MMI acting scenario

[Egg_McMuffin]

Prompt:

You are a cardiologist at a local hospital, who just finished a shift and has a tight run to your daughter's high school graduation ceremony. As you headed off to the door, Jennifer, a patient who knew you well, saw you from the waiting room and grabbed your attention. "Doctor! I have a bad chest pain. Please stay for a bit. I'll feel much better if you were here." Enter the waiting room and talk to Jennifer.

I was practising this with a friend, who wouldn't let me leave when I tried to suggest having another physician look after her. My approach was to listen to the patient and validate her anxiety/concerns re: having someone else look after her, explain to her that she needs an assessment right away but it'd be better to be performed by one of my colleagues who is available for the night (and that she'll be in good hands), as I do have prior engagements, and wouldn't want to rush her assessment and miss something. I would've been okay if I wasn't successful in handing her off to another physician by the end of the 5 minutes, since my main goal is to show that I can empathize, and communicate in a calm manner even when I have other things on my mind. However, when providing feedback, my friend suggested that I could've left the patient with an imaginary nurse while I go consult another imaginary cardiologist, then come back and introduce this imaginary cardiologist to the patient to make her feel more at ease about the hand-over.

Thoughts?

[hartk48]

I've done this exact scenario with someone who got into multiple Canadian med schools and while he didn't suggest to create imaginary characters, he did suggest to straight up call who ever is in charge. He's reasoning was, you are a human being too. If you spend time with this patient you open the possibility for mmi "traps". Obviously the delivery and how you use your words is vital here. 

[Egg_McMuffin]

1 hour ago, hartk48 said:

I've done this exact scenario with someone who got into multiple Canadian med schools and while he didn't suggest to create imaginary characters, he did suggest to straight up call who ever is in charge. He's reasoning was, you are a human being too. If you spend time with this patient you open the possibility for mmi "traps". Obviously the delivery and how you use your words is vital here. 

Like what kind of traps? 

Aren't you expected to engage with them for the duration of the station anyway? So was his approach was to listen and talk to the patient for most of the station, then finally hand them over to someone else?

[hartk48]

by traps I meant it as sort of "keep it simple". You definitely need to acknowledge, be polite and understanding but its okay if you refer them to who ever is on call. 

Anyone disagrees / thinks otherwise? just curious

[Arztin]

In real life, most people would listen a bit, and if the physician it can potentially be serious, tell the person to go to the ER (given the fact that it's next to the hosptital) and head for their kid's graduation ceremony since it might be serious, and you can't do much in the office anyways.

Recognize that depending on the specifics, how you approach it would be different.

e.g. small town, and you are the only family physician.... well this could potentially be serious. You would be just negligent to not see that patient.

e.g. in this vignette you said you just the clinic, so you'd be in the hospital. Depending on the seriousness, the patient will likely ECG labs etc... and it will take hours to follow up with. Since this could potentially be serious, better tell the person to go to the ER (or see the person on call), because you don't want to be stuck in the hospital for another 5 hours for something you shouldn't really be dealing with. 

What's most important in this situation is to recognize that you have a duty to care for your patient. However, having a balance in life is important. You can't possibly in real life each time stay for a patient who shows up after hours - you'd never go home, and you would be burnt out. Therefore, you need to balance both perspectives, and depending on the urgency of the situation, and the setting, you'd act differently.

If you say that you will head back to the office, the interviewer will likely challenge you with a follow up question like : "are you going to do this every time? What about your own family and your kids? you are not afraid of your partner leaving you?" Be ready to defend.

Now, since it's an acting situation, you probably need to listen empathetically etc... validate their point.... and reassure... and try to "negotiate" with the patient an action plan.

Edit: misread your case

[MedCoachMD]

You need to remember why these MMI stations are made in the first place. 

The goal is not for you to understand the mechanisms of an MI or a differential diagnosis - this is something you will learn in medical school.

So what is the goal? Since this is an acting station, the goal is to show empathy, compassion and reassurance. You are stuck in the room for 8 minutes so just leaving and saying "I need to go to my daughter's graduation" is not an option anyways.

I find a lot of students overanalyze these types of stations especially when they have a medical background.

It's not about what kind of specialist you will consult, its about knowing how to ask for help if you feel uncomfortable

It's not about diagnosing her medical condition, it's about listening to her concerns

Try this - it's something we learn in family medicine: The "FIFE"

Feelings - what does the person feel? Angry, stressed, worried?

Ideas - What do they think is going on - Heart attack?

Function - How is this affecting their life? Use this question to understand why this issue is so important to them

Expectations - What do they expect from you? Use this question to help find a solution in the scenario

Once you have calmed her down and reassured her, I would say something like: I know you might be worried about this, but I'm happy to see that you are feeling better. Do you think it would be ok if I had one of my colleagues take over your care? 

And then negotiate you leaving form there.

But first priority is making her feel safe.

Hope that makes sense!