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Medical exam question

Discussion in 'Current Events, World News, & LGBT News' started by silas99, Jul 1, 2009.

  1. silas99

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    OK I sat my exams a couple of months ago (and passed(!)) but there are some questions which appear time and time again in all medical exams. In essence each question stem is a three sentence statement and you have to decide what the most likely diagnosis is. There are patterns that you can pick up on....so for example "An Asian man comes in with a cough" the answer is always TB. Obviously it works on the basis that the vast majority of TB sufferers in the UK are from foreign countries.

    The one question which I have a huge issue is this one: "A homosexual man comes to your GP practice with a dry cough".....answer PCP (otherwise known as a manifestation of Aids).

    One gay boy in the year decided to write an essay in the back of the exam stating the misconception of the question. He has been pulled in front of the dean for misconduct! So what are peoples thoughts on the matter. Should medics be taught to think in stereotype. It would be interesting to hear from any other medics out there.
     
  2. Legnaj

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    25%......Yes, as much as we say we are equal, biology doesnt think so (we are equal by law). Some races and cultures are prone to certain desieases.

    75%.....NO. How are we supposed to look for something when we are dead set on looking for something that might not be there. The body is something that cannot be predicted without gathering up clues first.

    As stereotype is good as long as you keep other opitions open.
     
  3. Chip

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    The MOST important thing is that the diagnosis be made quickly and accurately. As Legnaj says, there are definitely biological differences that increase the likelihood of certain diagnoses, and to the extent that they reflect actual statistical probabilities rather than simply stereotypes, I think it makes sense to teach people to look at the most obvious/likely diagnosis first.

    However, it does seem like the "dry cough" question is probably dated, as, (as far as I know), PCP is less common than it used to be given testing and early detection of HIV, and also given that the people at greatest risk of new infection (at least in the US) include populations other than gay men.
     
  4. littledinosaurs

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    How do you know he is a homosexual man when he walks in?
    I mean yeah you can tell if they are a single race (normally) but sexuality isn't something you can pick up with sight all the time.

    and i agree with Calchip, it's probably dated and just has never been updated.
     
  5. hiker360

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    I"m REALLY confused... i actually had to google all the abrv. and i still don't get what this is about... it better not be racist because ... well actually i am japanese, but its included to asia to soo .... din't be mean:eusa_naug
     
  6. silas99

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    Hi there Hiker. I hope you havent misunderstood the question....it is not intended to be a racist post and I'm sorry if it came across like that to you.

    This is what most got me about the question...how the hell would you know anyway. Not everyone walks around with a big rainbow t-shirt and a stamp across their forehead! And the question is very dated. YES there is a greater proportion of gay men that suffer from HIV in the UK than straight people. However in terms of actual numbers there are many more heterosexual individuals with the condition. Unfortunately the professors who set the exams wont have any of it...and it's becoming quite a big issue among the student body.
     
  7. Chip

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    TB - tuberculosis. A lung disease once common in developed countries that is now less prevalent in the west, but still common in some Asian countries

    PCP - pneumocystis carinii pneumonia, a formerly rare form of pneumonia, found only in immune-suppressed people.

    The point being, if an Asian person comes in with a cough, it's reasonable to assume it might be TB if they have recently come from an area with a high concentration of Asian people... but some people would consider that stereotyping.
     
  8. silas99

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    :thumbsup:
     
  9. Bookmarked

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    It's a tricky question to answer, because frankly, there's quite a few issues involved.

    First, any medical practitioner has to strike up a balance between being reasonable in judgement and avoiding narrowing their diagnosis based on stereotypes. The phrase "If you hear hoofbeats, think horse; not zebra" springs to mind. One has to guess for the most common diseases, while not excluding the possibility of morbidity, or co-morbidity. Essentially, you've got to use Occam's razor, but not cut yourself with it.

    Second; on lifestyle and value judgements. I think that the problem lies in the curtness of the question. "A homosexual patient" doesn't sound quite right. If they had phrased it as "On questioning about relationship history, he mentions a male sexual partner/whatever" that might be better.

    Finally, on the actual disease itself. PCP (We call it Pneumocystis jirovecii in the UK) is something almost universally found in immunosupressed patients.And while it's certainly true that a majority of HIV cases are heterosexually transmitted worldwide, the truth is that homosexual transmission remains the highest method of transmission in the developed world. It's not a slur or an attack to say that statistically, the person most at risk of contracting HIV and AIDS related complications is a young, homosexual male. It's simply a truth that needn't carry a value judgement.

    Essentially, the doctor has to act in the best interest of the patient. If he suspects (from experience and epidemiology) that the patient is at risk of having a serious illness, he has to act on that suspicion. If not, the consequences could be quite dire.
     
  10. silas99

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    I think you made some excellent points in that post Bookmarked. Medicine is very much a talent of pattern recognition. Although I feel sometimes in the UK that we are taught to think within a box, rather than branch out with more lateral thinking.

    Anyway I commented mainly on the homosexual question because actually the overall rates of HIV are more prevalent in heterosexual individuals in the developed world. In terms of proportionality its still higher in homosexuals, however those differences are changing. I dont think that medics should be taught to think that HIV is a condition of gays, because it really isnt the case anymore. It's creating a false stereotype. I think in any individual who undertakes risky sexual behaviour HIV should be in the differential, but I dont think sexuality should be a marker for that.
     
  11. KaraBulut

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    One minor clarification here-
    The fastest growing population of new HIV cases in the US is women of color. They now account for over 25% of new HIV diagnoses. AIDS is the leading cause of death for black women age 25-34 years old.

    This is an important demographic shift and it seldom gets mentioned.
     
  12. Kenko

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    I agree with Bookmarked's points, and the clarifications by KaraBulut.

    Likewise the Asian patient. If the TB problem is because of recently being exposed to it in a country with high levels of the disease, then the question should clarify. I know many people who immigrate from other countries, and never visit their home country. Or they are third generation Canadians and have never visited their "home country". Others are 10th generation European descendant Canadians, that visit foreign countries for business. So the questions could clarify that "The patient mentions having recently returned from a trip to $HOMECOUNTRY$". There are of course some diseases that are more prominent in some races than others simply due to genetic makeup, and in those cases the patient's race does play a part.

    "If you hear hoofbeats, think horse; not zebra" certainly does come to mind. You start with what may be likely / possible.

    Both patients come in with a cough. It could be any number of things, and you're trying to narrow it down as quick as possible. If the Asian patient has a thick accent or something, you might think "maybe the patient recently traveled out of country", so you might first start inquiring about that, and could potentially end up ruling it out.

    Likewise the "homosexual man" may be what some may consider "flamboyant", so you may start questioning on their sex history / known STIs w/e. He may be a virgin, cross that off the list, and it may end up that he recently traveled for work. Likewise a heterosexual female may come in with PCP, but it might not be the most likely given her demographics, so it may take a little longer to reach that conclusion. Doctors don't yet have tricorders, so everything isn't immediately apparent.

    Now I think the test question in question may be a short question, so there isn't necessarily room for all this pontificating.
     
  13. Chip

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    What's funny is, I almost used that phrase in my original response, but couldn't quite remember the exact phrasing. Is that a medical school thing? I can't remember where I heard it, but it certainly seems to apply in this situation.
     
  14. Revan

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    The fact the boy is being held for misconduct is just wrong...Sorry I just don't have enough energy to write a huge thing about why...
     
  15. silas99

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    I know...it really is. It's not because he disagrees with the question its the manner in which he did it. The dean reckons it's not appropriate to write mini-essays on the back of an exam paper. It goes against the attitude and conduct expected of a doctor.

    All of us really feel for the guy and our academic rep is going to be the formal guiding tool to make sure this doesnt tarnish his GMC record, which could potentially happen.