use work experience and other first-hand experiences to support the things that
you say — make the answer personal to you
 Consider mentioning that you are also aware that it is extremely challenging
and stressful but that you believe the positives outweigh the negatives
Common Mistakes:
 Focusing on career advancement, respect and remuneration

 Saying that the life of a doctor is entirely positive and failing to appreciate the
emotional difficulty involved
Learn answer techniques at our Interview Course
What aspects of the working life of a doctor don’t appeal to you?
Answer Guide:
 Show that you understand, from research and work experience, that being a
doctor comes with a lot of challenges
 Without belittling these challenges, also keep a positive outlook and
demonstrate that you are up for the challenge
 Example: being a doctor can be very stressful and requires a huge commitment,
which might restrict your personal or family life. However, there might also be
good ways of finding a work-life balance that work for you
 Example: death of patients is an inevitable part of being a doctor — show that
you recognise that this will be an incredibly difficult thing to deal with.
However, you can also refer to the support available for doctors experiencing
difficulties with this
 Remember, there is a huge range of opportunities available to a doctor. You will
develop more of a sense of what you are best suited to as you move through
Medical School
Common Mistakes:
 Being blindly positive. Positivity is an excellent trait but not at the expense of
realism
 Saying that everything appeals and you can think of nothing that would be
difficult about being a doctor shows a lack of appreciation for the realities
 Referring too much to NHS cuts and working long hours for relatively small
remuneration could make you seem like you have the wrong priorities
Can non-scientific hobbies add to a person’s ability to be a good doctor, and why? Can you
think of any examples in your own case?
Answer Guide:
 Medicine isn’t just a scientific career. It is people-based and therefore requires
doctors to be well-rounded people who can relate to others
 Non-scientific interests can help doctors achieve this, and relate to patients who
don’t have a deep scientific understanding of their situation
 Some universities, like Imperial, focus a lot on extracurricular as a sign of well-
rounded candidates; find out each university’s stance beforehand
 If you play music / sport / paint / do comedy / other, tell them about it and try
to articulate why this might make you are stronger candidate
 Extracurricular activities can demonstrate skills relevant to Medicine; sports
people often show teamwork and leadership, for instance. Use extracurricular
achievements to signpost doctor-worthy traits.
 Example: I love playing the guitar, and have played in bands in my town for
several years. It is a great way of meeting new people, and playing music
together is one of the most enjoyable things I do. I would like to continue
playing guitar alongside my medical studies, as I feel it could provide catharsis
during stressful times. Patients or colleagues might also enjoy listening or
playing music together!
Common Mistakes:
 Focusing too much on extracurricular agendas at the expense of the Medical

School. Remember, not everyone shares the same interests as you.
 Being dismissive of non-academic pursuits and saying things like ‘a doctor’s
ability to diagnose illness is really the most important part’.
What do you find interesting about Medicine?
Answer Guide:
 While this question appears to be asking you to talk in detail about scientific
topics you have studied and find interesting, what it is really doing is providing
you with an opportunity to demonstrate the breadth of your engagement with
Medicine.
 Structure your answer to avoid being incoherent or going into too much detail
about one particular topic – and running out of time!
 Start by discussing a particular scientific aspect of Medicine that you have
studied or read about and found interesting – such as the special structure of
the epithelial cells in the myocardium that allows the heart to act as such an
effective and reliable pump.
 Connect this to any relevant clinical work experience you have had – for
example, did you see any patients with heart conditions or did you see an
echocardiogram? What are the real-world manifestations of the Medicine that
interests you? If you don’t have any relevant work experience, think about the
reading you have done.
 You might then move on to the practical side of Medicine. This lets the
interviewer know that you appreciate that Medicine is a practical science – and
often the practise of Medicine is less about scientific knowledge and more about
soft skills, pattern recognition and logic.
 You could then combine both the practical and scientific topics you have
discussed to talk about research or self-directed learning that you might want to
do at Medical School. Is there an Intercalated Degree that you have your eye on?
 Remember to demonstrate that you have thought about this question from
multiple aspects! Not just the scientific one!
Common Mistakes:
 Not taking the time at the start to think about what you want to say and
structure the answer accordingly. You run the risk of talking without any logical
structure, for an extended time – leaving the interviewer none-the-wiser on
your position!
 Focusing on one aspect and not demonstrating that you appreciate that
Medicine is a multi-disciplinary and varied area of study and practice.
What do you wish to achieve from your medical career?
Answer Guide:
 You need to have a basic understanding of what a typical medical career may
involve.
 Aim to cover your interests in the areas of clinical training, academia, general
skills development and social activities.
 Take why you wish to study medicine and translate that into something tangible
that you would like to achieve. For example, this may be an idea to train as a
Consultant then travel the world to engage in humanitarian work.
 What they want to see is if you have an idea of how a medical career could
satisfy your interests and how you can contribute to society as a doctor.
 It may be worth reading up on training pathways for doctors. Remember these
are a guide and many doctors take unconventional routes during their training
to take time out for doing research, travelling or having a family.
 As a doctor, excelling in clinical practice will be a given, but try to mention
things that shows appreciation of the other responsibilities of a doctor, such as
teaching junior doctors and medical students.
 Use your reflection on your work experience to strengthen your answer. You
may have been inspired by one or more of the doctors you interacted with.
 Try to be creative with your answer and show how you aim to make the most
out of your career in medicine.
Common Mistakes:
 Not being open enough. Many medical students and even doctors end up
changing their minds on what they would like out of a medical career.
 Forgetting to mention that you wish to help patients in some way. After all,
that’s what being a doctor is about.
 Focusing on financial rewards or social status.
More Topics
Work Experience Questions - The Medic Portal

5:43 PM
Clipped from: https://www.themedicportal.com/e-learning/interview/work-

experience/
Below is a selection of Medical School interview questions on the theme of ‘Work
Experience’.
What Medical work experience have you carried out?
Work experience: what did you learn from your work experience?
Answer Guide:
 The important thing is that you have done as much work experience as possible.
Medicine is such a diverse field, with so many different aspects and specialities
that you should be really eager to see and experience as much you can
 You should have kept a reflective diary of your work experience. Before
interview, you should go through this and extrapolate the key examples, reflect
upon them and come up with clear and succinct ways of getting across what you
saw and what you learnt
 Outline the type of experience you did, where it was and what you learnt, using
specific case-by-case examples to highlight things like communication,
teamwork etc. If you have multiple examples, give one of each
 Example: During my time in the hospital I worked in different departments
with different specialities including oncology, cardiology and radiology. During
my time in cardiology, I witnessed an emergency situation and it amazed me
how the whole team came together, under the leadership of the doctor, to
stablilise the patient
 Example: I organised work experience at my local GP surgery because primary
care is such a fundamental part of the NHS and I was keen to see what
healthcare in the community is like. One case that struck me was that of an
elderly woman who spoke little English. The doctor was able to adapt to
communicate with her in a clear and empathetic way
 Example: I really enjoyed my medical work experience and working closely with
patients. This motivated me to start volunteering in an elderly care home, which
I’ve been doing alongside my studies. Working there once a week has allowed
me to form some close relationships with patients and understand their
perspective
 Make it clear that you are not ending your experience after the interview. Say
that because there is still so much to see, you’ve been busy organising some
more work experience for the holidays
Common Mistakes:
 Simply providing a checklist of placements you’ve done with no case examples

or learning points. This will ultimately mean you did not make the most of the
time you have invested doing all of these great things
 Being closed minded. Saying things like ‘I’m only interested in becoming a
cardiologist so I only organised work experience in cardiology.’
What did you learn from your work experience?
Answer Guide:
 From each of your work experiences, you will have learnt many new things
about Medicine. No two days, even in the same GP surgery or the same hospital
ward, would have been the same
 The danger here is almost having too much to say. So explain that while you
have learnt an incredible amount, you would like to give an example of a key
learning point from each of your placements
 Example: During my time working on the wards in the hospitals, I saw the
concept of a ‘multi-disciplinary team’, something I’ve heard so much about,
come to life right in front of my eyes. Witnessing the doctors, the nurses and the
healthcare assistants all working together to provide a seamless healthcare
service, personalised for each individual patient, was incredible
 Example: In the GP surgery, one of the key things that really stood out to me
was the underlying importance of communication skills in the doctor-patient
relationship. Seeing the GP deal with an angry patient and calming them down
in a matter of minutes, really emphasised this
 Don’t be blindly positive and say that everything you saw seemed fantastic.
Make sure you get across that you saw the hard side of being a doctor, that you
appreciated it, but that you are still up for the challenge
 Example: throughout my work experience, I was also aware of the daily
challenges doctors face. In every setting, whether it was in the GP practice or in
the hospitals, the doctors worked very hard with very long days and faced many
stressful situations. But speaking to the doctors, and seeing them overcome
these obstacles, really inspired me. I understand that a career in medicine will
not be easy, but after my work experience I am even more determined and
motivated to pursue a career in this rewarding field.
Common Mistakes:
 Not reflecting on learning points prior to the interview and having to do this in
real time during the interview. It’s always apparent when this is the case. And,
unfortunately, it means you will not make the most of your efforts. Keep a
reflective diary
 Sugar coating. The interviewers won’t think you are being overly negative if you
mention some of the harder challenges you saw. In fact, they will appreciate
that you are going into Medicine with your eyes open
 Providing a list of unsubstantiated buzzwords as learning points. Saying ‘I saw
the importance of teamwork, communication, empathy etc.’ without giving
specific examples
From your work experience, can you tell me about a difficult situation you observed/had
to deal with and what you learnt from this?
Answer Guide:
 Start by acknowledging the challenges involved in being a doctor. It is a

stressful job and you need to demonstrate that you appreciate this
 From your work experience, you will have learnt that doctors are constantly
faced with difficult situations and challenges
 In these situations, a doctor’s ability to be flexible, use their initiative, and adapt
their communication skills to the present situation is what makes them stand
out
 You should then outline a specific example, since this is what they have asked
for, which you will have hopefully thought about prior to your interview
 Example: one particular incident that stood out to me was during my work
experience in a GP surgery, where the GP had to deal with an extremely angry
and aggressive patient/ break some bad news to a patient. This was challenging
because¦
 Then go on to outline the actions taken
 Example: I admired the way the doctor adapted his communication skills to the
situation to calm the patient down/demonstrate empathy by relating to the
specific set of circumstances
 Finally, extrapolate the key learning points and how you can apply them
 Example: this has made me value the importance of communication in the
doctor-patient relationship even more. Since then, I, myself, have also tried to
be more aware of the power of my communication skills in difficult situations
and have really noticed the benefits of being flexible and adaptable with
communication.
Common Mistakes:
 Failure to be empathetic. Saying things like ‘the patient was being a nightmare’
show that you have not seen things from their point of view
 Focusing on the negatives. You want to establish the challenge and how it was
dealt with. But don’t say anything that makes it seem like it has put you off
being a doctor
What qualities did you learn are important from the doctors and nurses during your work
experience?
Answer Guide:
 As with all work experience, this will come down to how well you have reflected
on what you have seen and done
 Make sure that you take note not just of how the doctors operate during your
placements, but how the nurses and other healthcare professionals perform and
how everyone comes together in a team effort
 Remember that the ultimate goal is to provide an excellent, efficient and
seamless healthcare service, in the best interests of the patient
 There are some key qualities you are likely to have seen, so you can go through
these, using actual examples for reinforcement
 Teamwork/Leadership example: one of the first things I noticed was the
importance of inter-professional working and excellent team work amongst all
the healthcare professionals. I admired the leadership skills of the doctor to
effectively lead the team, ensuring each team member was valued and had a
clear role. In one case¦
 Communication example: Seeing how the doctors and nurses were able to adapt
their communication skills to a given situation really highlighted the
importance of adaptability and flexibility in healthcare. In one case¦
 Ultimately, all of these skills are crucial in order to provide the best care for
each individual patient and this should be the focus of your answer
Common Mistakes:
 Failing to notice any important qualities from the nurses or other healthcare
professional and only focusing on the important qualities in the doctors
 Giving a shopping list of qualities, without backing them up using examples and
learning points
What aspect of your work experience did you find the most challenging/difficult and why?
Answer Guide:
 Make it clear that you understand that a career in Medicine is not an easy one
and there are many challenges that doctors face on a daily basis
 Bring this point to life by using a personal example of a time when you saw
something that seemed particularly stressful
 Example: for me, one of the most challenging aspects of my work experience
was seeing a doctor have to deliver some bad news to a patient
 But then take the learning points from the situation
 Example: however, I was really inspired by the way the doctor dealt with this
situation and this really opened my eyes to the importance of particular
qualities which make a good doctor, such as communication and empathy
 Specifically mention that since your work experience you’ve taken time to reflect
on this situation and have really made an effort to use what you’ve learnt to deal
with other difficult situations/challenges you’ve come across
 Another challenge around work experience is actually getting it. If you had to
ask over a hundred people or walk into twenty GP surgeries to get yours,
mention this as it shows commitment and resilience
Common Mistakes:
 Trivialising the harder parts of work experience under the misguided

impression that highlighting the challenges will make you seem less committed
 Leaning too far the other way, and saying that seeing the challenges doctors face
made you question your decision to study Medicine
What did you like most about the work experience you undertook?
Answer Guide:
 This is an opportunity for you to demonstrate what you observed and learned
from your work experience placements.
 As with all answers, stop for a moment and structure your response into a series
of themes or areas. Do not immediately go through a list of all your placements!
 This question should be structurally similar to your answer for ‘why do you
want to study Medicine?’ But the content should consist entirely of examples
from your work experience. If you are struggling for structure, refer to the
GMC’s Tomorrow’s Doctors.
 Under this structure scheme, you would consider: the scholarly aspects of work
experience (i.e. did you find radiology particularly interesting?); the scientific
aspects (i.e. do you understand more about disease presents and how that
relates to cell function?); the doctor as a practitioner (i.e. did you enjoy talking
to patients or watching the doctor-patient interaction?); the doctor as a
professional (i.e. did you enjoy the teamwork between healthcare
professionals?).
 Remember to illustrate what you learned from your time in a clinical setting!
 Did you learn anything about yourself during your placements?
 If you undertook multiple placements in different clinical settings and had a
particular affection for one of them, say so and explain your reasoning. Be
careful to end by acknowledging that it is far too soon to be thinking about
Specialties!
Common Mistakes:
 Interpreting the question as an invitation to list off all the various work
experience placements you have done!
 Not demonstrating that you have reflected on what you learned and putting that
within a wider context of your decision to study Medicine or what life as a
doctor will be like.
Why do you think we ask candidates to undertake work experience?
Answer Guide:
 You may be thrown a curve-ball question, such as this one. It is essentially

testing whether you have thought about the rationale behind the tests you need
to take to enter Medical School, or if you have simply followed instructions.
 Consider the challenges of Medical School: it is stressful; it requires an
enormous amount of self-determination; it is a far longer course to study; it is
designed to prepare you for a life-long career.
 From this, consider what the evaluators may be looking for (or worried about):
a visible interest in Medicine; a strong commitment to securing experience and
learning from it; a sober awareness of the downsides to Medicine; and therefore
a well-informed decision to study Medicine.
 Work experience not only provides an insight into how Medicine is practised
and what a career as a doctor is like. It is also an opportunity for you to reflect
on whether this career is right for you and if you realistically have the skills and
determination to do it.
 Medical schools therefore ask candidates to undertake work experience to
ensure that their decision to study is informed, but also to evaluate whether
students were engaged enough to learn from their placements – as placements
are a core aspect of learning during your clinical years.
Common Mistakes:
 Not recognising the link between work experience placements and student
placements during your clinical years.
 Suggesting that it is a ‘test’ of the student’s commitment, rather than an
opportunity for students to really examine their motivations.
Reflecting on your work experience, what event, if any, changed your views on modern
medicine?
Answer Guide:
 Your answer to this question will strongly revolve around your personal
reflection on your work experience and insight you’ve gained
 During work experience of all types, there will almost certainly have been an
event or interaction which surprised you or which went against your pre-
conceived ideas.
 For example, witnessing the effect of administering palliative care on family and
loved ones of the patient.
 It’s also important not to forget to reflect on such events and expand and link
them to current roles and attributes of doctors.
 Both positive and negative experiences are as valuable as each other!
Common mistakes:
 You don’t have to re-invent the wheel or spot a huge flaw in primary healthcare
to be able to make a valid reflection. Sometimes, the more specific and personal
the example, the more you demonstrate an awareness and insight into your
experience.
 Telling interviewers about all your work experience and what you’ve seen may
sound like a list as opposed to a genuine reflection. It’s not about the amount of
experience you’ve had, rather how much you learned from the experience you
have had.
Give an example of an interaction between a doctor or nurse and a patient that you
observed during your work experience. What skills did you find to be important for this
type of communication?
Answer Guide:
 Communication skills are extremely important in medicine and students are

often required to put them into practice quite early on as many medical schools
introduce patient contact towards the beginning of their course.
 Briefly describe an example of communication with a patient that you observed
during your work experience. You want to spend more time reflecting on what
you learnt rather than explaining the scenario itself so keep this concise.
 Discuss the skills that you felt the doctor or nurse employed when speaking to
the patient or any other skills that you personally feel are important during this
kind of interaction.
 Examples of important communication skills include some obvious points such
as eloquence, good body language, and eye contact as well as the ability to listen
and synthesize information.
 However, qualities such as empathy may also be considered important. This
means that a doctor should pick up on the patient’s concerns and react
appropriately in order to help reassure them. In addition, it is important for
doctors to adapt their vocabulary and explanation to suit each patient; for
example, you might need to adopt a different approach when speaking to a child
or a patient with a different mother tongue. These are just a couple of the
examples of communication skills that you might give.
 Consider explaining why good communication is so important in medicine. You
might want to mention some of the potential repercussions of poor
communication skills such as patients failing to understand instructions with
regards to their prescriptions.
Common Mistakes:
 Focusing too much on the situation that you observed; that particular doctor or
nurse may not have employed a huge range of different skills with regards to
communication but feel free to discuss other skills that you feel are important
when speaking to patients, even if they were not displayed in that scenario.
 Failing to consider the different aspects of communication. Communicating
with patients is not just about being articulate, although this is important; it
may also require qualities such as empathy and the ability to adapt your level of
communication depending on the patient that you are working with.
During your work experience, did you learn or see anything that did not appeal to you
about being a doctor?
Answer Guide:
 Interviewers want to know that you have a realistic view of life as a doctor. If
you have managed to get work experience in a clinical setting, it is important to
demonstrate that you picked up on some of the potentially negative aspects of a
career in medicine as well as the positive.
 Give an example of a scenario you witnessed or an observation you made during
your work experience that helped you to appreciate some of the challenges that
doctors face. Reflect on how this example might make life as a doctor difficult or
stressful at times.
 Doctors sometimes have to break bad news to patients or deal with patients that
are being difficult. There are also other factors to consider such as the record
keeping involved in treating patients which can be tedious at times. Doctors also
have a huge responsibility due to the importance of what they do which can
occasionally lead to issues such as medical practitioners being sued. These are
all valid examples of why a career in medicine might not appeal to everyone.
 Consider concluding with an explanation of how you would overcome the
challenges you described and why you still feel that a career in medicine is right
for you.
Common Mistakes:
 Failing to acknowledge some of the negative aspects of life as a doctor. Every
prospective medical student at interview is there because they want to be a
doctor but it is important to demonstrate that you have thought about this
decision and do not have an idealistic view of a career in medicine.
 Giving an extremely detailed description of what you observed during work
experience. Interviewers want to see that you have actually reflected on what
you observed and are less interested in hearing a list of everything you saw
during your work experience.
More questions on ‘Work Experience’ coming soon.
More Topics
Ethics Questions - The Medics Portal

5:43 PM
Clipped from: https://www.themedicportal.com/e-learning/interview/ethics/

Below is a selection of Medical School interview questions on the theme of ‘Ethics’.
When dealing with these questions, try to apply the 4 pillars of ethics:
 Autonomy — Does it show respect for the patient and their right to make
decisions?
 Non-maleficence — Does it harm the patient?
 Justice — Are there consequences in the wider community?
 Beneficence — Does it benefit the patient?
Ethics
What do you understand about euthanasia? Does euthanasia have a place in modern
medicine?
Medical Ethics: does euthanasia have a place in modern Medicine?
Answer Guide:
 First things first, what is euthanasia? This is the term given to describe actions
taken to deliberately end someone’s life, often to relieve suffering. There are
many different types of euthanasia, such as active euthanasia, passive
euthanasia, voluntary euthanasia and involuntary euthanasia
 Establish the fact that this is a complicated issue with lots of shades of grey and
no straightforward answer
 While weighing up both sides, think of the four pillars of medical ethics: justice,
autonomy, benevolence and non-maleficience. All of these play a pivotal role in
this issue
 Start with legality, if you know it, since it is the most clear cut. Currently, in the
UK active euthanasia and assisted suicide is against the law. However in
Belgium, Luxembourg and Holland, active euthanasia is legal. In countries such
as Switzerland and Germany, active euthanasia is illegal but assisted suicide and
passive euthanasia are both legal. Make sure keep up to date with any changes
 Euthanasia allows the patient to exercise their right to decide their own fate and
end suffering (benevolence). However, arguments against euthanasia include
the principles of the Hippocratic Oath which state a doctor shall “do no harm”,
and the related ethical concept of non-maleficence
 Assessing mental capacity and competency of patients (Mental Capacity Act
2005) is crucial in the discussion of euthanasia, as legalisation of this could
potentially put vulnerable adults at risk
 Some cases of patients who have travelled abroad for these end of life services
have also been a hot topic in the media so it would be good to reference any of
these cases that you are aware of
 The discussion of euthanasia is a sensitive one and thus it is always best to look
to the ethical guidelines provided by the GMC
Common Mistakes:
 Starting with a strong view point one way or the other. It is important to
establish that this is a complicated issue with arguments for both sides and to
present these in a balanced way
 Not using the four pillars of ethics. These should be referenced throughout
balancing of the two sides of the argument
Do you agree with abortion? What are the ethical issues here?
Answer Guide:
 Start by acknowledging that this is a complex issue with two sides and lots of
shades of grey. Then walk through both in a balanced way, showing an
appreciated of the four pillars of ethics.
 Is it legal? Under current UK legislation (The Abortion Act) an abortion can
only be carried out if certain criteria are met: the pregnancy is in its first 24
weeks, it is carried out in a hospital or licenced clinic and two doctors must
agree that an abortion would cause less damage to a woman’s physical or
mental health than continuing the pregnancy. In rare situations, an abortion
may also be allowed to be carried out after 24 weeks
 If we consider patient autonomy, there is a case to say that patients should have
the right to have an abortion if they wish
 Considering the ethical concept of beneficence, first, it is important to have the
best interests of the mother at the centre of their healthcare (both psychological
and physical well-being). Secondly, an abortion may be the most loving thing to
do in the case of a foetus with severe deformities, as this presents issues with
quality of life
 Non-maleficence – it is important to prevent any harm and thus considering the
harm to both the mother and the foetus is important in the discussion of
abortion. It is also important to consider the sanctity of life and some, based on
this principle, may disagree with abortion. But it’s quite subjective
 As with all consultations, confidentiality must be upheld in the case of abortions
 The discussion of abortion is a sensitive one and thus it is always best to look to
the ethical guidelines provided by the GMC
Common Mistakes:
 Starting with a strong view point one way or the other. It is important to
establish that this is a complicated issue with arguments for both sides and to
present these in a balanced way
 Not using the four pillars of ethics. These should be referenced throughout
balancing of the two sides of the argument
A patient refuses treatment for a life-threatening condition. Discuss the ethical issues
involved.
Answer Guide:
 In a scenario like this there are many ethical issues involved. It is important to
look at each one individually, in order to fully understand and weigh up the
scenario
 First of all, if we consider the duty of the doctor. In a case like this is it crucial
the doctor fully informs the patient of the benefits of the treatments and the
risks associated with not having the treatment
 If we consider the concept of patient’s autonomy, then doctors must respect the
decision made by a patient. However, patient autonomy is not absolute,
particularly if a patient is not competent
 Beneficence and non-maleficence often link together and this is no exception.
The most beneficial thing to do may be to provide the patient with the
treatment they need. However, if this is against the patient’s wishes this might
do more harm than good. Whatever the patient’s decision may be, doctors must
continue to provide the best care in the patient’s best interests.
 Always be clear that you would adhere to the GMC’s guidelines
Common Mistakes:
 Not knowing about autonomy. You need to be clear about all of the four pillars
of ethics. This is a key one that trips many people up
A 14 year old patient goes to the GP and asks for the oral contraceptive pill. Discuss the
ethical issues involved.
Answer Guide:
 As usual, we start by using the four pillars of medical ethics as a framework

 Currently, under UK Legislation, those under the age of 16 are not able to give
consent to sexual activity. It is always important to consult the GMC and their
ethical guidelines on young people and sexual activity for the most up to date
information
 If we begin with the duty of the doctor, they must fully inform the patient of the
benefits of the treatments/protected sex and the risks associated with not
having the treatment/unprotected sex. The doctor also has a duty to society to
ensure the safety of their patients and ensure child protection and safety
 Therefore, competence is a major aspect to consider. Establishing and assessing
competence (Gillick competence) is also very important in a case like this to
ensure sexual abuse is not taking place and for child safety
 Autonomy – doctors must respect the decision made by a patient. However,
patient autonomy is not absolute, again linking to assessing competence, which
will be an important part of this answer
 Beneficence and non-maleficence – doctors must continue to provide the best
care in the patient’s best interests, and their personal views must not interfere
with their professional duties
 It is also important to consider confidentiality and the effect on the doctor-
patient relationship, which is built upon trust
Common Mistakes:
 Being judgemental. Saying something like ‘14-year-olds shouldn’t be engaging

in sexual activity in the first place’ is a red flag
A patient diagnosed with HIV reveals to their GP they have not disclosed this information
to their partner. Discuss the ethical issues involved.
Answer Guide:
 This is a complex scenario and it’s important to consider and apply each of the
four pillars of ethics
 The doctor must fully inform the patient of the risks associated with not
disclosing this information and encourage them patient to disclose this
information to the partner, themselves. The doctor also has a duty to protect
and ensure the safety of society (justice) and, based on these grounds, may
choose to make a disclosure to the patient’s partner about the patient’s HIV
status. However, this would be a last option and the doctor would need to
inform the patient of their actions.
 Autonomy – this links to patient’s autonomy, as doctors must respect the
decision made by a patient. But patient autonomy is not absolute, particularly in
a case like this where society/another patient is at risk. In this case,
confidentiality may be broken, which may also affect the doctor- patient
relationship
 Beneficence and non-maleficence – doctors must continue to provide the best
care in the patient’s best interests. When making a disclosure, it is important to
weigh up the benefits (protecting another patient’s health) against harm (could
affect the doctor-patient relationship and future disclosures)
 You can say to the interview panel that it is always important and helpful to
consult the GMC’s ethical guidelines in cases like this
Common Mistakes:
 Not knowing but claiming you do. If you are aware of the above that’s great. If
you think you are, then say that you are not sure but you think it is the case. If
you don’t know the legalities then be honest about it
 Using common sense. You can’t just come up with a common sense reply, like
‘logically you should tell the partner’. You have to be aware of the legal
ramifications
You are a medical student at this School. One day in the teaching hospital, you see one of
your fellow students putting medical equipment from the stock room into their bag.
When you ask them about it, they say they only want to practise their clinical skills and
not to tell anyone. What would you do?
Answer Guide:
 This question is designed to examine your awareness of the duties of a medical

school and a doctor according to the GMC publications Good Medical Practice
and Tomorrow’s Doctors.
 The first thing you must do when answering this question is explain what the
dangers of the situation are: practicing clinical skills without supervision could
lead to the student seriously harming themselves; taking equipment from a
hospital is a serious breach of ethics and could risk lives (if that equipment
leads to a shortage of supplies); the student’s actions (while well-meaning) are
not in keeping with the professional standards of a doctor; if you do not report
this act, you are also not acting in accordance with these standards and risk
being sanctioned or removed from the Medical School.
 You should also explain the risks of the situation: if you confront the student,
they may react negatively; the student may have received permission from
someone to do this (unlikely, but possible); such an incident could damage the
ties between the teaching hospital and the university.
 Acknowledge what your authority is and therefore how you should approach the
situation. You are not a doctor, nor are you a Faculty member. You therefore
need to approach the student in a calm and supportive manner and not threaten
them with negative outcomes.
 I would encourage the student to see the danger of their actions, to come clean
about what they have done and support them emotionally with any difficulties
that might have led them to such a drastic act.
 If the student refused to act, I would then approach a Faculty member and
discretely report the situation.
Common Mistakes:
 Not having read Good Medical Practice or having an appreciation for the
standards you will need to live up to as a doctor or medical student.
 Immediately confronting the student without outlining your concerns and the
reasons for your actions.
 Reporting the student immediately without considering for why the student is
behaving erratically – are they suffering from mental stress or anxiety?
Organ donation should be an opt-out system rather than an opt-in system in this country.
Do you agree or disagree?
Answer Guide:
 Before launching in the standard medical ethics answer framework, set the
scene for the topic by explaining what the question is about!
 In December 2015, NHS Wales moved from an opt-in system (where consent
for organ donation must be given or asked for) to an opt-out system (where
consent must be actively removed). The rest of the NHS still operates on an opt-
in system – but the BMA actively campaigns for an opt-out system.
 Each year around 1,000 patients die while waiting for a transplant. The UK has
one of the highest family refusal rates for organ donation of any developed
nation – 43% of families refuse consent following a relative’s death.
 According to public polls around 90% of the population believe in organ
donation – but only around a third of people are on the organ register.
 After setting the scene, move into the standard ethics answer framework!
 Autonomy: An opt-out system obviously has the potential for someone who
does not want to donate an organ to become an organ donor, simply because
they did not opt-out. In Wales it was estimated that up to 30% of the population
did not know the system had changed. On the flip side, at the moment only a
third donate organs despite 90% believing it is the right thing to do – so
perhaps the opt-in system is the one removing patient choice?
 Other autonomy arguments: Under the current system, families can refuse to
allow organ donation. This means that families have the power to potentially
over-turn the wishes of the patient, in an emergency situation where the patient
cannot express their view. On the flip side, an opt-in system treats the human
body as property of the State and (it could be argued) goes against the idea of
individual sovereignty.
 Beneficence and Non-Maleficence: Quite straightforward here. Opt-out systems
mean more organ donors, which means more organs to save more patient lives.
It could be argued that since the organ donor is already deceased, no
maleficence can be enacted upon the donor. But non-consented organ donation
would harm the family.
 Justice: Patients on the active transplant list require on-going treatment while
they wait for a new organ (such as dialysis). These are expensive treatments. It
could be argued by increasing the rate of organ transplants, we could reduce the
NHS deficit – or redistribute saved treatment costs to support other treatments,
services or health research.
 Remember to finish by planting your flag. Do you agree or disagree? And why
have you reached that conclusion?
Common Mistakes:
 Not explaining what an opt-in versus and opt-out system is and therefore not
demonstrating critical knowledge.
 Not demonstrating an appreciation for the pillars of medical ethics.
What does ‘patient confidentiality’ mean? When would it be appropriate to breach this?
Answer Guide:
 Have an understanding of what patient confidentiality means and what kind of

information it covers.
 Briefly mention the purpose of having patient confidentiality and how it builds
trust in the doctor-patient relationship.
 If you have an example from your work experience where you were shown how
patient confidentiality works, be able to reflect on this.
 Then go on to mention different situations where patient confidentiality can be
breached. This may be where the patient poses a significant risk to health of
themselves or others.
 Countries may have differing guidance in place about this. Know what your
country recommends by consulting the appropriate literature. An example of an
organisation who sets such guidance is the General Medical Council in the UK.
 You may wish to mention implied consent, where a patient is aware that a
doctor will share information about them to other individuals in the healthcare
team to provide the patient with the best possible care.
 Mention how it is important to have a conversation with a patient about
confidentiality as a doctor or even medical student.
 Mention how one is duty bound as a doctor to abide by the regulations that are
in place to protect patient confidentiality and that professional duty should
always come above personal beliefs.
Common Mistakes:
 Not knowing the actual meaning of patient confidentiality.

 Not knowing the situations that patient confidentiality is applied in. As a
medical student, you will also be bound by the rules of patient confidentiality.
 Mentioning incorrect situations where patient confidentiality can be breached
or saying that it can never be breached. It is better not to mention specific
scenarios if you are not confident that they are correct.
A 13 year old patient reveals to you that they are sexually active and that their parents do
not know. What would you do as a doctor in this the situation?
Answer Guide:
 You must take the legal aspects of this scenario into account. This patient is
below the age of consent which is 16 in the UK but you must also consider
doctor-patient confidentiality.
 Explain that you would encourage the patient to make their parents aware that
they are sexually active.
 Consider the 4 pillars of ethics – here you are concerned with beneficence. You
must take into account the effects that being sexually active might have on the
physical and mental wellbeing of your underage patient. You might also have
concerns about whether the young patient is being taken advantage of.
 Doctors may provide advice on sexual health and contraception to underage
patients as long as the young person is capable of understanding this advice and
their physical/mental wellbeing will most likely suffer without it. In general,
patient confidentiality must be respected which means the parents must not be
informed.
 However, if a doctor deems that the safety or physical or mental wellbeing of an
underage patient is at risk, they have a duty to follow child protection protocol
which means breaching patient confidentiality if it is in the patient’s best
interests.
 NICE guidelines are a useful resource when dealing with ethical questions like
this.
Common Mistakes:
 Forgetting about the legalities of doctor-patient confidentiality. Even when

dealing with a very young patient, you cannot simply inform their parents of
their actions if you are concerned; you must follow the proper protocol.
 Failing to mention the potential risks of such a young patient being sexually
active and the fact that, in some cases, a third party may need to be contacted in
order to protect the patient.
A depressed patient who has refused treatment has mentioned having suicidal thoughts
and you are concerned about his well-being. Discuss the ethical issues involved.
Answer Guide:
 When addressing an issue like this it is important to consider the 4 pillars of

ethics, especially non-maleficence, beneficence and patient autonomy in this
case.
 Mention that it is important to ensure that the patient is aware of and
understands the treatment options available to them so that they can make an
informed decision.
 Autonomy – in this case, the patient has chosen to refuse treatment and, in
general, their decision should be respected.
 Beneficence and non-maleficence – in this situation, you are concerned about
the patient being a danger to themselves which means that the risk to their
wellbeing must be weighed against the harm that could come from breaching
patient confidentiality in order to protect the individual.
 Consider mentioning the possible repercussions of informing a third party of
your concerns. For example, the patient might be less open about their mental
health issues in the future, having lost trust in their doctor.
Common Mistakes:
 Failing to take into account the legalities involved such as the principle of
doctor-patient confidentiality.
 Not considering the 4 pillars of ethics. These can help you to structure your
answer and ensure that you touch on some of the points the interviewers are
looking for.
More questions on ‘Ethics’ coming soon.
More Topics
Autonomy
5:45 PM
Clipped from: https://www.themedicportal.com/medical-ethics-explained-

autonomy/
Welcome to the Series!
Autonomy Medical Ethics
Welcome to the first in a new series of articles that will focus on ethical issues in
Medicine today. In these articles, we will examine topical issues in order to inform
and familiarise you with how to tackle these often complex situations.
Being able to work through an ethical issue in a confident, logical and balanced way
is a critical aspect of success – both as a medical school candidate and medical
practitioner. (And we also hope they will be interesting to read, too!)
In this first article, we will discuss the conceptual framework that underpins medical
ethics and examine how these concepts can be put into practice in a clinical setting.
Of course, we should state that in real life situations can rarely be put into neatly
defined boxes, so while this framework is an excellent and powerful tool for
unpicking ethical issues, we still need to use discretion and judgement when deciding
on a course of action.
The Four Pillars of Medical Ethics
There are four pillars of medical ethics:
 Autonomy
 Beneficence
 Non-Maleficence
 Justice
Each of these pillars represents an entire realm of considerations that need to be
considered when faced with an ethical dilemma. As we will see over the course of this
series, not every issue will require us to consider every single pillar in this
framework. But having the full framework in mind ensures that we never miss an
area of examination – and it also provides a universal and logical structure for
discussing ethical issues in interviews or with colleagues.
We’ll explore each of these pillars in turn and get a sense for what they mean and
how we can use them. First up…
Autonomy
The patient has ultimate decision-making responsibility for their own treatment.
This means that a medical practitioner cannot impose treatment on an individual for
whatever reason – except in cases where that individual is deemed to be unable to
make autonomous decisions (see Mental Capacity Act and Emergency Doctrine).
To modern sensibilities, the principle that a patient has the right to choose what
happens to their body seems pretty straight-forward. But it’s important to remember
that historically this has not always been the case, and even today some patients
defer all decision-making to the “wise doctor” – even if they do not feel comfortable
with their treatment plan. And so, it is more important today than ever to bear the
autonomy of the patient in mind and ensure patients are actively involved in their
diagnosis and treatment.
How to approach a scenario with respect to autonomy
In our everyday practice then, the principle of autonomy demands that we consider
the following:
 Have we explained fully the patient’s medical condition, their options for
treatment and the advantages and disadvantages of those treatments?
 Is the patient able to retain this information, evaluate their options and arrive at
a decision?
 Has the patient provided informed consent for our actions?
These principles apply to all medical interventions, from a physical examination to
major surgery. If a medical practitioner fails to obtain consent, it is known as a
battery – a legal term that means “an infliction of unlawful personal violence.”
It is helpful, therefore, to think of autonomy as a limiter on how far a clinician can
intervene in a patient’s care. If the patient does not consent to an action, we cannot
intervene even if it will result in death.
Let’s look at an example:
A 26 year old male has been involved in a high-speed collision in which he sustained
blunt force trauma to his head as his head hit the front windscreen of his car. He
did not lose consciousness, he is fully responsive and has no indications of
neurological damage. He does, however, have a significant head wound which is
bleeding continuously. This patient has refused treatment on the grounds that he
feels “fine” and is refusing to have sutures to close his head wound. He would like to
leave the Department.
Even though the best interests of this patient would be served by undergoing a CT
scan and having sutures, as he is an adult with full mental capacity, we must respect
his autonomy in choosing to leave the Department. We cannot prevent him from
leaving, and if we did it would be unlawful detainment.
Tell us what you’d like to discuss
As we will see, things can get very complicated indeed once you start to apply these
principles to real-world situations. We’ll also find that there are other non-official
principles that we need to consider in certain cases.
All that remains to be said is that we want this series to be interactive, so if you would
like to suggest a topic for us to explore, please leave us a suggestion over on our
Community post!
Stay tuned for my next blog on Beneficence!
Uploaded by James on 3 October 2016
Beneficence
5:46 PM
Clipped from: https://www.themedicportal.com/medical-ethics-explained-

beneficence/
Welcome back!
Beneficence Medical Ethics
To continue on from my last blog on Autonomy, today’s piece will walk you through
beneficence and how to approach medical ethics questions.
What is Beneficence?
All medical practitioners have a moral duty to promote the course of action that they
believe is in the best interests of the patient. This is beneficence.
Often, however, beneficence is simplified to mean that practitioners must do good for
their patients – although thinking of it in such a simplistic way can land you in
trouble.
For instance, if there are a number of treatments that a patient can have and all of
them will provide some benefit which do you choose?
How to approach a question with respect to beneficence
It is better to think of beneficence as the process of ranking the available options for
the patient from best to worst – taking into consideration the following aspects:
 Will this option resolve this patient’s medical problem?

 Is it proportionate to the scale of the medical problem?
 Is this option compatible with this patient’s individual circumstances?
 Is this option and its outcomes in line with the patient’s expectations of
treatment?
You will notice that several considerations are concerned with the patient’s
expectations or circumstances. This is also known as holistic or patient-centric care.
It is important to bear the patient’s expectations in mind when ranking treatments

because when we refer to doing “good” we are not simply referring to what is
medically good for the patient, but also what is acceptable to the human being we are
treating.
Let’s look at an example
An 8 year-old child has been admitted to hospital with a significant open fracture to
their left leg. The limb is deformed with significant bleeding and the patient is
extremely distressed. The parents are demanding immediate action be taken.
There are a number of options for treatment here, but let’s take an extreme one –
amputation. If the bleeding is life threatening, the limb injured sufficiently and the
risk of infection extremely high then amputation could be a treatment option. It
would be “good” for the patient in as much as the injury would be resolved and the
threat to life from bleeding or infection somewhat reduced.
But let’s consider the implications of amputation. The treatment would result in a
life-changing injury and the risks of infection or massive bleeding aren’t
proportionate. The limitations to their physical movement also carry other future
risks that could inadvertently result in further physical and mental health issues.
Most important of all, there are other interventions available to us that have better
outcomes attached. Using blood products to manage the bleeding, reducing the
fracture if possible and orthopaedic surgery if necessary will have better outcomes
for this patient. That course of action is “more good” than amputation.
It’s a rather silly example, but I use it to demonstrate an important point.

Beneficence asks us to promote a course of action, but in practice we also need to de-
promote certain courses of action if there are better options available.
Next up, non-maleficence
Watch out for my next blog on non-maleficence. All you have to do to look out for it
is filter the blogs section of The Medic Portal website by ‘Medical Ethics’.
Stay tuned!
Non-Maleficence
5:46 PM
Clipped from: https://www.themedicportal.com/medical-ethics-explained-non-

maleficence/
Welcome back!
Non-Maleficence Medical Ethics
So, you’ve got autonomy and beneficence down. What about the other pillars of
medical ethics? Today’s post goes over…
Non-Maleficence!
Non-maleficence is the sister to beneficence and is often considered as inseparable. It

states that a medical practitioner has a duty to do no harm or allow harm to be
caused to a patient through neglect. Any consideration of beneficence is likely,
therefore, to involve an examination of non-maleficence.
Tackling a medical ethics scenario with respect to non-maleficence
In order to prevent harm to patients, we therefore need to consider the following

aspects:
 What are the associated risks with intervention or non-intervention?

 Do I possess the required skills and knowledge to perform this action?
 Is the patient being treated with dignity and respect?
 Is the patient being put at risk through other factors (e.g. staffing, resources,
etc.)?
Non-maleficence differs from beneficence in two major ways. First of all, it acts as a
threshold for treatment. If a treatment causes more harm than good, then it should
not be considered. This is in contrast to beneficence, where we consider all valid
treatment options and then rank them in order of preference.
Second, we tend to use beneficence in response to a specific situation – such as

determining the best treatment for a patient. In contrast, non-maleficence is a
constant in clinical practice. For example, if you see a patient collapse in a corridor
you have a duty to provide (or seek) medical attention to prevent injury.
Let’s look at a classic example:
A 52-year-old man collapses in the street complaining of severe acute pain in his
right abdomen. A surgeon happens to be passing and examines the man, suspecting
that he is on the brink of rupturing his appendix. The surgeon decides the best
course of action is to remove the appendix in situ, using his trusty pen-knife.
From a beneficence perspective, a successful removal of the appendix in situ would
certainly improve the patient’s life. But from a non-maleficence perspective, let’s
examine the potential harms to the patient.
First of all, the environment is unlikely to be sterile (as is that manky pen-knife) and
so the risk of infection is extremely high.
Second, the surgeon has no other clinical staff available or surgical equipment
meaning that the chances of a successful operation are already lower than in normal
circumstances.
Third, assuming that the surgeon has performed an appendectomy before, they have
almost certainly never done it at the roadside – and so their experience is
decontextualized and therefore not wholly appropriate.
Fourth, unless there isn’t a hospital around for miles this is an incredibly
disproportionate intervention.
Again this is a rather silly example but it is important to remember that before
leaping to action, we need to consider the implications and risks of intervening at all.
As we will see in future articles, in many cases the most harm is often caused with the
absolute best of intentions.
Next up… Justice!
Justice
5:46 PM
Clipped from: https://www.themedicportal.com/medical-ethics-explained-justice/

Welcome back!
Justice Medical Ethics

We’re on the blog you’ve all been waiting for: the fourth and final pillar of medical
ethics, justice. So far we’ve been through:
 autonomy;
 beneficence; and
 non-maleficence.
What is justice in medical ethics?
This principle states that when considering whether an action is ethical or otherwise,
we must consider whether it is compatible with the law and the rights of the
individual, and whether it is fair and balanced from a societal perspective.
The final point about societal justice is particularly relevant to us in the UK because
we operate a universal health system. This means that decisions about what
treatments to provide to whom need to be taken extremely carefully.
It also means that we must ensure that no one is unfairly disadvantaged when it
comes to access to healthcare. This is the reason why the NHS has certain
entitlements, such as free prescriptions for lower income individuals.
How to approach a scenario with respect to justice
Justice in medical ethics can be an extremely complex pillar to consider. Everyone’s

concept of fairness tends to differ. But, in general we should consider the following
aspects:
 Is this action legal?

 Does this action unfairly contradict someone’s human rights?
 Does this action prioritise one group over another?
 If it does prioritise one group over another, can that prioritisation be justified in
terms of overall net benefit to society or agree moral conventions?
Let’s take a look an example:
Patients suspected of having cancer are prioritised within the NHS with the
maximum waiting time for referral being two weeks (as opposed to eighteen weeks
for non-urgent referrals). Patients diagnosed with cancer are entitled to a range of
treatments including radio- and chemotherapy. These treatments are expensive
and treat a small, but significant proportion of patients.
First, let’s analyse the counter-arguments to prioritisation of patients with suspected

cancer. One could argue that the prioritisation of these patients over others perhaps
infringes the universal right of all patients to receive timely access to healthcare
services – in particular access to GP services.
One could also argue that the public expenditure on radio- and chemotherapy
treatments could be spent on less expensive treatments that would treat a greater
number of people, such as an increase in statins for those at risk of cardiovascular
disease.
Regardless of whether you agree or disagree with these two points morally, they are
valid points nonetheless and need to be considered from a neutral position.
Remember to consider both sides
On the first point about waiting times, one could argue that as cancer patients are
referred to specialist oncology centres, their urgent referral actually liberates other
services (such as General Practice) and therefore increases access for non-cancer
patients.
We could also point to the clinical evidence that shows that early diagnosis and
treatment of cancers not only increases survival rates, but also reduces the cost of
treatment. Therefore, urgent referrals actually optimises the distribution of resource
across the health service.
The second point is a bit more muddied and relates to what is known as the
“distribution problem”. In short, do you offer the treatment that maximises the
number of years of life, regardless of how many people benefit, or do you offer the
treatment that treats the maximum number of people, regardless of how many more
years those people will live as a result? Arriving at a morally acceptable answer to
this distribution problem is particularly tricky in a system which is publically funded
(i.e. almost everyone has paid into the system).
But let’s assume for argument’s sake that British culture is such that we believe in
attempting to save the lives of anyone, no matter the cost, because that is the morally
right thing to do. We could bolster our counter-argument further by saying if we fail
to treat a patient suffering from cancer, we will ultimately spend more money on
treating that patient for the co-morbidities associated with the cancer itself.
Therefore, unless we are prepared to remove all rights to treatment for that patient, it
is ethically and objectively better to treat them early.
Now, it’s important to note that while treating patients with suspected cancer is hard
to argue with, we cannot simply say that it’s a “no brainer” without going through the
pro’s and con’s of the medical ethics involved. You must be able to justify your ethical
position by first having considered all sides of the argument!
Stay tuned!
As we will see, things can get very complicated indeed once you start to apply the
principles of the four pillars to real-world situations. We’ll also find that there are
other non-official principles that we need to consider in certain cases.
Now that we’ve established and explained the four pillars, watch out for more blogs
in this series exploring current hot topics.
Watch this space, and get ready to improve your interview performance!
Qualities which are being tested

6:58 PM
Psychological psychometric testing such as the Understanding People construct
focuses on assessing personal attributes. Various studies into the selection of
students for medical courses have been undertaken, and these provide valuable
information about what are considered ‘desirable’ qualities. Candidates that have
such desirable qualities are more likely to perform well in the Understanding People
construct
The following table summarises some of the qualities considered relevant to selection
of applicants to the health science profession. Beneath the table, you will find a more
detailed explanation of some of the terms.
Personal characteristics that are Personal characteristics that are generally

generally considered desirable considered undesirable
Empathetic and interpersonally sensitive Unwilling and unable to empathize with others
(1)
Compassionate Tough-minded, insensitive
Ethically sensitive, having a positive Of doubtful ethical orientation, likely to engage
attitude towards ethical issues in ethically inappropriate behaviour
Emotionally stable, resilient, calm Easily stressed, predisposed to anger, panic and
temper, easily upset, defensive
Trustworthy and honest, trusting of Untrustworthy and dishonest, suspicious of
others others
Open and accepting Prejudicial and judgmental
Possessing humility and modesty Arrogant, aloof, dominant, power-seeking, self-
centred
Sociable, involved, warm and easy- Unsociable, detached, cool, reserved, tense,
going, enthusiastic, relaxed isolated, indifferent
Understanding Condescending, patronizing
Stable and reliable Unpredictable and unreliable
Willing to obey rules when required, Hostile towards authority, aggressive,
compliant manipulative
Self-disciplined and deliberate Impulsive, undisciplined, brash
Conscientious Expedient, self-sufficient
Possessing a high degree of emotional Possessing a low degree of emotional
intelligence (2) intelligence (2)
Communitarian (3), group-oriented Libertarian (3)
Low-Mach (4) High-Mach(5)
(1) Interpersonal sensitivity
Interpersonal sensitivity involves having an awareness of the needs and feelings of

others and using this awareness effectively in interactions and decision-making. This
concept is discussed in more detail in the Understanding People guide.
(2) Emotional intelligence
Emotional Intelligence (EQ) is a concept that involves a wide range of qualities such
as self-awareness, emotional resilience, motivation, sensitivity towards others,
persuasiveness, decisiveness and conscientiousness.
(3) Libertarian vs. communitarian
Those with a communitarian outlook value laws and norms and obey them, even if
this is detrimental to their own well-being. Libertarians, on the other hand, value
individuals’ freedom to act in their own best interests, with low regard for social
norms.
Libertarians focus more on individual rights and welfare, with less concern for the
group. In contrast, communitarians are more concerned with groups and society and
place less emphasis on the consequences of various actions for individuals.
(4) Low-Mach / High-Mach
Interactions between people can be rated high or low on a scale of human behaviour
called ‘Machiavellianism’. This scale is based on the writings of Nicolo Machiavelli, a
controversial political philosopher during the Renaissance in Italy.
The scale measures the willingness of people to place the interests of others above
their own. High-Machs are generally self-interested and are easily able to resist social
pressure. They are also inclined to cheat and break rules if necessary. On the other
hand, low-Machs more closely follow rules and conventions, are more trusting and
cooperative and need to be coaxed into breaking rules. In general, careers such as
politics and business tend to attract high-Machs, while low-Machs are generally
found in teaching and medicine.
Activity
Spend a few moments reflecting on the table. Ask yourself the following questions:
1. For each row or quality, where do I honestly fit? On the desirable side or the
undesirable side?
2. For each desirable quality, why would this be desirable - firstly as a health
science or medical student, and secondly as a health professional?
3. For each undesirable quality, why would this be undesirable - firstly as a health
science or medical student, and then as a health professional?
Presenting Yourself Positively

7:06 PM
2. Presenting Yourself Positively
Many students sitting UMAT will lack at least some of the characteristics listed in the
‘desirable’ column of the table, and may attempt to present yourself in a more
positive light in the UMAT. If you are planning on doing this, be careful.
Modern psychological tests often include ‘lie-scales’. They are specially formulated
questions to determine whether someone is attempting to fool the tester by
pretending to have qualities that they do not possess. This is not as problematic for
UMAT, because no one is going to analyse your answer to each question - your scores
will be statistically analysed.
Regardless, following this are some words of advice.
 Be consistent. Many psychological tests cover the same ground twice to catch
those who attempt to present themselves differently to what they are. It is
important to be consistent in the way you present yourself and try not to
contradict yourself. This is less relevant in a UMAT context, as questions will
vary considerably depending on the stimulus.
 Believe that you have the desirable quality(s). If you have a certain
quality, it is much easier to convey this during a test. If you do not, it may be
helpful to make yourself believe that you do.
 See the desirable quality(s) in others. The fundamental basis underlying
all psychological testing is that individuals with undesirable qualities will view
behaviours and situations differently to those with desirable qualities. For
example, research has revealed that people most likely to steal are those who
have a cynical philosophy of life. People who believe that ‘everyone steals
occasionally’ or it’s human nature to steal’ or ‘nobody is truly honest’ are those
most likely to engage in theft. Psychologists have found that a single question
can tell a lot about a person: ‘Do you believe that people are basically honest?’
 Consider the questions carefully. The UMAT is a time-pressured test. One
reason for this is that test-makers believe that by forcing you to think fast, you
are more likely to expose your ‘real’ personality. Time management can thus be
very important in this construct.
 Try self-improvement. Of course, it is much better for both the UMAT and
your future career if you actually develop these desirable qualities. While you
are ‘born with’ many, and many are ingrained during your childhood years, this
does not mean you cannot change. In fact, you should have a commitment to
continuous improvement in all aspects of your life, including personality traits.
Strategies for Self-Improvement
7:10 PM
3. Strategies for Self-Improvement
The following are some strategies to help you develop these desirable qualities:
 Do work experience or volunteer work, preferably in a healthcare setting. This

will develop your empathy skills. It will also help you gain a better idea of what a
health professional does and be useful in interviews.
 Become interested in people and expose yourself to as many people as you can.
Interacting with people from a wide variety of backgrounds will improve your
ability to relate to people and allow you to better understand other people’s
situations.
 Interact with people who have desirable personality traits. The people you
surround yourself with influence you greatly, even if you do not notice this
consciously. Their qualities tend to ‘rub off’ on you.
Empathy
7:12 PM
Empathy is the ability to identify, appreciate, understand and accept

another person’s thoughts, feelings, behaviour and motives. Basically, it is
being able to put oneself in another person’s ‘shoes’, and understand their emotional
situation.
Comments that show empathy are common in everyday conversations: ‘that must
have felt so exhilarating!’, ‘that’s awful!’, ‘I bet you just wanted to slam the door in his
face!’, ‘sounds like you had a great time!’. These very different comments all share a
similar message: ‘I know how you feel. I would feel similarly in that situation, so I
view your feelings as appropriate.’
These comments do not mean that the speaker is experiencing the same feelings, but
rather indicate that s/he recognises and understands them, and acknowledges that
if placed in the same situation, would have similar feelings. It validates the person’s
feelings, rather than being aloof to them or rejecting them (for example, as ‘weak’).
Empathising with others
It is difficult to empathise with people who are experiencing something that you have
not experienced yourself. For example, if you have never lost a loved one, it might be
difficult to understand what someone going through such a loss would be
experiencing. However, this is not to say that it cannot be done. For example, you
could empathise with the grief that the person is experiencing because you will have
experienced some kind of grief before. In the UMAT, your ability to draw from your
experiences and relate them to the scenario is crucial in empathizing with characters.
You may also find it useful in the UMAT to imagine that the person in the
passage/scenario is someone you care about. This may help you empathise with the
person.
However, it is important to realize that everyone reacts differently to illness or

adversity.
That’s why it is inappropriate, presumptuous and unhelpful for someone to say ‘I

know exactly how you feel’. We are all unique individuals, with a diversity of life
experience that will impact on the way we view and respond to certain situations.
The difference between sympathy and empathy
Sympathy is a true sharing of another’s painful emotions (literally, it mean ‘suffering

together’). In general, empathy is more appropriate than sympathy.
If as a health professional you were to ‘suffer together’ with every patient, you would
soon feel overwhelmed and therefore be of little use to your patients. This is because
you would be feeling the full force of their emotions, and would not be in a position
to actively understand, legitimize and act on their feelings. Sympathy can also result
in the opposite effect, creating power imbalance. When a person communicates
his/her pity of another person, the first person is placed in a superior position.
You might feel ‘sorry’ for a person, but an empathetic person needs to do more – you
need to understand their situation and act accordingly.
Activities in empathy
The following exercises will help you get into the mindset of others, which is what
you are often required to do in the Understanding People construct. They are
designed to help you begin thinking in the same way you should in the UMAT.
The Patient Mindset
Spend about five minutes reflecting on a time when you, a family member or a friend
was ill or experienced adversity. Think about how the person felt, how they were
treated within the medical system or by others and how the illness affected their lives
and the lives of those around them. Think in terms of emotions, and the effect on
financial situation, social situation and relationships. Literally imagine yourself in
their position. Jot down a few notes that you can refer to later.
Some situations you may reflect on include: illness (sudden onset or chronic), death
of a loved one, disability, family conflict or divorce.
Reactions to Illness and Adversity
Talk to people who are ill or who have experienced adversity in the past. You don’t
need to go out to a hospital and talk to patients (although this would be worthwhile),
but simply make an effort to seek out such people and take an interest in their lives.
These may be your neighbours, people you meet in community service / volunteer
activities, family friends, family members, friends, co-workers, your boss, your
teachers… When you open your mind to their stories, it will give you a greater insight
into adversity and how people deal with it. Hearing about one experience is
sometimes enough to gain an insight into the impact that adversity has on people’s
lives.
Literature
The next time you watch a film or read a book in which the thoughts, feelings and
behaviour of a person are examined in-depth, actively consider the concept of
empathy. Think about what the characters are feeling, the cause of their feelings, and
how this relates to their behaviour.
Empapthy/Sympathy
5:40 PM
Clipped from: https://www.themedicportal.com/whats-the-difference-between-

sympathy-and-empathy/
So what is empathy? How does it differ from sympathy? How important is it?
Moreover, how can we show empathy to patients?
Empathy is the ability to understand and share the feelings of another. Sympathy is
similar and easy to confuse, but not half as useful- sympathy is the feeling of pity or
sorrow for someone else.
Think of yourself by the side of a swimming pool. There is someone in there,

drowning. If you were to show them sympathy, you would involve yourself, telling
them about a time when you were also drowning. You make it about yourself as an
individual – and then you’re both drowning and nobody is on poolside to help. You
express sympathy. If you were to share empathy, think of yourself as throwing them
a life-ring. You are understanding their problem and accepting that it is an issue for
them, but not making the situation about you. You stand outside of the issue as a
source of comfort.
What’s the difference between showing sympathy and empathy?

What’s the difference between sympathy and empathy?
Both empathy and sympathy can be useful tools- don’t we all want to know someone
else has been where we have been? But sympathy can become patronising, and that’s
something we wish to avoid. Expressing sympathy creates a divide between you and
the other person- that you are lucky, you have come past the problem, but they are
unlucky and still struggling. ‘I’m sorry you feel like that’ is a statement that isolates
someone. You’re pitying them, not providing a sense of support. If you were to show
empathy, perhaps you could say ‘Many people struggle with this issue, you’re not
alone.’ This gives the other person a sense of companionship, that they are not the
only one and that there is hope.
Empathy occurs in the here and now. You show empathy by immersing yourself in
another person’s world, without making yourself into them – you retain your sense of
self and know that you yourself are actually outside of the problem. This enables you
to be helpful instead of getting caught up in the issue. Advice is an enemy of empathy
in some cases- you want to stay in their world, not make yourself feel better.
Why is empathy important in Medicine?
In medicine, not showing empathy means we would never truly understand our
patients and their motivations. We would ignore what makes our patients individuals
and force our own agendas on them – we could feel sorry for them, but that’s not
productive and doesn’t help the patient feel understood or empowered to make
decisions about their health. Sympathy alienates patients and makes the doctor-
patient relationship one-sided, unfriendly and less trustworthy.
A patient who is shown empathy is more likely to feel emotionally connected to their
doctor, and this helps them to improve their health. A patient who feels understood
is more likely to disclose important information that would entirely change a
diagnosis or treatment. They’re also more likely to follow the advice and treatment
regime set out by their doctor. You’re much more likely to listen to and feel
comfortable with a doctor you feel has truly understood your situation, than someone
who hasn’t acknowledged that you are an individual and your health needs are
unique to you.
You can show empathy by reflecting the tone and language the other person is using.
Avoid using ‘I’ statements and truly listen to what the other person is saying.
Empathy allows us to treat our patients with compassion, fostering strong
relationships that are mutually beneficial for the patient and the doctor. It requires
listening, kindness and time taken to truly understand the whole patient and their
life. It enables our patients to feel supported and understood during some of the
most stressful periods in their lives.
Words: Katie Hodgkinson
Empathy Questions - The Medic Portal

5:41 PM
Clipped from: https://www.themedicportal.com/e-learning/interview/empathy/

Empathy Questions
Below is a selection of Medical School interview questions on the theme of
‘Empathy’.
Empathy
How would you define empathy to someone who does not know what it means?
Empathy: how would you define the term to somebody who doesn’t know what it
means?
Answer Guide:
 Empathy is understanding another person’s feelings or situation, and imagining

what it might be like to experience these things yourself
 Phrases such as ‘being in another’s shoes’, ‘seeing things through their eyes’,
‘imagining their frame of reference’, or similar all suggest empathy
 Distinguish empathy from sympathy. The former is deeper and more involved
than the latter, which merely acknowledges another person’s problems or
feelings
 It involves effective person-to-person communication skills as well as the ability
to understand what another person is feeling
 Use examples from your daily life or medical work experience to illustrate when
you have shown this or seen it in action
Common Mistakes:
 Thinking that empathy is pretending to know what someone is feeling like in

order to make him or her feel better about the situation
 Believing that being empathetic is an easy way of getting someone to trust you
 Thinking that empathy is a skill to be utilised only in professional settings, and
not in everyday life
Why is it important for medical professionals to be empathetic towards their patients?
Answer Guide:
 When a healthcare professional tries to imagine things from the patient’s point
of view it can reveal to them ways to improve their care which they may not
have considered before
 A patient will find it easier to discuss their concerns with somebody who is
caring empathetically for them and has taken the time to try to understand what
they are going through
 A patient’s feelings, concerns, expectations and ideas are just as important as a
presenting a physical complaint. By engaging with them, a healthcare
professional can better understand these things, and ultimately provide better
care
 An empathetic healthcare professional will help to make the patient feel at ease,
and that they are valued
 Empathy can help to break down the perceived barriers between the patient and
the many healthcare professionals he or she may see, and help to make what
can be a daunting and seemingly anonymous environment more comfortable.
Common Mistakes
 Not having a good understanding of empathy. Confusing it with sympathy, or

that it is only used when the doctor thinks the patient is depressed
 Being empathetic means I tick the box of being a nice doctor
 Thinking too pragmatically. For example, saying that empathy is important
because it gives doctors a good feedback rating
Imagine that you are a medical student on a hospital ward placement. How would you
explain to a patient that they need to have another blood sample taken, as the results of
the last test having been lost?
Answer Guide:
 Put yourself in the shoes of the patient. What might they be worried about?
 They have been through a procedure which they may have found uncomfortable
and, through no fault of their own, are being asked to go through it again
 They also might be worried about the privacy issues involved around the loss of
their blood sample
 You would need to speak to them clearly and politely but make it absolutely
clear what has happened so they are left in no doubt what has occurred. Do not
use euphemisms
 Put yourself in their shoes; listen to their concerns and what they have to say
 You might say: ‘I am very sorry that you have to have more blood taken’
 You could also consider saying: ‘I can imagine that you are feeling frustrated
about this, as you have been waiting and have not yet received results for your
blood tests’
 And: ‘Please be reassured that we will not share the results of your test with
anyone outside your medical team. I can see that it might be worrying that your
last test was lost, but we take confidentiality very seriously and will do our
absolute best to make sure that this is preserved’
Common Mistakes:
 Saying things in a curt, impolite or distant manner. This is likely to further

frustrate a patient who is already going through a lot
 Using euphemisms like ‘a small hiccup’ which might mislead or confuse the
patient about what has happened
 Blaming other people. Even if it is somebody else’s fault, this will not make the
patient feel any better
Why should members of a healthcare team show empathy towards one another as well as
towards their patients?
Answer Guide:
 Working in healthcare (e.g. a hospital) can be very stressful and demanding.

One’s colleagues may need support from somebody who understands this well
 Extra-professional circumstances can impact on somebody’s ability to do their
job, and if they choose to share problems or concerns with you then it is
important to show empathy and try to understand what they are going through
 A better understanding of one another improves a team’s ability to work well
together and therefore improves patient care
 Working in a hospital can be traumatic or distressing, and this may affect team
members personally. Having empathetic colleagues can make them feel more
positive and that they are well supported in their work
Common Mistakes:
 Citing going to the pub with members of the team to build better bonds between
you as an empathetic solution
 Saying that working in medicine gives you no time for social activities, so you
might as well be friendly with the people you work with
Is the practice of being an empathetic healthcare professional something that you can
learn in a lecture?
Answer Guide:
 Although not the principal medium for learning about empathy, a lecture may
give some insightful points about the effect that being empathetic has on
patients, or ideas for how to go about conducting a good patient interview
 However, empathy is intrinsically people-based, and the skill of being
empathetic is therefore developed over time spent with people in one’s role as a
medical student
 By watching other senior healthcare professionals, one may realise the pitfalls
in one’s own approach to interacting with patients
Common Mistakes:
 Thinking a lecture could give you the stock phrases you need to seem
empathetic
 Assuming empathy cannot be actively improved upon or learnt about
 Viewing empathy as less important than things like anatomy or physiology
Which is more important in Medicine, being empathetic or being sympathetic?
Answer Guide:
 Start by outlining your personal definition of empathy versus sympathy. This

can vary but the standard definitions are that empathy is the ability to
understand how words or actions impact other people; sympathy is the act of
feeling those impacts and responding affectionately.
 Discuss what the core duties of a doctor are and therefore why demonstrating
both empathy and sympathy are critical skills in the execution of those duties.
 Doctors are responsible for delivering the best possible care and outcome for
the patient using a combination of academic knowledge, critical reasoning skills
and communication (with colleagues, the patient and their family members).
Crucially, doctors must not cause harm to the patient or perform a battery (a
medical intervention performed without informed consent).
 Empathy is therefore important because it enables a doctor to understand how
the patient may be feeling, what the patient may be expecting in terms of
clinical outcome (i.e. would an elderly patient find limited mobility an
acceptable outcome?). But critically, when interventions are painful or
frightening (as in the case of a lumbar puncture or surgery), it encourages the
doctor to communicate fully with the patient – the reasons for the intervention,
how it will feel, the risks and the dangers of not proceeding.
 Sympathy is important in how a doctor communicates with a patient. For
example, when injecting someone with a needle a doctor who shows empathy
but no sympathy would say: ‘This will hurt, but it won’t do any lasting damage
so don’t make a fuss.’ A doctor showing both empathy and sympathy would say:
‘Just to warn you that this might sting a little, but I’ll make it as painless and
quick as possible so try to relax and not focus too much on it. It’ll be over in a
second.’
 You have explored the interaction between empathy and sympathy in living up
to the duties of a doctor as outlined in Good Medical Practice.
 You now need to say which is more important? Or are they both equally
important? THINK: Are there circumstances where displaying too much
sympathy can be detrimental?
 USE YOUR WORK EXPERIENCE if you can cite an example of when you saw
these attributes on show.
Common Mistakes:
 Do not immediately answer the question before outlining your definitions of the
terms, the angle from which you are approaching the question and therefore
your argument leading up to your conclusion. If you do this, you risk muddying
your argument and not following a logical structure.
 Not thinking beforehand about the difference between the two attributes and
how it relates to being a doctor (or any other healthcare professional).
As a doctor, how would you deal with a parent who has brought their child into accident
and emergency and is angry about them having to wait a long time to be seen?
Answer Guide:
 Doctors sometimes encounter difficult patients but in a scenario such as this it

is important to demonstrate empathy and appreciate that the individual usually
has a reason for acting the way they are.
 Think about ICE – ideas, concerns and expectations. Explain how you would
find out why the parent thinks they are having to wait, why they are worried
about this, and what they would want you to do about the situation.
 Suggest why a parent might be feeling angry in a situation like this. They are
most likely worried about their child and might think that staff are not doing
enough to get patients seen quickly.
 Discuss how you would try to reassure the parent. It is important to appreciate
that someone showing up to A and E may be very distressed and you want to
help them be confident that their child will receive the best care possible.
 Parents or patients at A and E may also be stressed for reasons that you might
not think of such as children being left at home or being late for work. This is
why it is important to actually listen to the patient so that they can explain their
situation and you can provide the appropriate support, such as allowing them to
use a phone, for example.
Common Mistakes:
 Forgetting about the patient/parent. Explaining how you would get the
situation under control is fine but interviewers are more interested in how you
show empathy for someone who is frustrated or stressed and address their
concerns.
 Failing to ask the individual about their perspective on the situation. The ICE
system is what medical student are taught to use in a scenario like this.
What would you say to a female patient who is scared to get the HPV vaccine which
protects against cervical cancer?
Answer Guide:
 With this kind of question it is important to show how you would communicate
your professional opinion whilst respecting the patient’s concerns and giving
them a chance to explain things from their perspective.
 Explain how you would find out which aspects of the vaccination were worrying
the patient; patients want to feel that they are being listened to and taken
seriously.
 State that you would give the patient the relevant information about what the
vaccine does and why it is important. The patient has a right to know about the
treatment being recommended so that they can make an informed decision.
 Mention that you would speak in terms that the patient can understand; as a
doctor it is important to adjust your communication to accommodate different
types of people, even when discussing a treatment that you think might be
difficult for them to understand.
 Explain that you would not push your opinion on the patient. Although they
might not have your medical expertise, you cannot disregard the patient’s
personal views and, ultimately, patient autonomy must be respected.
Common Mistakes:
 Not respecting the patient’s opinion in your answer. Although you might think
having the vaccine is the right thing to do, it is important to recognise the
patient’s concerns as valid.
 Focusing too much on the vaccine itself. This question is about how you would
communicate empathetically with the patient; you don’t actually need to know
anything about the HPV vaccine in order to answer.
As a recently-qualified junior doctor, you are given the chance to perform your first
unsupervised colonoscopy. During the procedure, the colonoscope perforates the colon,
resulting in the patient becoming acutely unwell and dying just 2 days after. The patient’s
family has now come to see you; how would you base your approach to the situation?
Answer Guide:
 This situation could easily be set as a role-play station or one in which you talk
though your thought process.
 Start by describing the setting in which you’d want to speak to them – private,
comfortable environment without disruption or time pressure.
 Explain clearly and truthfully what has happened, the family will appreciate
your honesty.
 The family members will no doubt be very upset at the loss of a loved one,
throughout the conversation, be aware of how the family is feeling, listen to any
concerns they may have and don’t rush breaking this news.
 Given the circumstances arising as a result of a known but rare complication, it
may be appropriate to tell the family that certain measures are now being put in
place to prevent the same complications arising again or to say that you will
undergo a phase of supervised practice for a short period of time.
 You should ensure that the family are made aware of counselling services if they
were to want it at such a difficult time, as well as the ability to speak to a more
senior doctor
Common Mistakes:
 Jumping straight into describing what you would say – as mentioned above,
start by describing that this situation evokes very strong emotions and is to be
treated delicately.
 In stations where you describe your approach to a personal interaction, it’s
easier to be more flippant as you don’t have the direct face-to-face contact –
make sure you demonstrate the same level of empathy and respect for patients
and their emotions whether in their presence or not.
What thoughts and feelings will go through the head of a patient feeling after having been
told that their alcoholism has led to irreversible liver damage?
Answer Guide:
 This question aims to find out whether you are able to place yourself in the
shoes of a patient and understand their emotions whilst receiving bad news
such as this
 First, it may help by defining empathy and demonstrating that you are aware of
the sensitive and delicate nature of this situation
 It’s important to give examples of what the patient will be feeling alongside a
short description of why as well as how this might change the nature of the
consultation. This will prevent your answer sounding like a list of emotions and
will prevent your answer sounding pre-recorded.
 For example: ‘The patient may be feeling guilty and remorseful about their
actions and their respective consequences. It may be very difficult for the
patient to hear that such an effect has come about as a result of their own
actions’
 After having thought about what exactly the patient might be feeling, it may
indeed be worth talking to the interviewer about how you would then interact
with the patient given their thoughts and feelings.
 You could discuss if there’s any measures you would take in anticipation of this
consultation to make the patient feel slightly better. For instance, by describing
the setting or describing techniques such as ‘signposting’.
Common Mistakes:
 Going straight into the answer without first talking through the brief to ensure
understanding – it’s ‘belt and braces’ but it’s better to be sure that you’ve fully
understood.
 Forgetting that diagnoses such as this are life-long and will affect the individual
beyond the initial response to the diagnosis.
More questions on ‘Empathy’ coming soon.
More Topics
How to answer Empathy questions - The Medic Portal

5:41 PM
Clipped from: https://www.themedicportal.com/how-to-answer-empathy-

questions/
Empathy is definitely a common buzz word you think of often in terms of interviews.
It’s a word people throw about in their personal statement or use when describing
what makes a good doctor, but how is it defined? This post will guide you through
how to answer empathy questions.
Empathy is defined as ‘the ability to understand and share the feelings of another’ –
so in other words it is all about putting yourself in somebody else’s shoes and trying
to relate to things from another’s perspective. It is often confused with the term
sympathy which is ‘feeling sorry for someone else’s misfortune’. It is important that
you are able to distinguish these two words in your mind, as they often feature in
interviews.
The difference between the two is a relatively common interview question and could
certainly come up as a one on one station in an MMI. So, I’ve worked through a
potential answer below to demonstrate how you might go about approaching this
question.
How To Answer Empathy Questions: Worked Example
‘What is the difference between empathy and sympathy and do you think
they’re important qualities for a doctor to have?’
1. Firstly, make sure you identify the difference between sympathy and empathy.
For example, you could say, ‘It’s easy to get these two terms mixed up but for me,
empathy is about listening to somebody’s point of view, and understanding how
words or actions impact other people, whereas sympathy is the act of feeling those
impacts. I think both are important qualities for a doctor to inform their
communication with their patients.’
2. You could then mention any relevant work experience which enabled you to
demonstrate empathy.
For example, ‘In my work experience I was often impressed by the doctors who
showed a real understanding of what their patient had to say, allowing them to speak
their mind about what they felt was wrong instead of interrupting or rushing them.’
3. Then make sure you reflect on your work experience and what it taught you about
empathy.
For example, ‘I felt this made the patient more open, building trust between the
patient and doctor. In my opinion displaying empathy like this is key to a holistic
approach to patient care. It was clear to me from what I saw that most patients just
wanted to be listened to and to have someone try and understand where they were
coming from as opposed to just feeling sorry for them. However, expressing
sympathy can also help show compassion for patients and aids in helping them feel
listened to. For example, doctors could show sympathy in explaining a painful
injection to patients, explaining that they will try to make the injection as painless
and quick as possible. Overall I think they are both important qualities for a doctor to
have to build trust with their patients.’
That is just one way to approach this question but I hope it shows you that it is about
more than just giving dictionary definitions of these terms and that they are more
than just good words to throw about.
To summarise:
1. Make sure you can separate and understand these terms for yourself – and
define them at the beginning of your answer.
2. As with any interview question, you improve your answer if you can back it up
with personal experience, so draw on your work experience where possible.
Visit our Empathy Question Bank
Communication Skills
7:13 PM
3. Communication Skills
Communication is an integral part of all human relationships and is the cornerstone

of the patient-doctor relationship. Effective communication generates trust and
enables people to be treated effectively and compassionately.
From the doctor’s perspective, effective communication skills help elicit the patient’s
story. This aids accurate diagnosis and improves patient adherence to treatment.
From the patient’s perspective, a doctor or friend who conveys concern and a
willingness to listen in a non-judgmental manner can allow them to share their
concerns and anxieties, which can be therapeutic in itself. ‘Offloading’ emotions and
having them acknowledged, legitimized and listened to in a non-judgemental
manner can be a significant source of relief.
Activity in communication
Many of you will have had an experience with a health professional or other service-
provider who had poor communication skills. Think back to this experience and ask
yourself – why were they such a poor communicator? Did they not listen effectively?
Did they fail to understand what you were feeling and convey this to you? Did they
fail to address your concerns?
Consider how this experience made you feel and how it impacted on our willingness
to share information with the person.
Communication is about listening
It is often said that listening is the most important aspect of communication and
talking the least important.
Remember that listening is not hearing – it is far more complex. It is an active, not
passive process. It involves identifying major concerns, understanding these
concerns and thinking about the best way to respond to them. A good communicator
responds to what the person is actually saying, rather than what they assume the
person is saying.
Let’s take an example to illustrate:
Doctor: So how have you been Henry?
Henry: OK I suppose, doctor. It’s just that these headaches are starting to worry me.
Doctor (1): On a scale of 1 to 10, how painful would you say these headaches are?
Doctor (2): That’s understandable, Henry. What is it about them that is worrying
you?
Here, Doctor (1) has not listened to Henry. Henry has mentioned that his headaches
are ‘starting to worry [him]’. He has not said anything about pain at all and yet the
doctor leaps to this conclusion. In contrast, Doctor (2) shows superior listening skills,
identifying Henry’s main complaint (the ‘worrying’ nature of the headaches) and
inviting Henry to talk more about it (‘What is it about them that is worrying you?’).
The ability of a person to listen effectively can steer the interaction in a completely
different direction and ultimately have a positive effect on wellbeing and health
outcomes.
Open questioning
Open questions are important in order to a) determine what is wrong; b) find out
what the person’s priorities are and c) allow the person to explore more difficult or
complex issues that would not otherwise be raised.
Open questions allow the person to answer in a manner that they deem appropriate
and not in a ‘yes/no’ or limited fashion. Examples of open questions are: ‘What
seems to be bothering you?’, ‘how has this affected you?’, ‘how have you coped?’ and
‘how did you feel about that?’
In answering such questions, the person can focus on what they feel is important and
can describe their thoughts and feelings in their own language using their own
experience. This not only provides more information; it can also make the person feel
that they are being listened to.
Consider this example:
Doctor: Is the pain blunt or throbbing?
Hazel: Um… throbbing. I think.
Compare with this:
Doctor: Hazel, can you tell me a bit more about the pain you’re feeling?
Hazel: Well, it comes whenever I go for a walk, and it comes in sharp bursts, really
unexpectedly… (continues)
The second doctor is able to gain a much greater insight into Hazel’s pain and her
experience of it than the first. This will enable him or her to not only make an
appropriate diagnosis, but provide treatment that is catered to Hazel’s individual
needs.
Open questions are the opposite of closed questions, which direct the person to
respond in a particular way and thus close the discussion to other possibilities.
Consider the following example.
Closed questioning:
Doctor: How can I help you?
Patient: I’ve been getting this dry cough recently.
Doctor: Are you having any difficulty breathing?
Patient: No.
Doctor: What about pain?
Patient: A little bit, I guess, but not much.
Open questioning:
Doctor: How can I help you?
Patient: I’ve been getting this dry cough recently.

Doctor: Tell me a bit more about the dry cough – describe it for me.
Patient: Well I’ve been getting it for the last year or so and it seems to get worse in
winter and when I have a smoke.
As you can see, the interaction can move in very different directions. The example
also demonstrates how closed questioning can give the impression of an
interrogation rather than an interaction, and give the person little room for
description, explanation or qualification.
In general, the more open the question, the more revealing the answer.
Reflective listening and verbal encouragers
People can be encouraged to talk more by using the techniques of reflective listening
and ‘verbal encouragers’.
Reflective listening is useful to demonstrate that you are listening to a person by

rephrasing something they have said to you and extending it. It is not good enough to
simply repeat what the person has said. However, if you digest their main points and
present it back to them with further information, it shows that you are listening
actively. This is likely to encourage people to talk more.
‘Verbal encouragers’ are phrases such as ‘go on’, ‘I’m listening’ and ‘Please
continue’ that encourage the person to keep talking.
Responsiveness
7:13 PM
Responsiveness involves being sensitive to the needs of a person and responding to

them. This will often involve picking up on subtle cues communicated by the person.
People may not always feel comfortable talking about issues such as adversity, pain
or death, and may communicate in an indirect fashion. It is vital to pick up on such
hidden meanings and cues and respond to them. By doing this, you send the message
that you are willing to talk further about the matter, which in turn is likely to
encourage the person to open up.
Responsiveness is also vital if a person appears anxious, upset or angry. Such

emotions must be identified and addressed immediately. This may involve comments
such as: ‘It’s understandable that you are upset’. If such emotions are not identified
and addressed, they can hinder the interaction.
The following example shows the importance of responsiveness:
Doctor: (about vaginal discharge) Does it have an unpleasant odour?

Patient: Yes it does (looks away, dropping her voice)
Doctor: What colour is it?
Patient: Well, it’s difficult to describe, darkish I suppose.
Doctor: But is it white? Yellow? Green? Brown?
Patient: It could be any of those colours at different times.
Doctor: (frustrated) You can’t tell me what colour it is, then?
Compare with this scenario:
Doctor: Does it have an unpleasant odour?
Patient: Yes, it does (looks away, dropping her voice)
Doctor: You feel self-conscious about it? Do you think other people would be aware
of it?
Patient: Well… yes… my husband certainly. When it was bad last year, he made
remarks about it. I just avoid letting him come near me now.
Doctor: And has anyone, apart from your husband, said anything?
Patient: Well, not actually. But I’m always afraid that other people notice. I don’t go
out much socially nowadays. I don’t feel comfortable with others.
In this case, responsiveness by the doctor has helped uncover how much the problem
is affecting the patient’s life.
Respect
7:13 PM
Respect encompasses the overall attitude of a person to others. It involves qualities

such as humility, understanding and being non-judgemental. Having ‘respect’ for
someone does not necessarily mean you have to like them, and is not limited to
‘being nice’. Respect involves the understanding and acceptance of another person’s
situation, behaviour and beliefs. It involves recognising where another person is
coming from and why they are acting in a particular manner.
Respect involves realizing that everyone has something to give – every individual has
his or her own talents and qualities to offer. It may be helpful to identify and
acknowledge these traits – for example, that a person has coped well with their
illness. This will not only help you respect a person; it will also convey to the person
your respect for them. This helps reinforce the relationship.
The attitude of one person towards others should not be clouded by their personal
characteristics, beliefs, culture or personality. In the case of a health professional, it is his or
her obligation to treat everyone with the same high degree of respect and clinical care.
This can be difficult. For example:
Doctor: Have you been taking the medication I prescribed last time?
Patient: Nah – couldn’t be stuffed. You doctors are all the same anyway – just trying
to fob us off with drugs and all that.
In this situation, it might be easy for the doctor to get exasperated or even angry. The
doctor may have invested considerable time and energy diagnosing the patient’s
illness, identifying treatment and then explaining the importance of the treatment
only to be ‘slapped in the face’ by the patient’s attitude.
However, a part of being a health professional is maintaining respect for patients,

whatever their situation. Instead of getting angry or exasperated, an effective health
professional would try to find out why the patient feels this way, attempt to address
underlying concerns and determine the kind of treatment the patient would accept.
Humility
7:14 PM
Humility involves having a modest or low opinion of one’s own importance. It is the
opposite of being cocky or arrogant, and includes:
 Health professionals realising that they will be placed in positions of incredible

power and responsibility. They are likely to be interacting with patients who are
at their most vulnerable and may have involvement in issues determining life,
death and quality of life. This enormous responsibility must be approached with
humility.
 Health professionals realising that they are merely advisors to patients.
 Doctors, dentists, physiotherapists and pharmacists realising that individually,
they form only one part of the healthcare team. They need to cooperate with
each other and other allied health workers such as nurses and complementary
health practitioners to ensure optimal healthcare for patients.
 Any character realising that he, she, or anyone else does not know everything
there is to know about a person, situation or social issue
Compassion
7:14 PM
Being a health professional means putting oneself in a position of awesome

responsibility. A health professional is privy to people’s most intimate fears, beliefs,
personal details and emotions. Compassion is crucial if health professionals are to
assume this position of responsibility. They must really care about their patients,
care about their concerns and have a desire to help them back to health.
Compassion is also a vital aspect of non-medical interactions.
Honesty and Trust

7:14 PM
Honesty forms the basis of any relationship because it promotes trust and an
atmosphere of openness. This is true between friends, family and health
professionals. Even at the best of times, it is often difficult for people to consult
others for help and to share their problems. Imagine how difficult it would be if
people did not trust their health professional or friend to be honest.
Trust is important because it facilitates effective communication. If people feel secure

that sensitive and personal information will remain confidential, they are more likely
to share their concerns. The knowledge that a patient can trust their health
professional or friend to act in their best interests may in itself aid recovery. It also
encourages patients to respond to the advice of the health professional, which may
involve difficult treatments, lifestyle changes, complying with review appointments
or returning to the doctor if there are complications with the condition.
Evaluating Appropriateness
7:14 PM
9. Evaluating Appropriateness
In some Understanding People questions, you will be asked to evaluate the

appropriateness or inappropriateness of a character’s actions, comments or
behaviour, for example, that of a health professional. Following are some guidelines
as to what constitutes empathetic and appropriate responses. Responses should:
 Show evidence of listening to the person. What is the person really

communicating? Be perceptive – pick up on cues and read between the lines.
 Show respect for people’s beliefs, culture, attitudes and choices (including a
decision to refuse treatment or refuse to do something that may be ‘good’ for the
character).
 Encourage the person to talk about and share their concerns.
 Demonstrate empathy, reassurance and compassion.
 Address the person’s concerns.
 Be responsive. Responses should not ignore a verbal hint or expression of
emotion.
 Empower people. Responses should acknowledge the person’s resourcefulness
and expertise, and involve them in all stages of decision-making.
 Acknowledge and legitimize a person’s feelings, so they feel more comfortable
sharing their concerns. This involves being responsive and demonstrating
empathy.
 Respect the person’s individuality – that is, take account of the individual needs
and circumstances of each person in determining the most appropriate course
of action.
 Not make unwarranted assumptions about people.
 Convey a wish to support people through their time of adversity.
 Be diplomatic and non-judgemental at all times.
In judging appropriateness, it can be helpful to think about the possible

consequences of the remark or action. Ask yourself what might eventuate (e.g. Would
there be further discussion or argument? Would the situation be resolved?).
The Complete MMI Guide - The Medic Portal

5:47 PM
Clipped from: https://www.themedicportal.com/the-complete-interview-guide-

mmi/
This is part of our new ‘Interview Guide’ blog series, where each post will be focusing
on a different aspect of a medical school interview. This guide collects a range of our
resources on MMI, from topic-specific blog posts to Interview Questions.
What stations are there at an MMI?
An MMI is usually comprised of around 8-10 stations each lasting around ten
minutes each, although this varies between different universities. Stations are
designed to assess a range of skills and traits, including:
 Communication
 Problem-solving
 Critical thinking
 Resilience
 Initiative
 Interpersonal skills
 Teamwork
These skills are often assessed using a range of question types – for example, Ethics
questions may feature in a communication station or an interpersonal skills station –
or both! Stations can also vary between different universities, even if they’re
assessing similar things! For example, at one medical school you may be asked to
describe a vaccination to a young child, and at another you may be asked to instruct
somebody on how to tie their shoelaces. Both tasks will be assessing your
communication and interpersonal skills. To get a better idea of the kinds of stations
and timings, we’d recommend visiting each individual university’s website.
Key resource: MMI Top 5 Tips
What will I be asked in my MMI?
You may be asked a range of questions in your MMI designed to test the above skills,
and these will vary between medical schools as they’ll have their own set of criteria
they’re looking for in candidates. For example, you could be asked:
 Which principle of medical ethics do you consider the most important?

 You are given a map of a building with two doors marked at each end and asked
to give directions from door A to door B.
 An actor hands you a card, telling you that, in this role play, you are a close
friend of theirs. You have been house-sitting whilst they have been on holiday
and you have to explain to them that you broke the laptop they were given as a
birthday present. When informed, the actor becomes hysterical and very angry.
As with all MMI questions, the main focus is communication: your ability to
communicate your ideas and thought processes, to think clearly aloud while breaking
a task into logical steps, and your interpersonal skills and ability to empathise.
Generally speaking, the MMI tests personal qualities, like empathy, honesty and
integrity, rather than academic qualities (although at some schools, there are
exceptions: for example, calculation stations will assess your mental maths skills).
Take a look at our MMI Question Bank to get an idea of other questions you may be
asked – complete with a detailed answer guide to each question.
Key resource: MMI Question Bank
How can I prepare for my MMI?
Lots of practice! The key factor of an MMI is communication – so practice this in any
way you can, whether this is running through questions with a friend, setting up a
mock interview, or playing games with your friends or family. In a group, you could
take it in turns to answer a range of prioritisation/rational thinking questions:
 If you were stranded in the middle of the jungle, which one person would you
pick to accompany you and why?
 You are given the details of five people, including their age, sex and occupation
[for this question you would need to ask a friend to write the details of the five
people]. A nuclear attack is imminent and you can only save one person. Who
do you pick and why?
 You are going on a trip to a remote island and have two minutes to select three
objects from a table of ten [you could bring these objects in or have cards
describing them]. Which ones do you choose and why?
Try answering these in timed conditions of seven minutes – this will be great (and
fun!) practice for the MMI as they test your ability to communicate clearly, your
prioritisation skills and your ability to think rationally under pressure. You can look
at the MMI Question Bank’s answer guides for an idea of what interviewers will be
looking for at different stations.
And don’t forget that the same interview preparation tips apply: remember to
research the medical school itself, practice the obvious questions like ‘Why
Medicine?’, research NHS Hot Topics and the four pillars of Ethics. Good luck!
Key resource: MMI Interview
Other key MMI resources:
 How to do Drug Calculations – this is a great way to practice for

calculation stations at the MMI.
 Complete Interview Guide: Creativity – Creativity tasks are often a large part of
the MMI.
 Interview Question Bank – don’t forget to prepare for common interview
questions as well as MMI-specific ones!
Essential MMI Checklist - The Medic Portal

5:47 PM
Clipped from: https://www.themedicportal.com/essential-mmi-checklist/

Wondering how to approach your MMI, or worried about your timing? Our writer’s
essential MMI checklist details the five key things you need to remember on the day
of your MMI. Good luck!
Essential MMI Checklist: Top 5 Tips

1. Think of each station as a mini interview
You may feel extremely bewildered before you enter the interview, but try to think of
each station as a mini interview of only a few minutes. This will make the MMI much
easier to tackle. It will be easier to focus on each scenario if you think of it as
separate.
Focus your full attention on the station in front of you, and don’t worry about the one
you just left! Try your best to engage fully with the actor or question without
distraction.
2. Dress smartly
This may be an obvious one, but make sure you dress smartly on the day of your
interview. A freshly ironed blouse or shirt will emphasise your professionalism to the
interviewer.
3. Answer the question asked – and remember your timing
The individual stations will only last a few minutes, so it’s crucial you answer the
question within the time frame given. The hardest station to time will be the first, as
you won’t know how quickly the time goes in practice! Most medical schools have
details of how long their stations will last on their websites, so check this and try to
practise your answers with friends in these time frames.
Make sure you’re mindful of timing: for example, if you’re asked to weigh the
advantages and disadvantages of something, give yourself time to discuss both
arguments and then make a conclusive statement. Prioritise your best points to make
sure you have enough time to discuss them! You can read this post, Interview: How
To Manage Your Timing, for top tips on this.
4. Pick out the key skills the station is testing
At an MMI interview, different stations will be testing different skills. This means it
is crucial to identify what you are being assessed on. Some questions may be obvious
– for example, a station testing empathy may be when the interviewer asks you to
describe a situation where you have demonstrated empathy, or it may be more
ambiguous – for example, ‘how would you react to your best friend’s refusal to attend
school?’.
Taking a few seconds to consider which skills or qualities the interviewer may be
looking for will enable you to present yourself to the best of your ability and tailor
your experiences to the question. For an empathy station, think about your
experiences at your work experience with patients, or at groups or clubs at school,
and tailor these to fit the question.
5. If you mess up, move on
The great thing about MMI interviews is that if something goes wrong, within a few
minutes, you will have a fresh start. Use this to your advantage and make sure you
feel refreshed before each station, rather than dwelling on the previous one.
A great way to do this is to close your eyes for a few seconds and take a few deep
breaths between each mini interview to relax and revive yourself. Taking this break
will allow you to better answer the next question. If the interviewer seems harsh, try
to justify your statements as best you can and show them you are capable. Their
attempt to challenge you is probably because they can see you are able to articulate
your argument, so don’t get stressed!
Words: Oleia Green
MMI Stations: PBL Sessions - The Medic Portal

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Clipped from: https://www.themedicportal.com/mmi-stations-pbl-sessions/

Problem-Based Learning (PBL) is a common method of teaching in a lot of medical
schools. Some universities do a lot of it, some do a little and a few don’t use it at all.
So what is it? It involves creating your own learning objectives from material
provided such as a case history and then feeding back what you learned to the group.
Some universities in recent years have brought forward PBL sessions to interview.
You may be put into a ‘PBL Group’ with other people at the interview and then work
through a scenario to create learning objectives that in theory you would go away and
research. The main reason they do this is not to see if you’ll be good at PBL but to see
how you work in a team.
A rough overview of how you work through PBL sessions would be as follows:
1. Read through the scenario carefully and clarify any terms you’re unsure of.
2. Talk through the issues raised in the scenario as a group.
3. Turn these issues into learning objectives that you could research.
Obviously, at an interview you won’t have to go away and do the research, but you
should treat as if you would research the issues raised. This will help you engage with
it fully. Below are some tips on how to tackle mock PBL sessions at interview.
Make sure you speak up but don’t speak over everyone
Although it is important that you have your voice heard, don’t speak over other
people in your group during PBL sessions – that’s not demonstrating good teamwork
or listening skills! Listen to what other people have to say and respond accordingly.
It’ll help you gain a better understanding of the problem and is key to any teamwork-
based exercise.
They’re not trying to trick you with the scenario
Everything you need to form your learning objectives is in the scenario. Don’t go off
course trying to think of complicated or abstract learning objectives. Think about
what’s in the scenario and why it is there. This is where the learning objectives come
from.
Think of the underlying science behind the case
Clearly, if a disease or treatment is mentioned in the scenario, you’re going to need to

look into it, but also consider the basic science. For example, if someone has broken
their leg, don’t just think about how to fix it but also the basic anatomy of the leg.
Use what you already know in PBL sessions
If you know something about the topics covered in the scenario, don’t be afraid to
share it. This will help people think more about the problem and show the observers
that you have read a bit around the subject of medicine.
Encourage everyone to have their say
This is the role of the chair in a normal PBL situation but you may not have one at
interview. By encouraging everyone to take part, this will show you understand that
PBL is a team sport and you’re interested in what everyone has to say.
Words: Ruari McGowan
Practice Questions
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<<Practice_MMI_QuestionsUofS.pdf>>
1 Sample MMI Interview Stations: Question 1
6:50 PM
Clipped from:
https://onlinelearning.medentry.edu.au/mod/book/view.php?id=2452
Scenario
Imagine you are the principal of a large, respected school. There has been an
allegation that a humiliating film of a young disabled person has been circulating on
the Internet. Two final year students are up before you to explain their actions in the
creation of the video. The video appears to show a young person with intellectual
impairment being verbally abused by one of the students whilst a group of senior
students look on laughing. What are the issues that you, as the principal, are likely to
consider both before and at a disciplinary hearing?
Aim of the question
It aims to get candidates thinking about discrimination issues. It challenges them to

think about the importance of privacy and the ways in which privacy can be violated.
It aims to explore the consequences of one's actions on others. However, there is also
the very real possibility that this was a genuine film made collaboratively to educate
young people about discrimination against disabled people, which has been taken out
of context.
Prompt questions
1. How would you go about establishing the facts of the case?

2. What might be the impact of this case for the disabled young person?
3. What underlying reasons would you give for recommending the two final year
students are suspended from school?
4. What might your reaction be if the incident turned out to be a
misunderstanding, such as if the senior students and the disabled young person
had made a film about discrimination against disabled people?
5. How could you use this incident to raise awareness around disability
discrimination in the school?
List of skills and behaviours
(Marked on a scale of 1-5, where 5 = excellent, 4 = very good, 3 = good, 2 =

satisfactory, 1 = poor)
1. Has a sense of establishing the facts to ensure fairness

2. Demonstrates an awareness of the situation from a range of perspectives
3. Able to justify how he or she would balance conflicting interests
4. Appreciates the need for students to consider the consequences of personal
behaviours
5. Is able to draw lessons from the experience to inform future learning
Total mark: out of 25
Background and theory
Communication, confidentiality and consent in health care
Balancing a patient's right to privacy with the information needs of family and others
Families and friends play a vital role in the care and support of people with serious
illness. However, caregivers often complain that treating teams do not adequately
inform them of their loved one's condition and management plan. Failure or refusal
to disclose such information can be very distressing for those offering support and, in
circumstances where people with mental illness for example, behave in threatening,
violent or self-destructive ways, it can have serious repercussions.
Health care professionals owe a duty of confidentiality to their patients. As a general

rule, clinicians should seek a patient's permission before disclosing information to
others. This obligation is enforced in law. If health care professionals ignore this
obligation, they risk civil liability for breach of confidentiality or statutory provisions
that protect privacy, or a finding of professional misconduct by a professional
standards tribunal.
Generally, if a patient is able to understand the nature and effect of a disclosure of

information and refuses to agree to that disclosure, it would be both unlawful and
unethical to make the disclosure simply because the professional feels it to be the
better course. On the other hand, the right to confidentiality and privacy is not
without its limits, and it is widely accepted that confidentiality can be breached if a
higher obligation is involved, such as a serious threat to the health and safety of the
person or others.
Although it occurred in the United States and is not binding in Australia, the Tarasoff
case is often cited as an example of a situation in which there is an identifiable risk of
harm to others. In October 1969, Prosenjit Poddar stabbed and killed Tatiana
Tarasoff. Poddar had previously told a clinical psychologist that he was going to kill
an unnamed woman, who was readily identifiable as Tarasoff. The psychologist failed
to warn the Tarasoff family, and a California court found him negligent. In the
United Kingdom, a court held that a psychiatrist who sent a report, commissioned by
a patient's legal counsel, to the medical director of a secure hospital cautioning
against the patient's early release was justified in breaching patient confidentiality.
Although there are no Australian cases of "failure to warn" in the context of mental
illness, some state and territory mental health Acts permit the disclosure of
information where a clinician reasonably believes that disclosure is necessary to
lessen or prevent a serious threat to public health or safety. In addition, some, but
not all, mental health Acts in Australia specifically allow disclosure of less vital
information (usually about treatment decisions) to specified people such as close
relatives, friends or other people nominated by the patient. In some circumstances,
mental health Acts impose a duty on the clinician to impart specific information,
such as involuntary admission of a person, to the person's family or supporters.
Mental illness might affect a person's capacity to make decisions about information
disclosure. A patient experiencing persecutory delusions about his or her parents
may refuse to agree to a clinician discussing personal information with them for that
reason. If a patient lacks the capacity to make the refusal, and disclosure is necessary
in the best interests of the patient, then the disclosure can be made if it is necessary
to discharge the clinician's duty of care to the patient.
When a patient with mental illness refuses to consent to disclosure of information to

a close family member or supporter, the clinician should first discuss the issue with
the patient. This allows the patient to reconsider consenting to disclosure if his or her
concerns can be dealt with. It may be that the refusal is directly linked to features of
the person's mental illness and that these are impairing his or her capacity to consent
to the disclosure. On the other hand, the person may have good reasons for wanting
to maintain privacy, though even in these circumstances it may be possible to
negotiate with the patient for some agreed limited disclosure.
It is important to remember that as long as doctors do not disclose confidential

information, they are still permitted to see a patient's family members and friends to
listen to their concerns about the person and learn about the person's history. Simply
receiving information does not breach confidentiality.
In most cases, legal obligations around confidentiality and privacy are not valid
reasons for clinicians failing to communicate effectively with families and supporters.
Most patients will understand and agree to clinicians communicating with their close
family or friends if the reason for the communication is carefully explained. Even in
those rare cases where a doctor must keep matters confidential, family members will
usually be satisfied by having an opportunity to be heard, and most will respect their
relative's right to privacy. On rare occasions when it is necessary to disclose
information to protect the patient or other people from harm, this will be permitted
without the consent of the patient -- either because the patient does not have
capacity to consent to the disclosure or because the law permits disclosure in these
circumstances.
1 Sample MMI Interview Stations: Question 3

6:52 PM
Clipped from:
https://onlinelearning.medentry.edu.au/mod/book/view.php?id=2452&chapterid=1
021
Scenario
Dr. Blair recommends homeopathic medicines to his patients. There is no scientific

evidence or widely accepted theory to suggest that homeopathic medicines work, and
Dr. Blair doesn't believe them to. He recommends homeopathic medicine to people
with mild and non-specific symptoms such as fatigue, headaches, and muscle aches,
because he believes that it will do no harm, but will give them reassurance.
Consider the ethical problems that Dr. Blair's behaviour might pose. Discuss these
issues with the interviewer.
Instructions for the interviewer

1. Ensure that the applicant has read the scenario
2. Discuss some of the following issues with the applicant.
1. What's wrong with the way Dr. Blair treats his patients? Why is that
wrong?
2. Why do you think Dr. Blair does it?
3. Can you see any circumstances under which recommending a placebo
might be the appropriate action?
4. What is the difference between (c) and Dr. Blair's practice?
5. What action would you take regarding Dr. Blair?
3. The student has 8 minutes to discuss these issues with you. After 8 minutes a
bell will sound and you will have 2 minutes to complete the score sheet. Do not
give the applicants feedback.
4. In assessing the student, consider the following issues. Note, however, that
these are just a guideline and should not be considered comprehensive.
1. Did the applicant express balance and sympathy for both intellectual
positions?
2. Was there a clear analysis of the ethical problems paternalism raises?
3. Did the applicant suggest a course of action that is defensible and
moderate?
Background and Theory
Placebos are still commonly used in research, and they have been used for centuries
in clinical practice. The simple fact that Dr. Blair uses placebos, then, is not what
makes this case unpleasant. The ethical issues in this case arise because the doctor is
behaving paternalistically. He is treating his patient much as a parent would treat a
child, and he is deciding a course of care for the patient based on what he perceives
the patient's needs to be. This entails deceiving his patients, and making them do
what is good for them.
Paternalism is only one model of the doctor/patient relationship. Others see the
relationship as one between colleagues who share a common goal (the health of the
patient), one between rational contractors (who agree on a contract leading to
health), or one between a technician and a consumer of medical expertise. Each
metaphor for the relationship has some descriptive failings and some serious
normative failings.
Needless to say, the paternalistic model of health care has been severely criticized in
the past half-century or so. Paternalistic doctors may provide no worse care, but they
provide it at a very serious price: patient autonomy rights. This brings up an
important distinction in this OSCE: that between consequentialist and duty ethics.
Consequentialists judge actions by consequences; if the consequences are good, the
action is good, and vice versa. Many consequentialists would see little wrong with
Blair's behaviour in this case because only good is done to the patient - the doctor is
probably right in his assessments, and is probably even choosing treatment that
brings the best results in the shortest time.
Judged, then, strictly by the consequences of his actions, he has been acting ethically.
But duty ethicists would argue that the doctor has not been treating his patients as
fully rational, capable people, and hence has been acting unethically. Resolution of
these viewpoints might happen if we take a long-term perspective. It may be the case
that giving placebos has more harmful than beneficial consequences if we consider
the damage done to the medical profession. If Dr. Blair's patients were to become
aware of their deception, they might come to doubt the honesty and usefulness of
doctors.
Paternalism, while no longer considered a good model of interaction, is necessary

under certain circumstances. A paternalistic attitude is, of course, the only possible
relationship in cases where a patient is incompetent, and it is sometimes
recommended when the knowledge of a diagnosis might cause more harm than good.
Paternalism and deception (both of which must be justified if we are to allow placebo
use) might be allowable when the doctor cannot treat the patient as a capable person,
when no harm will be done to the reputation of the profession, and when the benefits
outweigh the harms. It is difficult to decide what action the applicant should take.
Some options are: reporting Blair to the college, speaking to him in private, and
ignoring this minor transgression. In their quest to appear ethical, though, and
especially in a trying environment such as this, people sometimes suffer from
excessive piety (this is the endless political capital of everything from anti-drug
campaigns to oil wars). Applicants should, I think, have a more measured and
considered response, one which is neither zealous nor laissez-faire. Perhaps the best
solution is further consultation - the applicant, being relatively inexperienced, should
probably seek out more professional opinions.
Example answers
 Dr Blair is treating all of his patients paternalistically. This is acceptable in rare

circumstances (when the patient is mentally incompetent), but not in most.
 Dr. Blair presumably does it because it leads to the best (short-term)
consequences with the fewest difficulties.
 Recommending a placebo should probably only be done when no real medicine
is suitable and:
 the doctor can't treat the patient as a capable person.

 no long-term damage to her reputation will result.
 the benefits will outweigh the harms.
 Obvious
 Measured and considered response - maybe more consultation.
1 Sample MMI Interview Stations: Many more

questions!
6:52 PM
Clipped from:
022
4. Many more questions!
QUESTION 4
Mr Wang, a 55 year old patient, has had back problems for over 3 years. He states
that ever since his back pains started he has not been able to sit still for more than
ten minutes. He has been on pain medications with minimal effect. His primary
doctor, Dr Ronaldson, believes that the only option left to entertain is back surgery.
For various reasons, Mr Wang is reluctant to undergo surgery, and instead asks the
doctor to refer him to an acupuncturist. He tells Dr Ronaldson that his insurance
coverage requires a physician’s approval for “alternative” therapy. Additionally, he
mentions that his wife has been successfully treated by an acupuncturist before.
 Should Dr Ronaldson write the referral?

 What would be the best approach by Dr Ronaldson in this situation?
 Dr Ronaldson feels there is no evidence to support acupuncture for Mr Wang,
and so declines Mr Wang’s request. Mr Wang becomes angry. What is the most
appropriate action to take?
 Is it ever appropriate for a doctor to write a referral for an insurance company
to assist a patient, even if the doctor believes it is not medically indicated?
 What are some reasons why patients may prefer alternative therapies?
QUESTION 5
Mrs A is a patient in your dental clinic. In spite of going above and beyond to help
her and accommodate to all her needs, she always complains and when it comes to
paying her fees she often makes unreasonable excuses. One day you receive a release
form from Mrs A which states that she needs her medical records to be sent to
another dentist. Additionally she states that she will try her best to pay the
outstanding balance that she owes your clinic, by next year.
 Would you respect her wish and release her records to another dentist?
 What is the most appropriate action to take in this situation?
 What would be the implications for Mrs A if you refuse to release her records?
 How would you address the issue of payment of fees?
 Is a dentist justified in refusing treatment to a patient who refuses to pay fees?
QUESTION 6
A 98-year old female patient comes to your dental clinic for a routine check-up. Her
teeth seem healthy for her age and in your professional opinion don’t need much
work. To your surprise she requests a follow-up appointment for several expensive
procedures including implants and veneers. You inform her that these elective
procedures would cost approximately twenty thousand dollars. She insists that you
go ahead and book the appointment for her and that she won’t have a problem
paying for the procedures.
 Should you respect her wish and fulfil her request?

 How would you approach this situation?
 Why might your patient be requesting such procedures?
 You are unsure if the patient is in fact able to pay for the procedures. Would you
request payment of the procedures prior to undertaking them?
 You believe that the procedures would cause more harm than good and advise
the patient of this. The patient says she will simply go somewhere else for the
procedures and asks for a recommendation for another dentist. What would you
do?
QUESTION 7
Mr J is 44 years old and works at a nuclear power plant. He lives at home with his
two teenage daughters who occasionally have friends over. One evening Mr J is
admitted to the local hospital after falling on the stairs and suffering a fractured
knee. Upon seeing the doctor he refuses to sign the release form for knee surgery and
says, “Just give me some painkillers doc. I cannot afford to miss work even for one
day.”
 Should his wish be granted? Why?

 How would you best manage the situation?
 What are some of the reasons why a patient may refuse surgery?
 How else could you assist Mr J?
 Is it ever appropriate for a doctor to force a patient to undergo surgery if it is
necessary?
QUESTION 8 (ACTING STATION)
You are a new volunteer in a retirement village. Your first assignment is to visit with
Mr Asennase who is 87 years old. He is from a very small town. He tells you that he
never cared much about technology but now that he has finally retired he is curious
to learn. The first thing he wants to learn about is the internet. Please enter the room
and greet Mr Asennase and try your best to describe internet to him. Keep in mind
that he has never even heard of the word internet and has absolutely no
background knowledge.
QUESTION 9
You and another fellow student are shadowing a senior physician as part of a
mandatory clinical rotation. During your second week you notice that the physician
often speaks Mandarin to his patients. Unable to understand Mandarin you become
frustrated and discuss the matter with the other student. Responding on how he feels
about the situation, the other student replies, “I don’t really care man, I just want to
finish this rotation and get out of here.”
 What would you do?

 What are the issues in this scenario?
 How would you manage the fact that you are unable to understand Mandarin?
 How would you manage the student who appears apathetic about the rotation?
 What are the issues associated with managing a patient who cannot speak
English?
QUESTION 10
Fee splitting involves payment from one dentist to another for referring a patient. Do
you think fee splitting should be forbidden in dentistry?
QUESTION 11
You are a newly recruited camp counsellor in charge of designing fitness programs
for autistic children. On you way to work one morning you witness your supervisor
holding hands with a female who definitely looks to be a minor.
 What actions would you take in such a sensitive situation?
 What issues should you consider in this situation?
 Is hand holding with a patient ever appropriate?
 What special considerations are required when working with patients who have
disabilities?
 How can you as a medical professional help protect the rights of minors?
QUESTION 12
You wrote a manuscript for publication, which you gave to your supervisor (principal
investigator) for review. After a month, he gives it back to you with minor revisions
and an additional name as an author: his wife’s.
 Knowing that you supervisor’s wife has had no involvement in preparation of

your manuscript, what actions would you take?
 How would you approach this sensitive situation?
 Does it really matter if an extra name is added as an author in a publication?
 What are the problems associated with including an author’s name on a
publication if they have had no involvement in the study?
 What are some other ethical issues that arise in research and publications?
QUESTION 13
You are an intern working in a busy hospital. A 29 year old female patient Natalie
Iberian is admitted to your unit after a car accident. Her chart indicates: concussion,
fractured jaw and severe blood loss. One of the interns points out to you that
Natalie’s 2 year old son Tommy has been killed in the accident. As you begin your
daily rounds Natalie directly asks you about Tommy.
 Would you share the news with her?

 What guiding principles would you use when sharing the news with her?
 Please act out how you would break the news to her.
 After sharing the news with her she understandably becomes extremely
distressed. What would you do?
 Is it ever appropriate to withhold information from a patient?
QUESTION 14
During an early morning lecture one of your professors, who is well liked by most
students, publicly makes fun of one of your class mates who is taking a “power nap”
in class. Even though you are not close friends with this particular classmate, you
have heard that he is suffering from a severe sleeping disorder.
 Would you intervene in this situation?

 What actions, if any, would you take?
 What are the issues involved in this situation?
 Why might the professor have made fun of the student?
 How would you support the classmate?
QUESTION 15
Many countries, including United States, Canada, United Kingdom and Australia
have implemented a program termed travel nursing to alleviate nursing shortage in
rural areas. Travel nursing enables nurses to travel to rural areas to temporarily work
in various nursing positions. Discuss with the interviewer the advantages as well as
the disadvantages of travel nursing in terms of health care quality and access.
QUESTION 16
You are just finishing a 17 hour shift and are about to leave home. You are extremely
tired. The co-worker who is taking over from you is late and you are being called to
review a patient’s chart. You realise right away that the matter will take at least an
hour to get resolved.
 What do you do?

 Your colleague turns up half an hour late. What would you say to your
colleague?
 Is it ever appropriate to leave on time if you have outstanding duties?
 What are the safety issues involved with working extended hours?
 What further action would you take in this situation? For example, would you
contact your supervisor or the management team?
QUESTION 17
In many clinical settings division 2 nurses (who have less training) often report to
division 1 nurses (registered nurses). Robert, a patient, observes Natalie, a division 1
nurse, speaking in an angry manner to Susan, a division 2 nurse. Natalie is criticising
Susan about her nursing care and how she takes too long to complete routine tasks.
 If you are the supervisor of the ward and such conflict is brought to your
attention, how would you resolve it?
 How would you manage Natalie?
 How would you manage Susan? What extra support could you offer?
 Is it ever appropriate to criticise a colleague in front of a patient?
 What are the problems associated with poor teamwork in a hospital
environment?
QUESTION 18
You are a Physiotherapist helping Mrs Salderhoe, a 78 year old patient, diagnosed
with AIDS and end stage liver cancer. She is severe pain and requests that you leave
her alone and let her have “a peaceful death.” You document her request and inform
the supervisor. Several days later, one of your colleagues tells you that everyone in
the unit believes that you have ceased treatment simply because you are afraid to
contract HIV.
 How would you handle such a situation?

 How would you address the rumour circulating about you?
 Would you discuss the issue with your patient, Mrs Salderhoe?
 What are some ways you can manage patients who decline care?
 Do you believe patients with HIV are discriminated against? Why might this be?
QUESTION 19
You are a well-established dentist working in an underserved area of town. A long

term patient of yours asks for your advice about travelling to a third world country to
save money on some costly cosmetic procedures.
 How would you discuss the issue with your patient?
 What are the issues associated with accessing such treatment in third world
countries?
 Are there any ethical issues associated with patients accessing such treatment in
third world countries?
 What options do patients have when they have limited finances to access care?
 What can the government do to assist patients in underserved areas to access
care?
QUESTION 20
A female patient comes to you complaining that one of your colleagues touched her
inappropriately during a clinical visit. She is asking you whether or not she should
press charges.
 What would you do in this situation?

 What are the issues involved in this situation?
 Your colleague is a close friend of yours. What, if anything, would you say to
him/her?
 Do you think that doctors should have to mandatorily report such issues?
 In what ways can trust within the doctor-patient relationship be enhanced?
QUESTION 21
You are a physiotherapist who has been out of school for many years. Due to
personal circumstances you move to a new city and look for a new job. The only
available position is in a busy and well-established clinic, situated several blocks
away from your residence. This privately owned clinic has goals set for each therapist
to see at least 15 patients a day. In spite of feeling very nervous about the workload,
you begin to feel more comfortable as you gain more experience with your new
position. One day you realise that you have made a mistake in managing a new
patient. Upon assessing the situation, you feel certain that you will lose this much-
needed job, which you financially rely on, if the clinic supervisor discovers your
mistake.
 What would you do? Would you tell the clinic supervisor about your mistake?
 How would you manage the patient? Would you tell him/her about your
mistake?
 What could you have done to help prevent this situation?
 What are the problems associated with booking too many patients?
 If you lost your job, how would you manage the situation and your finances?
QUESTION 22
You are an undergraduate student volunteering in a medical clinic situated in an

underprivileged part of town. In your very first day you notice that the secretary
often double books patients who are classified as “illicit drug-users”. She explains to
you that, “these people rarely show up for their appointments.”
 What would you do in such circumstances?

 What are the issues involved in double booking patients?
 What other ways can you manage patients who fail to turn up to appointments?
 Do you believe that “illicit drug users” are discriminated against in society?
 What can be done to further assist those with drug abuse issues?
QUESTION 23
It’s 3:00 am and you are coming back from a friend’s birthday party. In spite of the
heavy rain you decide to take the last bus home. You get on the bus using your
student bus pass and take a seat close to the driver. Three spots later you spot a 12
year old girl waving at the bus. She appears to be extremely cold, wet and tired. As
she gets on the bus she checks all her pockets but can’t find her bus pass or money.
She politely asks the driver to let her in without a bus pass but the driver refuses and
asks her to leave the bus.
 Given that you have no money on you, what if anything, would you do?
 Is it your duty to intervene in this situation?
 How would you manage the bus driver?
 How can you help the girl?
 Do you believe the bus driver has acted inappropriately in this situation?
QUESTION 24
You are volunteering in your local pharmacy when a 9 year old boy asks you where he
can find “some condoms”.
 Would you tell him where they are?

 What other action, if anything, would you take?
 Do you think it is appropriate that children under the age of 12 are informed
about condoms?
 Whose responsibility should it be to inform children about “safe sex”?
 Do pharmacists also have a duty of care to protect patients?
QUESTION 25
You are volunteering in the medical unit at the local hospital. Your role as a volunteer
is to talk to patients and keep them company. One evening a fellow volunteer asks
you to cover her shift. She tells you that she is scared and feels uncomfortable to talk
to one particular patient named Mr Albert. Upon reading his chart, you realise that
Mr Albert is a newly admitted HIV private patient. Furthermore, being an interstate
patient he has no one to visit with him.
 What action would you take?

 How else can you support Mr Albert?
 Do you think it is acceptable for the volunteer to avoid Mr Albert?
 Do you feel that patients with HIV are discriminated against?
 What can be done to reduce discrimination against people with HIV?
QUESTION 26
Mrs Boel is a 36 year old psychiatrist who has been involved in a horrific motor
vehicle accident and as a result is admitted to the emergency department. In addition
to severe blood loss, she has lost major facial tissue and severely fractured both her
legs in multiple places. Upon assessment, it is determined that due to the extent of
damage both her legs must be amputated. The patient can barely speak but is able to
communicate with the health care staff through writing. When asked to sign the
consent forms for the amputation surgery, she writes on a piece of paper, “I request
not to be treated further.”
 Should treatment be terminated?

 What are the issues that need to be considered?
 How would you manage this situation?
 Are there any situations where patients’ request not to be treated should be
honoured?
 What strategies can be used to reduce motor vehicle accidents on our roads?
QUESTION 27
James is a second year Australian medical student completing an anatomy elective in

Saudi Arabia. On the first day of the elective he signs up to observe an autopsy. Not
being able to speak Arabic he asks his partner, Jamal, to translate for him. Once the
procedure starts, Jamal makes several jokes about the cadaver which James finds
very offensive.
 In your opinion what should James do?

 What are the issues in this case?
 How should James manage Jamal?
 What are the special considerations associated with completing an elective in
another country?
 How can hospitals and universities help ensure that medical students behave
appropriately in clinical settings?
QUESTION 28
You are a senior manager in a busy primary clinic. A new trainee refuses to deal with
a client who is Aboriginal.
 How would you resolve such an issue?

 How would you manage the new trainee?
 Do you think racism is prevalent in Australian society?
 What strategies can be used to prevent racism against Aboriginal patients?
 What are some of the causes for the socio-economic disadvantage in Aboriginal
communities?
QUESTION 29
Your newly married best friend comes to your clinic complaining of male pattern
baldness. Following some routine assessments you prescribe him an oral medication
which has been shown to be safe for men but not for pregnant women. You explain to
him that if his pregnant wife consumes or even comes in contact with the medication,
their future child might have birth defects. He understands the warning but requests
that you don’t discuss his visit with his wife. Several months later his wife who has
had an elective abortion and subsequently is experiencing chronic depression comes
to your clinic and asks for help.

 Would you inform the wife about your consultation with her husband?
 How would you help the wife?
 How would you manage your best friend?
 What can be done to reinforce important information regarding medications to
patients?
QUESTION 30
It is final exam season and you are studying in the quiet study room at your school’s
main library. An hour later another student joins your table and as soon as he
unpacks his bag he reaches for his lunch box. Even though there are numerous ‘NO
EATING PERMITTED’ signs posted everywhere in the library, he starts eating his
lunch right in front of you.
 What course of action would you take?

 Would you confront the student?
 You choose to confront the student and he tells you to ‘mind your own
business’. What do you do now?
 What are some reasons for the ‘no eating permitted’ signs?
 Do you think Australia has become a ‘nanny state’ where regulations interfere
too much with personal choice?
QUESTION 31
You are a first year nursing student shadowing a staff nurse in a tertiary clinic.
During your first day you are asked to observe the nurse while she performs a routine
venepuncture procedure (process of obtaining venous blood) on a 25 year old
Chinese patient. While the nurse is preparing the equipment the patient loses
consciousness and lays flat on the examining bed. She tells you, “Don’t worry,
everything is fine,” and performs the procedure on the unconscious patient.
 You realise from your training that the patient is in fact in danger. What would
you do in such circumstances?
 You voice your concern but again the nurse says ‘everything is fine’. What do
you do now?
 Is it appropriate for a student to challenge a qualified nurse?
 What can be done to minimise anxiety in patients who are having minor
procedures performed?
 How do you go about managing situations when you feel ‘outside your depth’?
QUESTION 32 (ACTING STATION)
Your best friend Allen has been preparing to compete in the National Triathlon
Competition for the past 10 months. The competition starts in one hour. A mutual
friend has called you asking for help. He states that in spite of sustaining a serious
head injury several hours ago, Allen is determined to take part in the competition.
The mutual friend is worried about Allen’s health and has asked you to talk to Allen.
Please enter the room and greet Allen.
* In this scenario Allen is instructed to not say much to the interviewee. Additionally,
he insists that he wants to take part in the competition regardless of the
consequences.
QUESTION 33
One evening you come home after an exhausting day at university. Upon entering
your flat, which you share with two other flat mates, you smell a strong cigarette
odour. The next day you ask one of your flat mates if she know who has been
smoking in the apartment. She replies, “All I know is that it’s not me.” Additionally
she tells you that being an ex-smoker she does not mind the smell.
 Not knowing your other flat mate very well how would you handle this
situation?
 Would you confront the other flat mate about the issue?
 You mention the issue to the other flat mate who states that it is not him who is
smoking. What do you do now?
 What are the risks associated with passive smoking?
 What can be done to further reduce the incidence of smoking in the
community?
QUESTION 34
You visit your general practitioner for a routine physical examination. Before
beginning the examination he politely asks, “Would it be alright if some of our
medical students observe today’s session?” You approve and he invites three students
into the room. Half way through the session you realise that the doctor keeps asking
the students if the “video quality is clear”. Being curious you ask, “What video are you
talking about doc?” The doctor responds, “Oh we are broadcasting this session live
on the big screen for the rest of the class.”
 As the patient, how would you handle such a situation?

 Has the doctor acted inappropriately? If so, how should the doctor have
behaved?
 What are the advantages of medical students being present during
consultations?
 What are the disadvantages of medical students being present during
consultations?
 What are the issues associated with use of technology in medical consultations?
QUESTION 35
You are applying for acceptance into professional school and ask your long time
graduate supervisor to write you a reference letter and mail it directly to the school.
Several days later, you receive a letter in your mail box and realise that he has mailed
you an extra copy of the letter by mistake. Shortly after, you receive an email from
him directing you to discard the letter without reading it. Being curious you open the
letter and realise that your supervisor has written a very negative reference letter
which includes false information about your time in his laboratory.

 Would you confront your supervisor? If so, how?
 Would you contact the school, and if so, what would you say?
 What are some reasons why the supervisor may have written a negative
reference letter?
 Do you believe reference letters should be confidential and should not be read
by the applicant in any circumstances?
QUESTION 36
Many would agree that a health care professional should be a model of health, but a
significant percentage of healthcare professionals propagate a message that says, “Do
as I say, not as I do.” In your opinion, should health care professionals be held to
higher standard of health than the rest of us?
2 Ethics in Medicine: Sample ethical scenarios (MMI

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Example 1
You are an emergency room physician. This morning, a male patient arrived in
serious condition, with a high temperature, headache, and extreme weakness. You
treated him and ran various tests. Now he feels better and wants to go home even
though you have not yet received the results of his tests.
Rationale
 One of the characteristics that medical and therapeutic professionals are

expected to possess is a well-developed capacity for moral reasoning
 The goal is to examine the candidate’s ability to contend with complex
dilemmas
 The challenge is to measure the candidate’s ability to comprehend all aspects of
a complex situation and reach a considered decision regarding a suitable plan of
action
 Candidates should state the reasons for and against various courses of action.
After providing a detailed account of their considerations, they should state how
they would act, and why.
Example 2
Jane, 32, is a new teacher at a boarding school. After spending a short time at the
school, she discovers that the older students are subjecting new students to
humiliating initiation ceremonies and even forcing them to do their chores. Jane
reports this to the school principal, who tells her this is a longstanding school
tradition and she should not be concerned. He implied that should she make this
information public, she would no longer be trusted by the students or veteran
teachers. What would you advise Jane to do with this information? Why? What
considerations should she take into account?
Example 3
Passengers on Samoa Air do not pay for a seat but pay a fixed price per kilogram,
which varies according to the length of the route. The passengers nominate their
weight and are then measured, along with their baggage, on scales at the airport.
What are your views on this?
Example 4
Dr Harris recommends Chinese medicines to his patients. There is no scientific

evidence or widely accepted theory to suggest that Chinese medicines work, and Dr
Harris doesn’t believe them to. He recommends Chinese medicine to people with
mild and non-specific symptoms such as fatigue, headaches, and muscle aches,
because he believes that it will do no harm, but will give them reassurance. Consider
the ethical problems that Dr Harris’s behaviour might pose. Discuss these with the
interviewer.
A. What is wrong with the way Dr Harris treats his patients? Why is it wrong?
B. Why do you think Dr Harris does it?
C. Can you see any circumstances under which recommending a placebo might be
the appropriate action?
D. What is the difference between (C) and Dr Harris’s practice?
E. What action if any, would you take regarding Dr Harris?
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Dr Brian has been caring for the Lucas family for more than 10 years. John and
Mary’s son, Jimmy, is 4 years of age and was recently diagnosed with symptomatic
diabetes mellitus. This led to considerable stress on his parents. John and Mary
needed a lot of support and encouragement through the diagnostic process as Jimmy
was established on insulin treatment.
Dr Brian’s clinic has a message system (telephone and email) in place for patients to
use; messages are screened by the practice receptionists. However, Dr Brian gave
John and Mary his private mobile number in view of their anxiety and the clinical
situation. He encouraged them to call him with any problems as Jimmy was
stabilised on treatment. He stressed that the mobile number should only be used for
questions about Jimmy’s diabetes until they felt more confident in managing his
care.
Initially, John and Mary visited the clinic twice a week. They called Dr Brian on his
mobile phone only a few times, mostly for minor queries. Jimmy started to feel well.
His blood glucose levels were improving, but had not yet reached the target set by his
diabetes specialist.
One morning, on his day off, Dr Brian received a text massage from Mary on his
mobile phone. Mary asked for his ‘urgent help’ in arranging a referral to another
diabetes specialist.
Should Dr Brain immediately respond to the message? If so, how? What should he
tell Mary about the use of his private phone number?
What are the ethical issues?
This case raises questions about the impact of using technology (eg. mobile phones)
as a means of communication in the doctor-patient relationship, and the boundaries
of that relationship. We focus on questions that are relevant for virtual
communication:
 How are the duties and responsibilities of the general practitioner (GP) affected
by using virtual modes of communication?
 What kinds of limits should GPs place on their availability, and how are these
limits affected by mobile phones?
 What duties do GPs have regarding requests that are perceived to be ‘urgent’ by
patients?
The patient’s perspective
Mary was very pleased when Dr Brian gave his private mobile number to her. This
allowed her to contact him immediately when she was concerned about Jimmy’s
treatment, instead of relying on the message system at the practice, which can be
slow. She felt that Dr Brian trusted her. Using a text message instead of making an
appointment is faster and more convenient from her point of view, especially if she
wants a quick reply. She could also give the number to her mother, which would
reduce her mother’s anxiety about minding Jimmy, now that he has diabetes.
It might seem ideal to Mary, but communicating by text messages may not be in her
best interests if important information is not shared or important actions are
omitted. Dr Brian will not be able to see Mary’s body language, have a conversation
with Jimmy or see other clinical cues visible in face-to-face medical encounters. Text
messaging exacerbates these problems as the patient’s voice and affect cannot be
observed. Further problems might result, given the limits of text messaging,
including potentially significant misunderstandings. For example, lack of
punctuation can create ambiguous messages, widely used abbreviations may be
misunderstood and messages may be misinterpreted. These drawbacks may not be
obvious to Mary, who might be disappointed if Dr Brian does not respond in the
immediate way expected of messaging.
The GP’s obligations and duties
Dr Brian provided his private mobile number to John and Mary because he saw how
distressed they were with Jimmy’s diagnosis. He wanted to ensure that any problems
in Jimmy’s care were quickly addressed, and that John and Mary felt fully supported
as they managed his diabetes. Despite his beneficent intent, his actions may have
unintended consequences.
Electronic communication changes the dynamics between GPs and their patients.
GPs listen to all of the patient’s concerns, explore unvoiced concerns and respond
appropriately during face-to-face consultations. However, these duties are less clear
with other modes of communication. Time constraints make it impossible for each
text message sent by a patient to trigger a full virtual consultation.
The request might seem simple in this case, but Dr Brian has two concerns. First, he
is uncertain about the reason for the urgent request. It might reflect a deterioration
in Jimmy’s condition, which would require immediate attention. Alternatively, Mary
might have just found it more convenient to use the private number rather than
make a clinic appointment.
The second concern is limiting the demands on Dr Brian. Giving Mary his phone
number allowed her to contact him at any time. This kind of access may be warranted
in specific situations (eg. palliative care). Some GPs may feel greater access improves
the quality of care they offer, which makes them feel helpful and in control. However,
this can come at a cost. Disturbances to the GP’s private life can cause stress, trigger
feelings of invasiveness, increase burnout and have the adverse effects on the
doctor’s health and wellbeing.
There are questions about the impact of text messages and other forms of virtual
communication on the boundaries of the doctor-patient relationship. The informal,
immediate and sometimes ambiguous or intimate nature of text messaging alters the
tenor of the relationship, which can potentially cross that boundary. Text messages
relating to specific aspects of patient care may be effective in patient management
and can be valued by the GP and patient. However, crossing an apparently trivial
boundary can quickly escalate into more serious boundary violations, threatening
patients and physicians.
Finally, virtual communication raises issues of confidentiality and fidelity. Doctors

must follow simple rules when using these forms of communication, including not
revealing private information through unsecured media, and ensuring that patients
do receive intended text messages.
Potential actions and consequences
Dr Brian’s options are to respond immediately (eg. text, call or ask his practice staff
to contact Mary) or when he returns to work. He can fulfil the request for a referral
without meeting Mary or ask her to make an appointment. Dr Brian’s duty of care to
Jimmy (after all, there may be an emergency), and the expectations created by giving
Mary his mobile number suggest he should respond immediately rather than wait
until he is back on duty. Texting her to make an appointment for the next morning
will meet the expectations of immediacy engendered by this form of communication,
while reinforcing the importance of face-to-face consultations. An immediate
response preserves the doctor-patient relationship without leaving Mary feeling
abandoned.
Summary
Virtual forms of communication (eg. texting) can support patients and may
contribute to better care. However, these informal communication methods may
intrude on the doctor’s leisure time and undermine standards of care if they replace
face-to-face consultations.
Texting may cross boundaries in potentially unprofessional ways, especially when

particular patients are favoured with this privilege. It may disadvantage patients who
are not favoured or who are not comfortable using mobile technology. We also note
that GPs cannot control the distribution of their number or recall it without the
inconvenience of changing the number once it has been disclosed.
Virtual communication is an integral part of the way we live, despite the potential
pitfalls. Each form (social media, electronic messaging systems, video consultations,
mobile phones, etc.) has its advantages and disadvantages. This makes it important
for practices to develop policies supporting the responsible use of virtual
communication. Such policies should:
 Clarify (for patients and GPs) when its use is appropriate

 Accommodate doctors’ individual preferences regarding technology
 Provide guidance regarding GP’s duties, especially for interactions that do not
allow full evaluation of patients.
GPs may wish to have specific criteria for providing patients with this degree of
access, set very clear indications and contraindications to its use, explain that
potential pitfalls, and ensure that text messages augment good care rather than
replace it.
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As a General Practitioner, what should you do if a new patient presents you with a
long list of tests and tells you, ‘My naturopath needs you to order these tests before I
next see them’?
When faced with this type of request, GPs may feel caught between their professional
responsibility to only order clinically-indicated tests and their desire to comply with
the new patient’s wishes, or even a fear of missing something.
Such situations raise a number of questions for GPs: What is my duty of care? What
are the professional and medico-legal issues? Am I obliged to comply with or refuse
the patient’s request?
Duty of care
GPs owe their patients a duty to exercise reasonable care and skill in the delivery of
medical services, including taking history, examination, investigation, diagnosis and
management, as well as the provision of information and advice.
If a request for tests comes from a naturopath (via a patient) and the GP is not
involved in an initial assessment of the patient, with whom does the legal liability
rest?
From a legal perspective, the practitioner who orders a test has a responsibility to
review the results and determine if further action is required. The GP cannot delegate
this responsibility to the naturopath, especially since the GP has greater clinical
knowledge and the naturopath may not have the required knowledge to interpret the
results and determine appropriate clinical management.
There may be a heightened medico-legal risk for a GP in acceding to a patient’s

request for tests ordered by their naturopath, particularly if the GP is not familiar
with the tests and their interpretation. The GP is not following their usual practice in
managing a patient and ordering tests in this manner, which, again, leaves the GP at
potentially greater medico-legal risk.
There may also be additional challenges in follow-up, such as the patient refusing to
see the GP to discuss any clinically significant test results.
Professional obligations
The standards of ethical and professional conduct expected of doctors by their peers
and the community are set out in the Medical Board of Australia’s ‘Good Medical
practice: A code of conduct for doctors in Australia’ (the Code).
If a GP orders the tests with the intention of handing over the results for
management by the naturopath, the Code states:
‘Good medical practice involves taking reasonable steps to ensure that the person to
whom you delegate, refer or handover has the qualifications, experience, knowledge
and skills to provide the care required.’
The need for the GP to respect a patient’s right to make their own healthcare
decisions must be balanced against the GP’s obligation to ensure the services they
provide are necessary and likely to benefit the patient.
Medicare
Medicare benefits are only claimable for ‘clinically relevant’ services. A medical
service is clinically relevant if it is generally accepted in the medical profession as
necessary for the appropriate treatment of the patient. When a service is not
clinically relevant, the fee and payment arrangements are a private matter between
the practitioner and the patient.
Specifically in relation to Medicare benefits for pathology services, the treating

practitioner must determine that the pathology service is necessary in order to bill
the service to Medicare. In this situation, the naturopath may be able to order the
tests, but the patient would be responsible for the full cost and it would appear the
naturopath is asking the patient to see the GP so the tests can be ordered under
Medicare.
Conclusion
If the GP does not believe the tests requested by the naturopath are clinically
relevant, they are not obliged to order them and the tests must not be billed to
Medicare. Ultimately, however, it is still important to note that the patient can still
consult the naturopath, even if the GP refuses to order the tests.
Depending on the circumstances, the GP may therefore choose to: say ‘no’ at the
outset of the consultation, especially if the new patient has only attended the GP for
the purpose of obtaining the tests under Medicare; or proceed to assess the patient as
per their usual practice in order to determine if the tests are necessary and clinically-
indicated.
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An ethical bequest: Whether to accept a gift bequeathed from a patient's will is not
an easy decision.
It may sound like fiction: a call out of the blue telling you that you've been left an
unexpected bequest. But if it is from a patient, that can pose legal and ethical
dilemmas, as well as potential concerns for your relationship with the patient's
remaining family. Doctors seeking advice on this fraught issue tend to focus on their
legal obligations, but while there are some legal issues to be aware of, it is the ethical
issues that can be more of a concern.
The essence of the doctor-patient relationship is one of trust. GPs, in particular, often
form very close and longstanding relationships with their patients, and perhaps with
their patients' entire families, over many years. To reflect the importance of this role,
some patients choose to bequeath gifts to their GP in their will.
In some cases, the first the GP comes to know about this gift is when they are
contacted by the deceased patient's family or executor to advise that they are a
beneficiary under the will. In other cases, the patient may speak of their intention to
leave a bequest. Doctors are likely to experience some discomfort and specifically,
question whether they are ethically compromised if they accept such a gift.
The ethical issue
When a doctor accepts a gift or the promise of a bequest, the patient's expectations
may change and the boundaries required for ethical patient care can become blurred.
The nature of the doctor-patient relationship means the doctor stands in a position of
power and influence relative to the patient, especially when a patient is particularly
vulnerable such as at the end of life. This is why boundary issues are regarded so
seriously and why it is important to avoid any suggestion of actual or perceived
conflict of interest with the primary interests of the patient.
It is very difficult for a doctor to accept a personal benefit from a patient's bequest
without the question of undue influence arising. Especially since the patient can no
longer clarify their intentions. The issue is not only whether a doctor may, however
unwittingly, have influenced the patient to make the bequest. Where a doctor is seen
to be personally benefiting from having provided professional care to a patient, this
can affect the public perception of that doctor, and the profession as a whole.
Professional obligations
The Medical Board of Australia's Code of Conduct reinforces the importance of

independence of medical practitioners when treating patients. Clause 8.12 of the
Code states, “It is important to avoid any suggestion of actual or perceived conflict of
interest with the primary interests of the patient,” and that doctors must be honest
and transparent and must not encourage patients "to give, lend or bequeath money
or gifts that will benefit you directly or indirectly".
In all likelihood, the doctor will at no time have encouraged patients to leave them a
bequest. However, it can be very difficult to demonstrate this at the point the estate is
being settled, if concerns are raised about inappropriate influence or capacity.
In circumstances where a doctor is a beneficiary under a patient's will and they are
employed by or practise at a hospital or other health facility, the doctor should check
whether the hospital or health facility has a policy about accepting gifts from
patients.
Managing relationships with family members
Accepting a bequest may damage a relationship with family members or other

beneficiaries under the will.
On the other hand, declining an actual, or intended, bequest can also cause distress.
Rejection may also harm the doctor-patient relationship, or insult family who wish to
honour the deceased's wishes as part of their grieving process.
Suggested strategies
If there is no workplace policy on how to respond to patient gifts, the decision

whether or not to accept the gift is a matter of judgement.
If in doubt about whether to accept or decline the gift, one suggested guideline is that
doctors consider if they would feel comfortable with colleagues or the public
becoming aware that they had received the bequest from the patient. Generally, the
best approach is to decline to accept it as sensitively as possible.
If they are notified that they are a beneficiary under a patient's will, doctors may elect
to contact the executor and/or any member of the patient's family to express their
gratitude for the gift. This can be an opportunity to seek to understand the attitude of
the family.
If it is difficult to refuse the gift; for example, because there is no other family, or
because to refuse would be very offensive, taking away the suggestion of personal
benefit can be helpful. An option can be to suggest that the gift be donated to charity
in the name of the deceased or be directed to appropriate medical services or
organisations.
Each situation is unique, so we encourage practitioners to seek legal advice from

their medical defence organisation. This is particularly important if the patient has
left a significant asset.
2 Ethics in Medicine: Case Study 4

6:50 PM
Clipped from:
045
An ethical tightrope: Placebos work because there is no informed consent. It's a
tricky balancing act.
There is little research on how often Australian doctors prescribe placebos. But if
they are like doctors in other countries, it is common practice despite the ethical
boundaries it may cross.
In talking about placebos it's important to distinguish between pure and impure
placebos. A pure placebo is a straightforwardly fake treat¬ment: a saline injection or
a sugar pill, for example.
An impure placebo is a sub¬stance or treatment that does have clinical value, but not
for the condition for which it is being prescribed, such as antibiotics for viral
infections or unnecessary blood tests to calm an anxious patient.
A 2012 survey in the UK found 1% of GPs use pure placebos, and 77% use impure
placebos at least once a week. However, although the placebo effect is unques-
tionably real, it is not yet fully understood. It is believed that there are different types
of placebo effect involving diff¬erent mechanisms.
These include response conditioning based on prior experience, expectation and

reward effects mediated through the dopamine sys¬tem, and natural analgesia
through the production of endorphins, the body's own painkillers.
But what triggers the placebo effect is belief: the belief by patients that they are
receiving a treatment and that it will be effective. The placebo itself is simply a prop
to sustain the illusion.
The placebo effect also has an evil twin, the nocebo effect, where a patient
expe¬riences adverse side effects from a harmless placebo, or where the expectation
of neg¬ative symptoms precipitates those symptoms.
So, are they ethical? The two primary ethical duties of doctors are to act in the
patient's best interests and to respect a patient's autonomy.
The doctrine of informed consent dictates that patients have an absolute right to
make treatment decisions based on full information about the risks and benefits of
proposed treatments.
Yet, the placebo effect sug¬gests that complete informat¬ion and unvarnished
honesty are not always in the patient's best interests. In this case, it may be beneficial
for patients to have expectations their doctors do not share.
Similarly, there is an emerging concern that telling patients about all the possible
side effects of a treatment can trigger a nocebo effect.
It is obviously important to know about the side effects of treatments, but this kind of
information is not therapeutically neutral. It can condition expecta¬tions or focus
anxieties in harmful ways.
With placebos, what doc¬tors are doing essentially is implementing a cognitive

intervention that can produce significant pain relief and measurable improvement
for a variety of other symptoms.
This is, unquestionably, medically important. But it's questionable whether we

should incorporate it into standard practice, given that it requires deception.
Further, the placebo effect has a serious image problem. It can be embarrassing for
patients to discover that an apparently helpful medicine was merely a placebo. It is
often seen as implying gulli¬bility or delusion, or perhaps that the illness was
exaggerated. The emphasis on decep¬tion frames the placebo effect as a kind of
illusion that is "all in the mind".
But the placebo effect is not a weird anomaly. It shows us something about how the
body responds to injury and disease function. If beliefs, expectations and
dispositions are involved in the neuro-physical mechanisms govern¬ing pain
response, then it may matter a great deal how we understand, imagine and anticipate
pain.
Career in health
12:00 PM
https://www.myhealthcareer.com.au/will-i-get-a-job/
https://en.wikipedia.org/wiki/Medical_education_in_Australia
http://www.smh.com.au/national/health/more-doctors-becoming-specialists-but-a-shortage-
of-gps-aihw-report-warns-20160824-gqzwxf.html
http://newsroom.melbourne.edu/news/how-fix-shortage-country-doctors
The most leading causes of mortality in the US is heart diseases, malignant neoplasms
(cancer), and chronic lower respiratory diseases (emphysema, asthma, bronchitis).
Dentistry
11:56 AM
Becoming a dentist in Australia involves being competent in six main areas, which are
summarised here:
1. Professionalism – your personal values, attitudes and behaviours, and includes things
such as practising evidence-based dentistry in a way that involves patient-centred care
2. Communication and social skills – your interpersonal skills and the ability to
communicate with and work cooperatively with a range of people
3. Critical thinking – applying your knowledge to identify and solve real-life problems; it
includes performing and/or interpreting diagnostic tests, using clinical reasoning and
judgement and formulating a treatment plan which integrates your expertise and takes into
account the patient’s views
4. Health Promotion – enabling individuals to be responsible for their own oral health – you
need to be able to promote the principles of oral health and disease prevention
5. Scientific and Clinical Knowledge – applying biological, medical, technical and clinical
knowledge to recognise the difference between normal and abnormal conditions; it
includes selecting the least invasive therapy necessary and prescribing medications as
appropriate
6. Patient Care – gathering information, diagnosing, treating and evaluating the treatment
From <https://www.myhealthcareer.com.au/latest-news/becoming-a-dentist>
http://www.adc.org.au/documents/Attributes&Competencies_Dentist%20v1.0%20Final%201
0-06-11%20Updated%20July%202013.pdf
https://www.myhealthcareer.com.au/dentistry-career
<<226.full.pdf>>
Double click to open file
http://www.uq.edu.au/study/program.html?acad_prog=2367

Interview

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Interview

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UNSW Information Evening

Friday, July 14, 2017

Insights into Medicine

Create a scaffold of a regular weekly study timetable

Goals should ignite emotions within you

Self-directed learning - self-reflection

How I overcome challenges, how I

"why not nursing"

Assessing my academic understanding and knowledge is not a priority of the interviewers.

Some key inquiry threads that they may pursue:

Some key principles:

UNSW introductory questions

The UNSW medical interview is unlike any other - it is a highly psychological

Tell us a bit about yourself.

What are your interests / hobbies?

What is your most valued achievement?

This will differ considerably between people. It is important to explain why it is

Questions such as this assess personal qualities such as perseverance, self-

What achievements or accomplishments do you take pride in?

Who was your favourite teacher at school and why?

Who in your life has influenced you and how?

5 Tips for a Panel Interview

Clipped from: https://www.themedicportal.com/5-top-tips-panel-

It might seem obvious and, no doubt, hard enough to do in one of the

Be aware of the likely structure of the panel interview

The medical school may send lots, little, or absolutely no information to

 Desire to be a doctor (“Why medicine?”, “Why this

 Skills (“Give an example of a time when you used your

Arm yourself with facts

Background and Motivation Questions - The Medic

Clipped from: https://www.themedicportal.com/e-learning/interview/background-

Background and Motivation

Why do you want to go to Medical School?

Background and Motivation: why do you want to study Medicine?

 Focusing on career advancement, respect and remuneration

What aspects of the working life of a doctor don’t appeal to you?

 Focusing too much on extracurricular agendas at the expense of the Medical

Work Experience Questions - The Medic Portal

Clipped from: https://www.themedicportal.com/e-learning/interview/work-

What Medical work experience have you carried out?

 Simply providing a checklist of placements you’ve done with no case examples

 Start by acknowledging the challenges involved in being a doctor. It is a

 Trivialising the harder parts of work experience under the misguided

 You may be thrown a curve-ball question, such as this one. It is essentially

 Communication skills are extremely important in medicine and students are

Ethics Questions - The Medics Portal

Clipped from: https://www.themedicportal.com/e-learning/interview/ethics/

 As usual, we start by using the four pillars of medical ethics as a framework

 Being judgemental. Saying something like ‘14-year-olds shouldn’t be engaging

 This question is designed to examine your awareness of the duties of a medical

 Have an understanding of what patient confidentiality means and what kind of

 Not knowing the actual meaning of patient confidentiality.

 Forgetting about the legalities of doctor-patient confidentiality. Even when

 When addressing an issue like this it is important to consider the 4 pillars of

Clipped from: https://www.themedicportal.com/medical-ethics-explained-

Autonomy Medical Ethics

The Four Pillars of Medical Ethics

There are four pillars of medical ethics:

How to approach a scenario with respect to autonomy

Let’s look at an example:

Tell us what you’d like to discuss

Stay tuned for my next blog on Beneficence!

Uploaded by James on 3 October 2016

Clipped from: https://www.themedicportal.com/medical-ethics-explained-