Demonstrating Personal Integrity During Your PA School Interview

During the PA school interview process, you will be asked a handful of ethical questions.  These questions are designed to evaluate your professional and academic integrity, as well as your sense of morality.  These questions are a way to see how you would react in situations that challenge your ethical standards, and generally place you in an uncomfortable scenario.  In these scenarios, you’ll likely have to balance your emotional response, moral code, and understanding of what a PA can and cannot do when providing care.

Here’s a perfect example of an ethical question:

“Let’s assume its five years from now and you’re a practicing PA in an emergency room.  You’re managing several patients at this particular time during your shift.  A pediatric case comes in with an allergic reaction.  As part of your treatment, you order prednisone, a corticosteroid.  The order is picked up as you check on another patient. As you walk by the treatment area where your pediatric patient has been placed, you notice the nurse is giving the prednisone to a child in the treatment area next to your patients. The medication has just been administered to the wrong patient! How do you manage this situation?”

Let’s break down the facts of this scenario:

  • You just witnessed a patient getting the wrong medication
  • Since the patient is a child there are potentially special considerations of the effects of the medicine
  • Because the patient is a child, you are not dealing directly with the patient but most likely a parent or guardian (who will not be happy with you)
  • You will have to address a situation where a colleague you work with everyday has made a medication error
  • You have to consider that the ER attending physician is responsible for everything that goes on in the ER
  • You have a responsibility to each person in this scenario

Don’t worry if the situation described above makes you nervous.  The solution is actually very simple as long as you can remove emotion from the equation.

You may be inclined to not get the nurse who administered the medication in trouble because they are a close co-worker or friend. On the other hand, you may want to place the entire blame on the nurse in an attempt to shift any responsibility away from yourself. Friendship and professional perception may be important, but your ethics should override any attempt to hide or suppress what happened in order to “save face”.

Rather than placing the blame entirely on the nurse or pretending like they had no involvement, consider approaching this situation as a team.  You should speak with the nurse and offer them an opportunity to go to the attending physician with you.  Let the nurse explain it if they wish and let the attending make the call as to who informs the child’s parent or guardian.

The attending may want to handle the situation personally or may want you and the nurse to do it as a team. Remember, you have a responsibility to both the patient and the attending physician, so letting your attending make the final call is a better choice than making a snap judgement on your own.

Once you determine how communication should be made, consideration should be made as to any potentially harmful effects of the administered medication.  Medical countermeasures should be taken if necessary to reverse any ill effects.  Finally, an in-service should be done reviewing the situation to determine if there are measures that can be implemented to avoid this from happening again.

A primary part of the Hippocratic Oath is “above all, do no harm”, so keep this in mind when formulating a plan as to how you’d resolve the issue.  While you may think that one approach is correct, you need to look at the situation holistically and isolate all of the facts before you make a plan of attack.  When posed with an ethical question, try your best to make a bulleted list of each person affected by or involved in the situation, and what steps may need to be taken. Once you know what needs to happen, you can come up with an order of tasks (which can actually help you decide what actions you should take in some situations). As long as you approach the situation logically, you’ll be able to answer any ethical question thrown your way!

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