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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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  #1  
Old 10-17-2011
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Default Endocrine

A 65-year-old Hispanic woman has been treated successfully for diabetes over the past 5 years by a combination of dietary management and prescription medication. Today, at a routine monitoring visit, the examination finds nothing out of the ordinary and you tell the patient “everything looks good.” “I was wondering what you would say,” the patient replies with a smile, “because I have not taken the medication you prescribed for the past month, and I feel fine.” She says that she is still watching her diet, but in place of the prescribed medication, she is taking an herbal remedy suggested by a local bruja. At this point, which of the following is the best response?



A.

“Tell me more about why you decided to make this change.”


B.

“Well, what you’re doing seems to be working. Let’s monitor you carefully and have you back in here for a checkup in 2 weeks.”


C.

“What exactly is the herbal remedy you are taking?”


D.

“You are taking a big risk and I recommend that you go back to taking your medication at once.”


E.

“You have been lucky this month, but it is important for you to take your medication as I prescribed it to maintain your health over the long term.”
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  #2  
Old 10-18-2011
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my option s ans C. encourage d pt to tell abt herbal medications. den oly wen gv proper councelin. bt m nt 100% sure.. ans pl.
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  #3  
Old 10-18-2011
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A.

“Tell me more about why you decided to make this change.”
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I'm Predictable In The Unpredictable Future !
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  #4  
Old 10-18-2011
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the ans is C ask about the remedy in detail.
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Old 10-18-2011
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Default Answer

The correct answer is A. Before jumping to any conclusion, gather more information. Find out why the patient made this decision and what prompted her action. Clearly the patient did not feel comfortable discussing her decision to stop taking her medication with the physician before acting. This suggests some breakdown in the trust of the physician-patient relationship that should be explored and addressed. As a general rule, be accepting of folk medicine practices unless it is reasonable to suspect some probable harm or danger. A nonjudgmental tone is all-important. Notice with this reply the physician has not decided yet whether the patient’s action is harmful or actually may be acceptable. It is possible that dietary control is sufficient and she no longer needs to be on the prescribed medication.
Choices B and D are premature and close down a necessary discussion. The physician needs to find out more and explore why the patient did not say anything before stopping her medication.
Asking detailed questions about the herbal remedy is inappropriate at this time (choice C). Getting a sense of how the patient is thinking and why she took the action she did is more important.
This implied threat may well express the physician’s actual belief, but chides the patient rather than exploring with her why she acted as she did (choice E). Get more information before making pronouncements.
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