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Old 01-16-2011
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Medicolegal and Ethics When to refer a patient to specialist in USMLE exam cases?

Hi guys,
I have a question.
when to refer a patient in the exam to a specialist or to other doctor as I remember it should never occurred , right?
or there is Exceptions?
thanks
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Old 01-16-2011
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I disagree Never

Dr.Daughtery from Kaplan live lectures advised NEVER refer a patient in USMLE exam. he said there r no exceptions, but if there r any i also what to know
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Old 01-16-2011
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That's what I learn from him too but the problem is that when I did NBME forms there were referral things ....so what to choose in real exam?
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Old 01-16-2011
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On the Step1 in an ethics question you never ever refer. Thats what I've always heard.
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Old 01-16-2011
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Quote:
Originally Posted by ashishkabir View Post
On the Step1 in an ethics question you never ever refer. Thats what I've always heard.
This is almost true in all cases, but may be there's an exception. In case you don't want to do a legal abortion procedure, you still have to refer the patient to another healthcare professional who will do it.
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Old 01-16-2011
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Originally Posted by Haisook View Post
This is almost true in all cases, but may be there's an exception. In case you don't want to do a legal abortion procedure, you still have to refer the patient to another healthcare professional who will do it.
I think for the exam you should NEVER refer. You are expected to always provide treatment and make decisions that are free of your personal beliefs. I don't think your exception is ethically valid.
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Old 01-16-2011
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Warning! The 'abortion' issue is debatable.

Quote:
Originally Posted by Shibtag View Post
I think for the exam you should NEVER refer. You are expected to always provide treatment and make decisions that are free of your personal beliefs. I don't think your exception is ethically valid.
You are right, but abortion is a special case.

During President Bush's administration:

Quote:
President Bush's Rights of Conscience Act proposed stronger job protections for doctors and other health care workers who refuse to participate in abortions because of religious or moral objections.

Health and Human Services Secretary Michael Leavitt said that health care professionals should not face retaliation from employers or from medical societies because they object to abortion.

"Freedom of conscience is not to be surrendered upon issuance of a medical degree," said Leavitt. "This nation was built on a foundation of free speech. The first principle of free speech is protected conscience." - Link.
But, President Obama has been working to repeal this in an attempt to protect women's rights for medical care regarding this procedure. This new law still does not enforce healthcare professionals to perform abortions, but no longer protects them from losing their employment or getting sued.

Quote:
According to Dr. David Stevens in a January 12 interview on Moody Radio , the new Health Care Bill only guarantees that insurance companies can't sue health care workers. The health care workers are still left in jeopardy of law suits by individuals and being fired from their jobs for refusing to distribute abortive drugs or refusing to perform an abortion. This may also apply to refusing to assist patients in suicide, or refusal to prescribe end-of-life drugs in Oregon and Washington where assisted suicide is legal. - Link.
The debate is still ongoing, but my previous post fact stemmed from a question in UW for Step 2 CK that I had just come across.
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Fair enough, if that's the law. Perhaps in the real world you can refuse to do the procedure and refer.

But for the sake of the exam, forget about the law - you aren't being tested on this. The questions are testing your understanding of basic ethical principles. So the correct answer in the exam is the one that is ethically best, and not neccesarily what you would do in real life. In the case of abortion, in the the exam, I think the correct answer will be to do what the patient wants.
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