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Geriatric Physician Interview
Questions

25 Questions and Answers by
| D. Leo is a retired Physician and Health Educator. He has also served on Admissions Committees for Medical School and Residency Programs. As a retired Physician, he enjoys writing and helping students prepare for their medical interviews.

Question 1 of 25

If you were to receive a communication from the Executive Committee about a practice issue of yours that it seems could have clinical repercussions, how would you address the members when meeting with them?

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Geriatric Physician Interview Questions

  1. 1.

    If you were to receive a communication from the Executive Committee about a practice issue of yours that it seems could have clinical repercussions, how would you address the members when meeting with them?

      This is more than just hospital policy, but a challenge to your clinical authority, which is traditionally up to the physician alone. Therefore, this can be upsetting. It is a question of how you handle personal challenges to your privileges. Even if you're right and they're wrong, you have to show you're willing to be a good sport about the whole thing.

      D.'s Answer

      "Prior to my meeting, I would research the literature about what I was doing in this particular practice, be it off-label prescribing or using protocols not considered to be evidence-based. My authority allows for some latitude. If in researching this, I discover a serious problem that justifies their concern, I would report that I have learned from this and will not be repeating the practice(s) of concern. If I found that I can defend the practice based on my research, I would make my case but tell them I will abide by their decision on this."

  2. 2.

    If your patient is terminal and is at home with Hospice in terrible pain, how do you feel about medicating him or her for pain relief if you know it will hasten death?

      This is really a commonsense question disguised as a dilemma. It isn't really a dilemma though, and it is asked to see if you know the difference between 'above all, do no harm' and 'do what is needed'.

      D.'s Answer

      "In the case of someone who is at home dying, I have the responsibility to keep him or her comfortable, even if that means providing medication that could shorten life. Pain is harm, and 'do no harm' should therefore mean to not allow unnecessary pain or any pain at all, especially if such treatment will not change the ultimate result: death. For a terminal patient, death is inevitable, whether it is today or tomorrow. What matters most is if there's agony for another day until their inevitable death."

  3. 3.

    If you’re on a rotational call for indigent patients or patients without a doctor, how would you feel about having to see a patient in the ED whom you had dismissed from your practice?

      This is a test of your willingness to comply with policy. Most physicians have dismissed patients from their practice for failure to pay or a failure in compliance. If you're fulfilling an obligatory role and a dismissed patient is assigned care by you, you have to accept it.

      D.'s Answer

      "Although I would not choose to see this patient electively, I would follow policy and accept him or her without any personal asides to the patient. If the patient chose not to accept me as his or her doctor for this episode, I would call the Patient Advocate and arrange a consultation with the patient to remedy the conflict."

  4. 4.

    How would you handle a family member who disagrees with the intentions of your patient’s Advanced Directive?

      This question tests your attitude towards advanced care directives. You need to follow the law. If the patient is/was competent at the time of the advanced directive, that plan remains, despite whatever a wife, child, or pastor may choose that conflicts with the patient's wishes.

      D.'s Answer

      "I educate all of my patients on the use of advanced directives and follow the law, even when a family member disagrees with the patient's 'do not resuscitate' wishes or the opposite. This may not make everyone happy, but it's a dedication to my patient's wishes that cannot be breached."

  5. 5.

    How would you handle a problem in which Utilization Review wants you to discharge a patient who you feel isn’t medically ready for discharge?

      This pits you against the hospital to come up with a solution for everyone's benefit. UR actions are usually based on dollar issues, protecting the hospital bottom line from insurance denials.

      D.'s Answer

      "If I felt it would be dangerous to send a patient home, I would write a note of necessity for continued admission, on medical grounds, so that UR could submit it for approval from a third-party payer. If the patient just wanted to stay for their convenience, I would explain that he or she has satisfied criteria for discharge, but I would also offer home health follow-up, if the patient or family desired and it were allowed/authorized.?"

  6. 6.

    How do you feel about telemedicine?

      Since the COVID-19 pandemic, telemedicine is probably here to stay, and everyone--including hospitals and groups--is looking for ways to incorporate it in a fiscally prudent way. You should be seen as ready to embrace it, not blindly, but thoughtfully within the parameters of what is considered good medical care.

      D.'s Answer

      "To me, the difference between telemedicine being appropriate or not is a function of Signs-vs-Symptoms. That is, I require a patient's physical presence and an exam to document signs that are applicable to the chief complaint, but symptoms are a different matter. If the patient is established with me and I am familiar with his or her case, I can discuss and manage symptoms or medications via telemedicine. If the patient is seeking an initial appointment with me, I would need to see him or her before relegating appropriately to telemedicine protocols."

  7. 7.

    Would you be willing to accept whatever electronic medical record process is in use here?


      This question is asked as another test of your willingness to comply with policy. You should feel comfortable complying with all policies of the organization to which you are applying.

      D.'s Answer

      "Of course. If I am part of this group/hospital, I want to be all in and that includes my compliance with all the protocols."

  8. 8.

    If you were to see a peer disrespecting an elderly patient or doing or saying something inappropriate, how would you respond?

      This isn't your problem to fix. You can't go wrong answering this question by saying you would go up the chain of command. A hospital or group wants something like this handled a certain way, especially with the patient's whole family watching, and their best assurance that this will happen (when you're involved) is to pledge yourself to that chain of command, i.e., up the ranks to department chairman, Executive Committee, administrator, etc.

      D.'s Answer

      "First, I would make sure I saw or heard correctly. I would then either confront him or her discretely to resolve it--versus reporting it up the chain of command--if I felt it compromised patient care, would reflect poorly on the hospital/group, or be unethical, immoral, or illegal."

  9. 9.

    Do you feel a DNR advanced directive patient should take up a spot in the ICU?

      This is an interesting philosophical question, especially with the recent COVID-19 pandemic, during which ICU resources were scarce or in jeopardy. The question is designed to test if you avoid the temptation to alter your care for one patient, based on the needs of many. You can't go wrong putting your patient first--always!

      D.'s Answer

      "A DNR order does not preclude my patient's admission to an ICU spot, if he or she were to need intensive care. Intensive care is for more than just survival--it is also for recovery when feasible and even comfort. Regardless of the needs of an entire demographic or the infectious environment in progress, I will still make my decisions based on how my patient will be best served."

  10. 10.

    If a patient with severe dementia has two equally authorized persons disagreeing with management, e.g., two children or two siblings, how will you decide whose directives to follow?

      In these days of advanced care directives and powers-of-attorney, unusual scenarios are going to happen, no doubt. This question is asked to demonstrate your logic, if such an unusual scenario were to occur. The logic here is that you won't tolerate indecision in a case of two disagreeing persons, neither of whom is the sole authority. You will, however, do what's best for your patient, re-assuming the care in the spirit of the advanced directive.

      D.'s Answer

      "I educate all my patients to have an advanced care directive, because it is good for everyone. I also encourage only one person being named the highest--if not the only--authoritative person, if the advanced care directive doesn't specify a particular course of action. In this case you present, if the directive doesn't specify care in a particular instance and there is no one authority, but two who are in disagreement, then it is I who will direct care."

  11. 11.

    Many people, especially family members, feel that their loved one requires intensive care. What is your feeling regarding placement, if the patient doesn't actually require this?

      There is a fiscal reason for not over-treating patients--especially the elderly, for superfluous care may not be reimbursed by third-party payers, especially Medicare. Your answer should reflect a sensitivity to this.

      D.'s Answer

      "I don't plan to admit any patient to any environment in which it will do no more good than a more basic setting. That being said, I won't hesitate to take an ICU spot for my patient who requires it."

  12. 12.

    How is your attendance at general staff and department meetings?

      Running a group or a hospital, unfortunately, requires significant bureaucracy. The doctors are needed to make that run, which means taking responsibility for the clerical drudgery involved. This means meetings--lots of meetings. And they're always at night or during office hours, which can cut into your income. Note that the question doesn't ask whether your attendance will be good, but how it has been in the past. This implies that your answer may be verified by a phone call or two, so tell the truth. (Most likely, no one will be checking up on your answer, so even if you've been truant in the past, pledge to do better.)

      D.'s Answer

      "I may have missed meetings from time to time--usually due to my being occupied in clinical duties or vacation. However, I realize how important the business of the hospital/group is, and will make every effort to improve my attendance."

  13. 13.

    What would be your response to hearing a code being called in the middle of the night as you’re getting ready to go home after attending a patient?

      This is a no-brainer question. Of course you would respond. It is tempting to assume that certainly someone else would be there to respond, and that is typically true, but you don't want to be seen as the type of person who would need to hear the code called repeatedly before you responded.

      D.'s Answer

      "Unless managing a clinically unstable situation or in the middle of a procedure, I would respond, and then only drop out if others were whom I felt were more qualified to attend the code."

  14. 14.

    Would you be willing to serve on a committee investigating an issue with one of your colleagues?

      Internal affairs and investigation are just necessary. Things happen, and when patient care is affected or jeopardized, they must be explored and dispositions made so that they don't recur. Besides Joint Commission accreditation and insurance reimbursements, a public reputation is jeopardized by uncorrected omissions or errors in care. The interviewer wants to know if you'll have the courage to step up and do what's right.

      D.'s Answer

      "There is no easy answer for this, only a difficult one: yes, I would have an obligation to do what's right when it comes to patient care and safety, even if that means possibly being resented by a colleague. If it were a close personal friend being targeted by the investigation, I would ask to recuse myself, but I would be prepared for that not to be granted. The only thing I would want is to not be the only one making a judgement--having more than one investigator, I feel, is necessary to take politics out of such an inquiry and give it additional objective credibility."

  15. 15.

    How timely is your practice to sign off on chart entries and make all of your dictations current? Have you ever been suspended from a staff for failure to do these?

      This type of suspension is not a 'hard' suspension, per se: it doesn't mean there are any deficiencies in your medical care or expertise. Most physicians get a little behind from time to time, the only thing lighting a fire under them to get these clerical loose ends tied up is often suspension. Although this is frowned upon but not necessarily condemned, it does impact the hospital or group's bottom line, so the question is one of fiscal importance.

      D.'s Answer

      "Although I've been occasionally remiss in keeping all sign-offs and dictations current, I feel it is important for me to be diligent in keeping current. It is not lost on me how reimbursement by third-party payers can be affected by incomplete charts. Just as important--to me--is the need for accuracy, and attempting to remember specifics from a procedure or rounds can become spotty if too much time has passed. For these reasons, I agree that keeping current is important and strive to do that."

  16. 16.

    Tell me about yourself.

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  17. 17.

    Are there any substance abuse, domestic violence, or other background items that could impact the integrity of our hospital/group?

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  18. 18.

    Are you going to be doing any chronic pain care?

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  19. 19.

    What invasive procedures are you planning to do?

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  20. 20.

    Do you have any personal problems with our seeing or assigning you indigent or “charity” cases?

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  21. 21.

    If you’re not available, due to illness or vacation, for example, how will your patients be cared for?

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  22. 22.

    Here we have a policy of _______. Do you have a problem with that?

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  23. 23.

    Do you have any lawsuits currently or in the past, including any settlements?

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  24. 24.

    What can you bring to our group/hospital?

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  25. 25.

    What is it about this group/hospital that makes you want to be a part of it?

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