This multiple mini interview sample question should help you prepare for any future MMIs you have in the future. Get an idea of what the interviewers are looking for and how you can give the best answers possible.
Admissions MMI – Sample Station 1
Instructions for the interviewer
1. Ensure that the applicant has read the 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.
2. Discuss some of the following issues with the applicant. Some background information is given on the following pages.
A. What’s wrong with the way Dr. Blair treats his patients? Why is that wrong?
B. Why do you think Dr. Blair 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. Blair’s practice?
E. 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.
A. Did the applicant express balance and sympathy for both intellectual positions?
B. Was there a clear analysis of the ethical problems paternalism raises?
C. Did the applicant suggest a course of action that is defensible and moderate?
Background and Theory of Question
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.
A. 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.
B. Dr. Blair presumably does it because it leads to the best (short-term) consequences with the fewest difficulties.
C. Recommending a placebo should probably only be done when no real medicine is suitable and:
a) the doctor can’t treat the patient as a capable person. b) no long-term damage to her reputation will result
c) the benefits will outweigh the harms
E. Measured and considered response–maybe more consultation.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of ProspectiveDoctor. Follow ProspectiveDoctor on Twitter @ProspectiveDr