By Jeremiah Fleenor, MD, MBA, author of The Medical School Interview: Secrets and a System for Success
To make a goal of comfort or happiness has never appealed to me; a system of ethics built on this basis would be sufficient only for a herd of cattle.
-Albert Einstein (1879 – 1955)
I was recently asked by an applicant how to approach ethical questions asked during an interview. His concerns about answering this type of question echoed those of many other applicants. In light of this common woe, I’d like to share a simple three-step approach for handling interview questions regarding ethics. You’ll be happy to know reasonable answers are probably easier to frame than you think. Further, interviewers are often as nervous about asking ethical questions as you are about answering them!
Abortion, euthanasia, stem cell research, and pharmaceutical “perks” are super-charged topics currently facing physicians and our health care system. It is a truly scary proposition to be asked about your stance on such issues, especially in the glare of an interview. When your goal is to make a good impression (and not rock the boat), it can be hard to share your views on these sensitive topics. What’s an applicant to do?
I suggest the use of three concepts to help guide your responses:
- Realize a correct response is one which falls within a fairly broad range; in other words, there is not necessarily a right or wrong answer.
- Be consistent in your remarks.
- Always answer with a patient-focused approach.
Normal or Extreme?
It may come as a shock, but as long as your belief about a particular ethical issue is within a fairly wide spectrum of “reasonable” it doesn’t really matter what it is. We are entitled to have our own opinions regarding controversial issues. The majority of the nation may view an issue one way – you may hold the opposing opinion. That’s okay. The key to this concept is as follows:
“It doesn’t matter what you believe as much as why you believe it.”
Most often applicants feel a strong urge to try and tell interviewers what they think they want to hear. Ethical questions usually concern sensitive, emotionally charged subjects. In the pressured setting of an interview, nobody wants to create tension. So it’s easier to simply mouth the popular view, or to try and discern views of the interviewer and espouse those. This, however, can be a very dangerous practice. (Please see the following section for further details).
Simply spend time [before a given interview is to take place] figuring out what your views are on current ethical dilemmas. Think about why you hold these views. After all, your beliefs are just an extension of who you are as an applicant and future physician. Incorporate them into the overall package you are presenting to the admissions committee. This will allow you to be who you are and will help facilitate a genuineness that is so important to success in the application process.
A quick note. The idea of reasonable or normal can be a little slippery but I like to think of it in terms of a bell shaped curve: you can probably hold a view that is within two standard deviations from the “mean” of public opinion on a topic and be within the norm. However, a view in the third standard deviation from the mean would likely be thought extreme. This approach isn’t absolute but provides some guidance.
In hopes of determining whether an applicant is really saying what they believe, an interviewer will often ask two seemingly different moral questions and see if the applicant answers the same way, or changes his/her stance. What’s worse, these questions can come back to back, making it all the more deceptive. Therefore, it is imperative not to tell the interviewer what you think he wants to hear. Now that you know that you are entitled to have reasonable opinions, simply answer questions sincerely and consistently.
It’s Always About the Patient.
A patient-focused answer is the cornerstone to any ethical question response. Remember, as a physician (soon to be), your purpose is to take care of patients. The very nature of the job is to help someone else. Regardless of your personal stance on stem cell research or abortion, your views should have the patient’s best interest in mind. Having this understanding will prove valuable during an interview and in daily practice. As I struggled through ethical dilemmas in my own practice, a mentoring physician once told me, “Do what’s right for the patient and you’ll never go wrong.”
In the End
The drive of ethical questioning is to determine whether you have thought about common dilemmas facing physicians. The questions are not designed to trip you up. The committee must determine if you have a reasonable approach for dealing with these challenging issues. You can have your own opinions on controversial matters. However, they must be reasonable, a true extension of who you are as a person and focused on the best interests of the patient.
Please view the approach I’ve presented here as a place to start. Preparation for ethical questions is best accomplished by discussing the issues with your friends and professors. Share your ideas with others as a reality check. Compare your views to those who feel differently. Become educated on as many different sides of an issue as possible. This will allow time and opportunity to strengthen your arguments and become comfortable talking about sensitive issues.
Please email your medical school interview questions to
Dr. Fleenor at [email protected]