The “Fundamental Four” Rules of Doctoring Questions on Step 1

Just by following these 4 rules you should be able to narrow it down to 1-2 answers on most doctoring questions.

1. Anything that sounds the least bit rude, insensitive, or unprofessional should be ruled out right away. This rule alone will eliminate a couple answer choices for a lot of these questions.
2. Any option that includes referring the patient to another provider, referring patients to another source of information, or seeking legal/ethical consult is wrong. All of the questions given are things you need to be able to figure out yourself.
3. Always try to get more information from the patient. Don’t jump to diagnostic tests or treatments before you have the full picture. Get a complete history first.  Whenever there is an option like “tell me more about_____” or “Why do you feel that way about ______” it is usually right.
4. Any statements centered on the physician are wrong. Don’t bring your beliefs, desires, or feeling into the answer.  Answer choices need to be focused on the patient and their family.

 

 Approaching Emotional (Worried, Angry, Upset…) Patients

Do’s:

• Do acknowledge the patient’s feelings and empathize with them
• DO ask about what has them worried/angry
• DO apologize for any mistakes you or your staff made to upset the patient

Don’ts:

• DON’T tell the patient to calm down or to stop worrying
• DON’T ignore the patient’s feelings
• DON’T blame any mistakes or problems on other healthcare workers

Dealing with Non-Compliant Patients

Do’s:

• DO ask the patients why they did not or could not follow the treatment plan
• DO ask the patient what their understanding of the treatment plan is
• DO give patients more information about the treatment plan and address any misconceptions with clear directions
• DO ask if there is anything you can do to help make following the treatment plan easier

Don’ts:

• DON’T blame the patient for non-compliance (more than likely it is the fault of the provider)
• DON’T adjust the treatment plan based solely on 1 case of non-compliance (like giving a drug because the first attempt at a lifestyle change was unsuccessful)
• DON’T make any assumptions of lack of competence or psychiatric disorders based solely on non-compliance
• DON’T threaten a patient with any consequences of being non-compliant

 

Motivational Interviewing (Encouraging Lifestyle Changes)

Do’s:

• DO ask the patient how interested they are in making the lifestyle change
• DO ask the patient what they know about the subject
• DO ask the patient about past attempts and expected road blocks to success
• DO ask the patient about the concerns related to the lifestyle change

Don’ts:

• DON’T spout out facts or numbers on why they need to make a lifestyle change
• DON’T threaten patients with the negative consequences that will arise if they don’t make a change

 

Approaching Religious/Cultural Beliefs and Alternative Medicine

Do’s:

• DO be respectful of a patients beliefs even if they are different than your own
• DO acknowledge the importance of these beliefs to the patient
• DO allow patients to seek alternative remedies in conjunction with their prescribed treatment as long as those interventions do not interfere with their medical treatment

Don’ts:

• DON’T base a psychiatric or neurological diagnosis on something that could be related to religious beliefs or cultural practices
• DON’T feel obligated to share or participate in a patient’s religious belief if you do not share those beliefs

 

 Dealing with Family/Friends in the Exam Room

Do’s:

• DO ask family members to leave the room if they are answering the questions themselves and not allowing the patient to be heard
• DO ask parents to leave the room to have private interactions with teenage patients
• DO talk to the patient in private if there are any signs of potential abuse or neglect

Don’ts:

• DON’T ask the patient if they want their family members present while the family members are in the room

 

Now that you have finished the last section of Behavioral Sciences for the USMLE Step 1 you should check out the Biochemistry section.