Jump to content
Premed 101 Forums

Need Advice On How Not To Sound Patronizing On Mmis


chronicconic

Recommended Posts

Hi everyone. I would like some advice on how not to sound patronizing towards certain groups of people - especially minors - in the MMIs. For instance, I would say, "this 12-year-old patient does not possess the capacity to make his own decisions, as they may not have reached the level of maturity to plan ahead and grasp long-term consequences" in my response. I've received comments that this sounds particularly patronizing and possibly paternalistic.

Link to comment
Share on other sites

Hi everyone. I would like some advice on how not to sound patronizing towards certain groups of people - especially minors - in the MMIs. For instance, I would say, "this 12-year-old patient does not possess the capacity to make his own decisions, as they may not have reached the level of maturity to plan ahead and grasp long-term consequences" in my response. I've received comments that this sounds particularly patronizing and possibly paternalistic.

 

Personally, I don't think your response comes off that way- I suppose that it would also come down to how you delivered it, though, and what the context is. You might consider changing your wording to something like "the 12-year-old patient *may* not possess the maturity to make his own decisions", which acknowledges the possibility of this being an unusual case or there being extenuating circumstances. Anyone else?

Link to comment
Share on other sites

Hi everyone. I would like some advice on how not to sound patronizing towards certain groups of people - especially minors - in the MMIs. For instance, I would say, "this 12-year-old patient does not possess the capacity to make his own decisions, as they may not have reached the level of maturity to plan ahead and grasp long-term consequences" in my response. I've received comments that this sounds particularly patronizing and possibly paternalistic.

Agree with the comment above, you can try to use relative instead of absolute terms. The delivery is also a huge part of it, make sure you are speaking slowly and calmly. Finally, just an aside, don't underestimate the ability of young patients to understand things! Although they may not be the final decision makers, always, always, always make sure that they are informed and take into account their ideas and feelings at all times.

Link to comment
Share on other sites

I agree with the comment above. Delievery is everything.

However, I do see why some people think your answer sounds patronizing. I don't know the full context, but maybe you could add some nuance by saying that while 12 years-old can take some short term decisions, this specific one will have a huge impact. This is why it is maybe best if their parent (I assume?) decides for them. You could also highlight the value of the kid's input. Even if he's not the final decision maker, his opinion still matters. 

Link to comment
Share on other sites

Thanks for your comments everyone. I may say something like,

 

"Although children may lack the capacity and maturity to make long-term decisions, I think it would be worthwhile to explore this child's maturity by a thorough discussion with him and his parents. It is important not to generalize and to assess children on a case-by-case basis when allowable. As often as we can, we should encourage children to participate in the delivery of their own healthcare."

Link to comment
Share on other sites

I was at one of the public consultations on physician-assisted dying recently, and one woman stood up to speak about her little boy who died at age twelve after battling bone cancer for several years. She described said he was diagnosed at age 9 and had been through the chemo and the radiation, but now he was in palliative care. They had an excellent team, but his pain could not be controlled. He was not going to get better and they talked about death and dying. He wanted to die. His mom said it was clear to the whole health care team that he completely understood what that meant and absolutely had the maturity and capacity to make that decision. Of course no one was legally able to help him with that request at the time and he continued to live in pain. She told her story as part of an argument for capacity assessment, rather than a strict age limit, for access to physician-assisted dying.

 

That's an extreme example, but sometimes it is helpful to know a story that illustrates an uncomfortable concept, like allowing minors to make health care decisions.

Link to comment
Share on other sites

I was at one of the public consultations on physician-assisted dying recently, and one woman stood up to speak about her little boy who died at age twelve after battling bone cancer for several years. She described said he was diagnosed at age 9 and had been through the chemo and the radiation, but now he was in palliative care. They had an excellent team, but his pain could not be controlled. He was not going to get better and they talked about death and dying. He wanted to die. His mom said it was clear to the whole health care team that he completely understood what that meant and absolutely had the maturity and capacity to make that decision. Of course no one was legally able to help him with that request at the time and he continued to live in pain. She told her story as part of an argument for capacity assessment, rather than a strict age limit, for access to physician-assisted dying.

 

That's an extreme example, but sometimes it is helpful to know a story that illustrates an uncomfortable concept, like allowing minors to make health care decisions.

 

Thanks for sharing your story. According to a CMAJ article on bioethics I read, some provinces mandate a discrete age cut-off for decision-making capacity, while others rely purely on professional judgment.

Link to comment
Share on other sites

"Diplomacy is the art of telling somebody to go to hell in a way that he will look forward to the trip."

- anon

 

Don't get hung up on words and phrasing.  Focus on tone of voice, body language and delivery.

 

 

 

/Full disclosure - never did an MMI.

I could agree with this. I highly speculate my dismal MMI performance last year was mostly due to my body language.

Link to comment
Share on other sites

Practice talking in front of a mirror. Actually say these things out loud. Then you'll know you look, and how you sound.

 

Find someone who is charismatic and watch how they phrase things, and how they move their hands and pause in their delivery.

 

It's never a bad idea to sound confident, but that you've also put some thought into it, with deliberate pauses.

Link to comment
Share on other sites

Thanks for sharing your story. According to a CMAJ article on bioethics I read, some provinces mandate a discrete age cut-off for decision-making capacity, while others rely purely on professional judgment.

true but you don't need to know any of that for an MMI - that isn't the point of the question. You have to avoid trying to figure the "correct answer" based on rules simply because those are the rules - there is no single correct answer.

 

So you can say you are aware there are various definitions of capacity - but what would you do with what you know currently? How would you approach the problem? Would you default to rigidly following some rules? Is there room for more :)

 

Their feedback is very useful. I mean you want to go beyond not just sounding paternalistic - you actually want to not BE paternalistic or patronizing. No matter how you phrase "I won't grant this person autonomy because of their age" you are going to sound like you are imposing your position on them, and you will be graded accordingly (as in not in a good way). You can look thoughtful, phase, have the right tone.....blah, blah. So what? The content is also being examined. This is deeper than just superficial expression.

 

When people above are changing the words from "doesn't" to "may not" that is beyond just softening the expression. That is a completely different position.

 

The only way to get around that is to actual start with the assumption that they can actually make that decision - and try to prove otherwise by assessment. You have to assume everyone understands their personal situation better than you can or ever will until that is shown not true. Then, almost in desperation, you turn to a guardian/caregiver etc to help make that decision. Your gut reaction on a fundamental level should be one of extreme discomfort at overriding anyone's choice.

 

To reinforce the point kbinners made when I was doing rounds with patients - even young ones - you really learn just how much variability there is in comprehension. I have seen 8 year olds that have wisdom I wouldn't assume 80 year olds had - those patients teach you things in ways that cannot be described by mere words. I have also seen people make amazingly "silly decisions" - honestly right now I am dealing with the effects of one such patient from my call shift on Monday whose choice is resulting in an agonizing death I wouldn't wish on anyone (there are a lot of ghosts to carry around in medicine). Still processing that. It is a strange and big world.

Link to comment
Share on other sites

true but you don't need to know any of that for an MMI - that isn't the point of the question. You have to avoid trying to figure the "correct answer" based on rules simply because those are the rules - there is no single correct answer. 

 

So you can say you are aware there are various definitions of capacity - but what would you do with what you know currently? How would you approach the problem? Would you default to rigidly following some rules? Is there room for more :)

 

Their feedback is very useful. I mean you want to go beyond not just sounding paternalistic - you actually want to not BE paternalistic or patronizing. No mater how you phrase "I won't grant this person autonomy because of their age" you are going to sound like you are imposing your position on them, and you will be graded accordingly (as in not in a good way). You can look thoughtful, phase, have the right tone.....blah, blah. So what? The content is also being examined. This is deeper than just superficial expression.

 

When people above are changing the words from "doesn't" to "may not" that is beyond just softening the expression. That is a completely different position.

 

The only way to get around that is to actual start with the assumption that they can actually make that decision - and try to prove otherwise by assessment.  You have to assume everyone understands their personal situation better than you can or ever will until that is shown true. Then, almost in desperation, you turn to a guardian/caregiver etc to help make that decision. Your gut reason on a fundamental level should be one of extreme discomfort at overriding anyone's choice.

 

To reinforce the point kbinners made when I was doing rounds with patients - even young ones - you really learn just how much variability there is in comprehension. I have seen 8 year olds that have wisdom I wouldn't assume 80 year olds had - those patients teach you things in ways that cannot be described by mere words. I have also seen people make amazingly "silly decisions" - honestly right now I am dealing with the effects of one such patient from my call shift on Monday whose choice is resulting in an agonizing death I wouldn't wish on anyone (there are a lot of ghosts to carry around in medicine). Still processing that. It is a strange and big world.

 

well said!

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...