Multiple

Mini-stations
Interviews
(MMIs) Guide
From DRTP MMIs Previous recalls
2021 Edition

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 Contents
- Previous MMI questions
- Ethics Review
o Ethical principles
o Confidentiality
o Competence and capacity to make decisions
o Advance directive
o End of life issues
o Reproductive issues
o Organ donation
o Malpractice
o Doctor / Patient relationship
o Doctor / Industry companies
o Doctor /doctor relationship
o Child abuse
o Elderly abuse
o Spouse abuse
- Answer structure
- Example

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 Previous MMI Questions
Ethical Decision Making
Patient autonomy
- Patient came to ER wit asthmatic attack, senior resident went to examine the
patient didn’t allow, the clinician agreed, what do you think?
- You are working in rural area. Patient with intestinal obstruction comes to
you, he wants you to do the surgery, you don’t know how to do it and you
want o refer him, he insist on that
- Health care worker supplied for job. He must take the flu vaccine. He doesn’t
want to take it. What will you do now?
Patient consent/ privacy
- In a research, Mr x was suggested to give blood to study genetic material. It
was written in the consent form “the donor will not be liable for any financial
or patentship of study” what should you discuss here?
- Teacher asked the patient to take off her shirt to examine her breast, later he
called the student and told him to examine the patient after examination he
left the room. What is your opinion regarding the scene?
- Girl 15 year old bleeding needs life saving surgery and blood transfusion.
Mother refusing blood transfusion
Patient’s requests/ concerns
- An athlete who is training for the Olympics admits that he is using anabolic
steroids and asks you to monitor his liver function. He would prefer to be
under your care, as you are his family physician and you know his history.
However, he states that if you do not agree, he will go to a walk-in clinic.
Discuss the ethical issues in this case
- Your patient come to you for follow up and he tells you that he read some
information in internet regarding his drug and found some information which
you didn’t mention to him. How to handle the situation

Medications refusal/ Alternative Medicines

- You are a family physician seeing Jane, a 67 year old woman with recent
history of multiple fragility fractures. You diagnose her with osteoporosis and
prescribe some bisphosphonate drugs and other pharmacological treatments.
Jane tells you that she heard some good things over the internet about
alternative medicine, and she is adamant on trying these as well. You are
concerned about the use of these alternative medicine treatments and the
possible negative effects they could have on Jane’s health. How would you

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 handle the situation and what would you recommend Jane do? Discuss any
ethical considerations that are present
- Mother came with a child having asthma, developed cough. You treated with
medication but mother said it didn’t work and she gave a herbal tea. It worked
for baby. What is your opinion
- Diabetic patient doesn’t want to use hypoglycemic medications instead she
want to use herbal medicines. How will you explain to her
- Dr Smith recommends homeopathic medicines to his patients. There is no
scientific evidence or widely accepted theory to suggest that homeopathic
medicines work, and Dr. Smith doesn’t believe them too. He recommends
homeopathic medicine to people with mild and nonspecific symptoms such as
fatigue, headaches, and muscle aches, because he believes that it will do no
harm, but will give them reassurance. Consider the ethical problems that Dr.
Smith’s behavior might pose. Discuss these issues with the interviewers
Gift acceptance
- Case if you can accept gift from patient
- Pharmaceutical company insist on you to write ACE inhibitors instead of
Beta blockers for hypertensive patients
- Case if you can Accept gift from pharmaceutical company
- Pharmaceutical company arranged a lecture regarding new drug in another
country and offer you to participate in the lecture. They booked hotel and pay
for all your expenditure. Will you accept
Palliative care
- Doctor Mahmood made a group of doctors who heal by touch. What do you
think about this attitude
Patient safety
- Old lady comes to you. You suspect her being abused and beaten by her
husband. What will you do?
- A couple is treated in the clinic. The husband tells you that he will kill his
wife. What will you do?
- Child abuse
Local policies in certain medical situations
- A patient comes to you with a cardiac arrest and family ask you not to do
CPR. What will you do?
- Your friend’s father is ill. She thinks that no treatment is required as the
outcome is death. She wants your advice
An old man with end stage disease comes to you saying that he wants to die.
He has no family and lives alone. What will you do?
Abortion

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- Female sterilization
Critical thinking
1. A message that recently appeared on the Web warned readers of the dangers
of aspartame (artificial sweetener – Nutrasweet, Equal) as a cause of an
epidemic of multiple sclerosis (a progressive chronic disease of the nervous
system and systemic lupus (a multisystem auto-immune disease). The
biological explanation provided was that, at body temperature, aspartame
releases wood alcohol (methanol), which turns into formic acid, which „is in
the same class of drugs as cyanide and arsenic.‟ Formic acid, they argued,
causes metabolic acidosis. Clinically, aspartame poisoning was argued to be a
cause of joint pain. numbness, cramps, vertigo, headaches, depression,
anxiety, slurred speech and blurred vision. The authors claimed that
aspartame remains on the market because the food and drug industries have
powerful lobbies in Congress. They quoted Dr. Russell Blaylock, who said.
„The ingredients stimulate the neurons of the brain to death, causing brain
damage of varying degrees.‟ Critique this message, in terms of the strength of
the arguments presented and their logical consistency. Your critique might
include an indication of the issues that you would like to delve into further
before assessing the validity of these claims.
2. You are presented with a list of 15 individuals, including details of their age,
sex and occupation. You are being told that a nuclear attack is imminent and
you are only allowed to save 5 of them from destruction. Which ones and
why?
3. Epidemic break out, save 3 people only
4. If you would like to boost up your energy will you take any pills offered by
your friend in order to achieve that ?

Problem Solving and conflict Management

1. Patient pass away and the relative shouting and fighting that it was your
fault. How will you handle the situation
2. You gave the Wrong medication to a patient, he died. Family want to go to
court. What do you tell them, is it your fault or seniors?
3. You hit a car, the owner of the car is angry. How do you tackle this?
4. Angry patient
5. Baby wit heart failure came to you, you want to give 0.1 digoxin but you
forget to put the decimal. The nurse gave 10 mg dose and the baby died,
what you will do now and what is your next step
6. If one of your colleagues did a medical error that affected the patient, what
will you do?
Communication skills (acting)
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1. Parking Garage (Communication Skills) The parking garage at your place
of work has assigned parking spots. On leaving your spot, you are
observed by the parking attendant as you back into a neighbouring car, a
BMW, knocking out its left front headlight and denting the left front
fender. The garage attendant gives you the name and office number of the
owner of the neighbouring car, telling you that he is calling ahead to the
car owner, Tim. The garage owner tells you that Tim is expecting your
visit. You enter Tim‟s office
2. Your friend Jason hasn't come to class for a few days. Being a
hardworking premed student, he very seldom skips classes. You know that
he is applying to medical school in the past several weeks. You called his
house and he said you can visit him. You decided to pay him a visit after
your classes. Enter the room and talk to Jason (in the exam his name was
Ali) 
3. You and your best friend try out for the varsity track team. You just find
out you got in, but your friend was rejected for the 3rd time. Enter the
room
4. Couples come to your clinic for checkup because they are going for
mountain trip, husband found to have high blood pressure. How will you
tell him that it is dangerous to him if goes to the trip
5. You are employer. Your employee dresses poorly, what will you do?
6. Lady comes to you for the 3rd time worrying anout misscarriages. CTG
done and it was normal. What will you do
7. Patient investigation confirm that he has cancer. He come to you with his
daughter. He doesn’t understand your language very well, but his daughter
knows, will you accept his daughter as translator
8. A patient comes to you he cant speak your language, what would you do?
Current healthcare & societal issues
1. Preferential Admission (Knowledge of the Heath Care System): Due to the
shortage of physicians in rural communities, it has been suggested that
medical programmes preferentially admit students who are willing to
commit to a 2 or 3 year tenure in an under-serviced area upon graduation.
Consider the broad implications of this policy for health and health care
costs. For example, do you think the approach will be effective?
2. Deterrent Fees (Knowledge of the Health Care System) Recently, the
Prime Minister raised the issue of deterrent fees (a small charge, say $10,
which everyone who initiates a visit to a health professional would have to
pay at the first contact) as a way to control health care costs. The
assumption is that this will deter people from visiting their doctor for
unnecessary reasons. Consider the broad implication of this policy for
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 health and health care costs. For example, do you think this approach will
save health care costs? At what expense? Discuss this issue with the
interviewer (in the exam they a cost of 50 dirhams I guess)
3. There is a saying “medicine will reach its peak, then preventive medicine
will be prevailing” in order to help this medical field reach this level, what
would you do?
4. What will you add in Dubai to promote awareness?
5. How will you make people in your community aware about risk of
obesity, smoking and their relations to heart problems
6.
Standard interview Questions/ Uncategorized Questions
1. Why do you want to be a physician? Discuss this question with the
interviewer
2. What is the biggest accomplishment of your life? What is the biggest
disappointment?
3. Describe your experiences with physicians. What traits would you and/or
would you not emulate?
4. You work in emergency department and you feel so sleepy and board.
What will you do to keep yourself awake
5. you are a resident. You just finished your shift you are very tired. There is
shortness of staff in the AE department. Will you go and help them?
6. How will you change emergency department to be more active
7. what do you know about stress management?
8. You got very tired and always have a lots of patient in hospital. How will
you cope
9. How to conduct a research
10. What is the importance of money, how will it affect your decisions?
11. If you were to make a movie. What would be your topic, what will be your
role?

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 Ethical Principles
The following four principles are those used in biomedical science to guide
decisions:
- Beneficence: it means that you must act in the patient’s best interest.
- Non-maleficence: You must not harm your patients. It is important to
remember that many treatments may actually harm the patient (e.g. through
side effects) but what you need to keep in mind is the balance between
benefit and harm.
- Autonomy: The patient has the right to choose what they want (i.e. whether
to accept or refuse treatment).
- Justice: Patients must be treated fairly. This principle deals mainly with the
distribution of scarce resources and is particularly relevant when dealing
with expensive drugs or procedures.
Ethical dilemmas:
It is because of clashing two or more ethical principles. For example, a Jehovah’s
Witness refusing a blood transfusion will cause a clash between:
- Beneficence – transfusing is the best option to manage the patient
- Non-Maleficence – not transfusing may result in the patient’s death
- Autonomy – the patient can choose what they feel is best for them
The net result:
- If the patient is competent, Autonomy always prevails over Beneficence and
Non-Maleficence, i.e. the patient can do what they want with their body
whether you think it will benefit them or harm them.
Local Guidelines:
Not always applicable in UAE, the issue will be raised to the most senior
consultants, then an agreement will be issued

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 Confidentiality
Breaching patient confidentiality
Although patient confidentiality should be protected, there may be instances where
it needs to be breached, some of which may be relevant to your daily practice:
1. Sharing information with other healthcare professionals or others involved in
the care of the patient
2. Using information for the purpose of clinical audit
3. Disclosures required by law: such as notifying a communicable disease
4. Court order
5. Disclosures to a statutory regulatory body: When investigating the fitness to
practice of a health professional
6. Disclosure in the public interest and to protect the patient or others from risk
of serious harm or death; There may be cases where the benefit to society far
outweighs the harm to the patient caused by the release of information:
 In extreme cases of HIV patients knowingly infecting others
 An epileptic driver who continues to drive
 Any case of very serious abuse where the victim is at serious
risk of harm or death, even if they are a competent adult
 Notifying the presence of a sex offender
 A patient who is a doctor placing patients at risk through a
medical condition (e.g. a surgeon with Hepatitis C).
7. Treatment of children or incompetent adults: This may happen when a child
comes to see you, is not competent enough to make a decision, but is asking
you to keep their visit confidential (the same would apply to any
incompetent adult). In the first instance, you will need to negotiate with the
patient to convince them to involve an appropriate person. If they refuse,
then you may need to involve a third party anyway but only if you
consider that the treatment is essential and in the patient’s best interest
8. Abuse or neglect of an incompetent person: e.g. child or elderly abuse, or
abuse of a patient with a mental illness

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 Competence and capacity
The difference between competence and capacity:
- Competence is a legal judgment e.g. who
understand the information and are capable Mental capacity
of making a rational decision by themselves
- Capacity: This is a medical judgment. The assessment of mental
capacity should be made in
Capacity is formally assessed by doctors and
accordance with the Mental
nurses who must be sure that a patient is able Capacity Act, a patient is
to understand the proposed management, to considered to have capacity if he:
comprehend the risks and benefits and to
o understands the information
retain that information long enough to make provided in relation to the
balanced choices e.g. “capacity to consent” decision that needs to be
or “mental capacity” made
o Is able to retain the
information
o Is able to use and weigh up
Informed consent: the information
o Informed consent is the agreement, granted by a o Can communicate his
decision, by whatever means
patient, to receive a given treatment, or have a possible
specified procedure performed on them, in full
consideration of the facts and implications
o Consent can be verbal or written
You should get written consent:
1. For complex or more involved procedures
2. If there are serious risks involved
3. If there are potential consequences for the patient’s employment, social or
personal life
4. when providing clinical care is not the primary purpose of the investigation
or procedure
5. When the treatment is part of a research or innovative programme
6. For procedures where written consent is required by law (such as organ
donation or fertility treatment
Who should take patient’s consent?

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The person who is most knowledgeable about the procedure should obtain
informed con sent. Because we must inform the patient about all the options of
treatment, risks of the options, and risks of not performing the procedure in a
language the patient can understand, the consent must be obtained by a person
qualified to make the explanation

Dealing with a patient who lacks capacity

The doctor should take account of a wide range of issues, including:
1. whether the patient has signed an advance directive stating how he wants to
be treated in situations when he can’t give informed consent
2. The views of any individuals who are legally representing the patient or
whom the patient has said they wanted to involve
3. The views of any individuals who are close to the patient and may be able
to comment on their beliefs, values and feelings (e.g. their relatives)
4. Whether the lack of capacity is temporary (e.g. the patient may be
temporarily unconscious) or permanent.

Competence in psychiatric patients

- A patient's psychiatric history is intrinsic to the concept of competence and
to the patient's capacity to understand her medical problems
- A patient with the clear capacity to understand or one who clearly does not
have capacity does not need a psychiatric evaluation. However, a psychiatric
evaluation can be useful to help make a determination of capacity in
equivocal or questionable cases.
- All suicidal patients are considered to lack capacity to understand because of
their active suicidal ideation is deemed to be a sign of impaired judgment

Capacity to Refuse Procedures in an Otherwise

Mentality Disabled Patient
- A patient with mental illness or mental retardation that might be considered
incompetent for other areas of life may still retain the right to refuse medical
procedures.
- The criteria to determine competence in areas of finance are at a higher
standard than those for refusing medical procedures.

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 - Your patient might have schizophrenia, mental retardation, or autism to the
point of needing to live in a group home, but that does not mean they are
incapable of understanding medical procedures.
- This means that an adult with a mental age of 8 or l0 nay still be allowed to
refuse medical procedure

Competence / capacity in children

Adolescent patients are capable of participating
and guiding their medical therapy. The extent of
each patient’s ability will depend on the
developmental maturation of the patient. Child competence age
In US : 18 and above
In general, parents retain the responsibility to
direct care for patients less than 18 years of age In UK: 16 and above with some
unless there is disagreement about the course of considerations

therapy
Parental Rights to Guide Care:
Parental rights:
o Society has given the right of making medical care decisions to parents
because they are viewed as uniquely capable of determining the child’s best
interest.
o This included authorizing treatments AND refusing treatments (even life
sustaining treatments).
Limitations to parental rights:
o If the parents’ actions appear not to be in the child’s best interest, the
parents’ rights can be challenged.
o You have the ethical responsibility to advocate for the patient if you believe
the parents’ actions are imminently dangerous, neglectful or abusive
Clinical applications “Jehovah Witness in Pediatrics”
Means: refusing blood transfusion based on religious grounds.
Action in pediatrics age group:
- If the child’s needs blood to save his life, you must give blood even over the
objection of the parents, it seems contradictory to seek parental consent for a
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 procedure that you will perform even if they refuse, but in this case, you
should attempt to obtain their permission nonetheless
- Withholding lifesaving therapy for a child is considered “child abuse”
- The parent’s right to practice their religion in terms of health care would
cover their ability to refuse transfusion for themselves, but not for their
children

Special considerations:

As a caregiver for pediatric patients you should be able to define the following
special categories of patients:
Emancipated Minor:
There are specific categories of adolescents who are legally capable of directing
their medical care. The categories include:
1) Married,
2) Pregnant/parent,
3) In the military,
4) Self-supporting.
Mature Minor:
Courts can grant decision-making capacity to minors; this may be limited to
specific categories of care or in some cases of chronic illness when the
PHYSICIAN case determined that the patients is capable of informed consent.
Types of Permissions in Pediatrics
As a caregiver for pediatric patients you should be able to define the difference
between:
Informed requires that the patient be competent to make health care
consent decisions, physician disclosure of relevant information,
patient understanding of the information and a voluntary, un-
coerced patient decision
Parental Parents give permission for therapy provided to their
permission children. The same standards and procedures for giving
informed consent to a competent patient apply.

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Child Assent Helps patients acquire a developmentally appropriate
understanding of her condition, telling the patient what he
can expect for the treatment, assessing the patient’s
understanding of the situation, including determining
whether they fell pressured to accept/reject the treatment.
It also includes soliciting the patient’s willingness to undergo
the procedure (you can see how this is probably a team effort
with the parents!). This approach is not limited to adolescent
patients but is appropriate for ALL pediatric patients

Consent when dealing with emergencies in the clinical

setting
o If a patient is competent at that time and needs a procedure, you should seek
consent, even if only verbal.
o If the patient is not competent and you cannot determine the patient’s
wishes through the relatives or other sources, then you can treat them
without their consent, on the condition that the treatment that you administer
is limited to what is immediately necessary to save their life or prevent a
serious deterioration of their condition.
- The guidelines also specify that the treatment you provide must be the
least restrictive of the patient’s future choices.
- If the patient regains capacity, you should explain what was done.
- For any other treatment beyond the strict minimum, you should seek
consent from the patient.

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 Advance Directives:
An advance directives: is the method by which a patient communicates his wishes
for his health care in advance of becoming unable to make decisions for himself.
- The advance directive is a byproduct of the success of medical therapies such as
the mechanical ventilator that can keep a patient alive when in the past he
would have died. Because of these therapies, doctors are now in the position of
trying to determine what each patient wanted for himself in terms of his health
care.
- The advance directive is part of the concept of autonomy.
Health-Care Proxy
The two most common forms of advance directives are:
1. The living will
2. The health care proxy the health-care proxy or “medical power of attorney"
is the durable power of attorney for health-care decisions or medical proxy:
it remains in effect even after the patient loses decision-making capacity
because of medical illness
- The proxy is not there to give his personal opinion as to what he thinks should
be done for the patient. The proxy is there to communicate the patient’s original
wish’s in order to ensure that they are carried out.
- In the absence of an advance directive there is a list of relative importance in
terms of surrogate decision makers. You should start first with the spouse, then
parents, then adult children, then siblings, then friends. This is an
approximation only.
- If the family is split in its wishes there is no easy solution. When the family is
split and there is no proxy, you must refer to the ethical committee or the court
for a judgment

Informed refusal (AMA letter in DHA “against medical advice”)

- If a patient refuses therapy it is not sufficient to say that the patient was a
competent adult who had the ability to refuse therapy.
- The patient must be fully informed of the effects and possible outcomes of
refusing therapy including all the harm that could occur if the patient still
refuses then there has been no malpractice
- He/she must be sign in informed refusal letter
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 End of life issues
- DNR: “don’t resuscitate” : it means if the patient dies “ cardiopulmonary
arrest”, doctor doses not perform chest compression, attempt electrical
conversion, or administer acute antiarrhythmic medications
- Artificial nutrition: means feeding using nasogastric, jejunostomy tube
placement
- Hyper alimentation: refers to total parenteral nutrition TPN
o Forcible insertion by anyone of an artificial feeding device into an
adult patient with the capacity to understand the meaning of its
removal is not allowed
- Euthanasia actually means that the health-care worker is prescribing and
administering the method of death
In UAE:
DNR, Euthanasia, termination of artificial feeding or withholding it is not allowed
by law

PHYSICIAN PARTICIPATION IN EXECUTIONS

A physician cannot ethically participate in executions in prisons
The physician's ethical duty to relieve suffering and to protect life supersedes any
ability to participate in the execution

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 Reproductive issues
Abortion in UAE:
Performed in governmental facility: (accepted only in case of)
o Continuing pregnancy pose risk to mum life
o Proven that fetus is abnormal “anencephaly”
o Fetus suffers from serious mutation, incompatible with life or if born
alive would be bad and painful for fetus and the family
- Consent: signed by the mother, husband or legal guardian
- Timing : Only in 1st trimester, before 3 months
- Mutation proven by report: consultant OBG , peds , radiology

Female sterilization in UAE:

Consent from both couple
o Don’t need husband approval only if, pregnancy will threaten mums life
o Don’t need husbands consent if consultants prescribed
3 physicians advise women to tubal ligate, because pregnancy is harmful
Consent must be signed from CEO of the hospital

Organ donation in UAE:

No law about that currently.

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 Reportable conditions:
o HIV
 Encourage the patient to disclose the information the partner
 If refused confidentiality will be breeched by consultant
o Psychiatric/ homicidal risk:
 Breech the confidentiality and Inform the people at risk
When you breech confidentiality: provide the least informative amount of data to
the person who you are reporting to
Communicable diseases in UAE law, and what are the notifiable diseases ?
The resolution has an appendix for the form used to report any communicable
disease, level of isolation at hospitals, and a table on the very dangerous contagious
diseases such as plague, the yellow fever, anthrax, Mad cow disease, Hepatitis type
(B) & (C), HIV / Aids as well as some moderately hazardous diseases such as the
avian flu, cholera, malaria, tuberculosis, measles, whooping cough and tetanus.

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 Malpractice
Definition: preventable error in care of the patient resulting in harm to the patient
- The intent or the level of goodwill of the practitioner is not relevant if harm
occurred
- Physicians must practice according to accepted therapy based on demonstrated
efficacy, because there is certain amount of subjectivity in the care, it is
incumbent upon the doctor to determine what the locally accepted standard is,
and inform the patient about all options in care in order to make a truly
informed choices
- Complications of therapy does not imply malpractice, the main issue in
determining malpractice is whether the patient was fully informed that the harm
could occur and whether or not he was informed of other valid options of
therapy, if he was fully informed and signed consent anyway, then malpractice
has not necessarily occurred

Admitting medical mistakes (Medical Errors)

o A medical error or mistake is a preventable or unexpected outcome of a
medical treatment.
o An adverse event is a side effect that may occur in a certain percentage of
cases that are treated.
o Medical mistakes are usually not due to negligence. They arise from
incomplete knowledge base, an error of judgment, lapse in attention or a
“systems” error.
o You have a professional responsibility as a health care provider to disclose
errors to your patients. Although it is difficult and uncomfortable disclosing
errors, most patient appreciate honesty (wouldn’t you?). Loss of trust usually
arises from nondisclosure of errors
Case approach:
1. When you identify a medical error:
2. Determine the effect (actual or potential) on the patient
3. Investigate/identify possible causes
4. Explain in a calm, unhurried, truthful and apologetic manner that an error
has occurred.

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5. Answer all questions the patient has and be open for additional questions in
the future
6. Provide information about follow up of the incident
7. Accept responsibility and apologize in necessary

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 Doctor/Patient relationship
Gift from patients:
- Small gifts from patient of nominal or modest value are acceptable on the
part of the physician. This is provided that there is no expectation of a
different form of therapy or a higher level of care based on the gift
- Refusing such signs of gratitude would be hurtful to the doctor/patient
relationship if they are a sign of the good relationship with you.

Doctor/ industry companies’ relationship

- How physicians respond to the promotional activities of the pharmaceutical
industry is the subject of ongoing debate and controversy.
- Drug companies constantly surround physicians in an attempt to influence
prescribing patterns. It is ethically acceptable to participate in educational
activities sponsored by the pharmaceutical industry.
- Modest meals are also ethically acceptable.
- Although the speaker may accept a cash honorarium for preparing and giving
the lecture, it is not ethically acceptable for members of the audience to accept
direct monetary payment for participating.
- Hence, it is ethically acceptable to attend the lecture and the meal, but not to
accept a check for cash for the participants
- Sample drugs are alright, because they can distribute those to those who are in
need who can not afford the medication
- But some companies use gifts as a form of bribery to compel you into
prescribing their medication.
- They evaluate how much profit you make and in return you receive a gift this is
ethically unacceptable.
- Small gifts like stethoscopes, hammers, things for educational purposes or for
the benefit of the patients is acceptable.
- Doctors must not let drug companies influence their prescribing habits.
Treatment must always be given to benefit the patient, not a drug company.
Always bare in mind the patients best interest.
- When making decisions about investigations or treatment doctors are advised to
consider the most appropriate medication based primarily on clinical suitability,
bearing in mind the cost effectiveness of the treatment. Although some
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 treatments may be extremely effective, their price may limit their use since it
would be unjust to allocate a large portion of money to one individual

Doctor /Doctor Relationship

Reporting impaired physicians
- If you know that another physician is not functioning normally and may be a
danger to patients, the privacy of the physician is less important than the
safety of his patient’s.
- This is true whether the impairment is from substance abuse, psychiatric
disorder, Alzheimer’s disease or emotional disturbance
- Report to the lowest local authority

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 Child Abuse
Caregivers’ legal responsibility:
- Physicians who care for children have a legal obligation to report suspected
child abuse.
- It is your responsibility to determine whether the abuse occurred, what person
may have perpetrated the abuse or any other specific details.
- There are often complicated social interaction and caring for abused children is
a team effort. We work with nurses, social workers, other physicians and child
protective services as a team to help determine what happened.
- If you do NOT report it and you suspect it you are legally liable.
Do
- Be vigilant about this issue
- Be non-judgmental—just because you suspect abuse doesn’t mean it
happened OR you know who the abuser might be.
- Be honest about what you see with the parents and ask for their explanation
of your findings.
- Discuss your observation with your faculty supervisor (senior)
- Clearly document what you see and what you are told
- You SHOULD NOT disclose your concerns to the family before discussing
this with your supervisors.
- Discussing these issues is the faculty/attendings responsibility
- Reporting child abuse is mandatory even if suspected
- To child protection services / Wedema Law
UAE law in Children's rights
“Federal Law No. 3 of 2016 concerning child rights, also known as Wadeema's
Law, stresses that all children must be provided with appropriate living standards,
access to health services, education, equal opportunities in essential services and
facilities without any kind of discrimination. The law protects children against all
forms of negligence, exploitation, physical and psychological abuses.
In addition, smoking in public and private vehicles and indoor facilities where
children are present is also prohibited under the law. Violators will be subject to
penalties as set out by the law.

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The law allows childcare specialists to remove children from their homes against
parents' wishes and without judicial permission in cases of imminent danger. In
less severe cases, specialists may intervene by visiting the child regularly,
providing social services and mediating a solution between the family and the
child.
Those who put children in danger, abandon them, neglect them, leave them without
supervision, do not enroll them in school or register them upon their birth will be
subject to a prison sentence or a fine or both. The law applies to all children up to
the age of 18.”
 ‫هذا نصا القانون‬

Elderly Abuse
To report to adult protective services
- Reports made in good faith can be done without liability to the reporter.
- The circumstances with elderly abuse are less clear r than with child abuse,
because the elderly person is often a still competent adult who may object to
the report of the abuse on the basis that they are afraid of repercussion in the
home or the loss of the home.

SPOUSAL ABUSE
- The ethics surrounding spousal abuse are somewhat different from child and
elderly abuse because you are dealing with competent adult and you cannot
report against her/his wish
- Many victims are not in the position of leaving the relationship or reporting
abuse for the fear of worse abuse, so you cannot report to anywhere without
victim’s consent

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 Answer structure in any MMI question
1. Collect information using ICE method
2. Provide wide range of solution without preferring one over the other
3. Apply ethical principles whenever appropriate

Algorithm for any Ethical Question

Collect information ICE method:
 I = Idea “explore patient’s idea about the X
drug or management”
 C = Concern “ explore patient’s fears and
concerns”
 E = Expectations “ explore patient’s
expectations”

Solution Start with I will follow the local rules

Keep my senior updated with the case

Apply ethical Assess patient capacity/age

principles
If I followed autonomy principle I will …..
If I followed beneficence principle I will ….
If I followed Non Maleficence I will …

Alternatives Think outside the box

Provide solution that are not related directly to the
question but it may help

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 Example
15 years old girl with nose bleed requires blood transfusion, mother refuses, what
to do?

Collect information ICE method:

 I = Idea: ask the mother about the reason for refusal”
 C = Concern “ any previous experience of blood
transfusion, afraid of having contaminated blood”
 E = Expectations “ can we get blood transfusion from
the family”

Solution Start with I will follow the local rules

Keep my senior updated with the case
Apply ethical principles Assess patient capacity/age
Child is minor < 18 years, if emergency I will transfuse the
blood since no consent is needed, If not urgent I can still give
blood since she is minor, but of course I have to respect mother
wish, for that I will let her have a talk with my senior to
convince her since the condition if not urgent
If still she refuses, then I will follow my local rules which says
that …….(mention the law if present, here you can say about
Jehovah witness) …..
If I followed autonomy principle I will ….. respect mother wish
If I followed beneficence principle I will ….transfuse
If I followed Non Maleficence I will … transfuse

Alternative Ask for family donation

Give her iron supplement if it will help
Consult ENT to treat any organic cause

Note:
This example is very simple, you can expand your answer so by that it will fit in 8 minutes (since
station time is 8 minutes)
I tried not to provide more examples so that you will have the chance to think and make your
own

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Tips not to miss:
 Think always outside the box
 Protect yourself and your answer by saying “ I will ask for my senior help”
or “ I will follow the local rules”
 Don’t be races to any point of view
 Remember that there is no wrong answer, Examiners are trying to know
your critical thinking skills and if you are safe doctor.

Exam day tips:

 Exam will be approximately 8 stations, 2 resting (may differ)
 Read the question carefully before entering to the station
 If you didn’t understand the question, Ask the doctor for more explanation
about the case
 Start the station by summarizing what you have understood from the
question, so the doctor will correct you if you miss understand any point
 Relax, relax, and relax
 Be confident.

The End
Best of Luck

Contact details:
[email protected]

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