COVID-19

E: Misinformation has been an issue throughout the coronavirus pandemic. What are
some strategies and solutions to curb health misinformation?
Misinformation is a major issue in today’s society. A large proportion of the population
believe in inaccurate statements or conspiracy theories regarding pandemic or related
policies.
Several solutions to curb health misinformation:
1. Teach individuals to learn how to identify and avoid sharing health misinformation.
Most of the time when health misinformation is shared this is not done
intentionally. Educate them that social media posts, blogs, and forums are shared
daily, but not always reliable source of information. Encourage individuals to verify
accuracy of information by checking with trustworthy and credible sources
(credible news media, journal article). If not sure of accuracy, then don’t share.
2. Social media platforms can play a major role in confronting misinformation.
Improve algorithms to detect misinformation. They should mark posts that contain
misinformation, and direct users who read the post to health information from
credible sources. Impose no-tolerance policy for individuals who repeatedly spread
misinformation, remove platforms for content creators who distribute
misinformation.
3. Physicians and other medical professionals: seen as trustworthy by people in their
community, can play a vital role in educating patients and correcting
misconceptions about the virus.
4. Journalists and News Media: ensure that information they are sharing is accurate;
be non-biased in ongoing debate about health topic: should schools remain virtual
during the pandemic (consider both positives and negatives of a health policy); try
to avoid sensationalism/emotionalism in news media.

Overall misinformation is a major problem in our society. Especially true in era of global
communication technology; possible for one person to spread ideas quickly to many
people. Good news is that there are strategies, outlined above, that can be used to fight
misinformation.
 E: Do you think the spread of health information through the internet has been more
of a positive or more of a negative throughout the COVID-19 pandemic? Please discuss
your thoughts.
We live in the era of global communication. Through the internet, it is easy to spread
information to all over the world. However, the ease of spreading health information
has had both positive and negative effects during the COVID-19 pandemic.
Positive: 1. There is a greater ease of access to information. You can find the
information that you need, such as quarantine guidelines, social distancing guidelines,
places to purchase masks, nearest COVID-19 vaccination center. Also, if the info is
public, then anyone who has access to the internet can access this information. On the
other hand, distributing this information through physical means (pamphlets) is costly,
and difficult to spread to a large number of individuals.
2. Patients have access to real-time information. For example, the JHU COVID-19
tracking dashboard allows you to see the number of cases and hospitalizations in your
state real-time.
Spread of health information through the internet also allows you to know the
state/local laws and policies regarding COVID-19 (vaccine mandates, mask mandates,
state of emergency declared etc)
Negatives:
1. Misinformation: Misinformation is a major issue in today’s society. A large number of
social media posts contain misinformation regarding COVID-19. There are content
creators that purposely spread misinformation to a large number of people. A large
proportion of the population believe in inaccurate statements or conspiracy theories
regarding pandemic or related policies.
2. Some privacy concerns. Some COVID-19 patient health information has been leaked
to the internet. Can be difficult to remove this information once its been leaked.

Overall, I do believe that spread of health information has been more of a positive than a
negative during COVID-19 pandemic.
Address the negative consequences: misinformation: technological platforms strengthen
policies to combat misinformation, important to educate individuals to double check the
accuracy of a post before sharing it with others.
Privacy concerns: Make sure health employees are using devices that are secure from
hackers, make sure that data transmitted is encrypted, make sure that employees are
aware of and follow HIPPA guidelines.

E: What systemic health and social inequities have caused healthcare disparities
throughout the COVID-19 pandemic?
COVID-19 pandemic has changed everyone’s lives. Unfortunately, certain populations
have been more affected by COVID-19 than others. During the pandemic, the underserved
population has suffered from higher rate of infection as well as mortality from COVID-19.
Causes:
1. Underserved individuals are disproportionately affected by chronic illnesses. Lack
of healthy diet contributes to cause. This is caused by lack of food security and
underserved individuals not being able to afford healthy food; caused by lack of
availability to healthy foods (food deserts, areas that have limited access to
affordable and nutritious food). Lack of health insurance contributes to cause.
Underserved individuals lack access to healthcare, which leads to lack of treatment
and thus exacerbation of their chronic conditions. Income inequality contributes to
the cause (Underserved individuals have to work at low wages and longer hours to
support their families. This leads to increased stress, lack of time for physical
exercise, lack of time to cook nutritious food, all of this contribute to risk of chronic
disease)
Chronic illnesses contribute to higher rate of COVID-19 mortality (E: kidney
disease, hypertension, diabetes, COPD, obesity etc)
2. Underserved individuals suffer from lack of education and health literacy. They
may struggle to understand information about COVID-19, such as social distancing,
masking guidelines, and COVID-19 vaccinations. They may also be more
predisposed by believing misinformation about COVID-19.

Ways to mitigate health disparities in COVID-19 pandemic

1. Improve access to healthy food in food deserts; governmental programs such as
SNAP (Supplemental nutrition assistance program) can also help low-income
individuals afford nutritious food)
2. Expand access to health care by expanding community free clinics across country
 3. Reduce income inequality by increasing minimum wage and income tax reforms
4. Ensure that COVID-19 information uses short statements and clear language;
expand access to health information in underserved communities.

E: Should there be a COVID vaccine mandate? If so, who’s responsibility is it to create

and enforce a vaccine mandate?
COVID-19 pandemic has caused over a million deaths in the U.S. and trillions of dollars in
healthcare costs. Due to the large impact that COVID-19 has had in our society, there are
certainly talks of having a COVID-19 vaccine mandate.
Pros: Vaccine mandates do increase the rate of vaccinations. The COVID-19 vaccine has
been shown to be safe and effective at protecting you from the virus. Furthermore, even if
you do get the virus, the vaccine protects you from being seriously sick.
COVID-19 vaccine also promotes herd immunity. Herd immunity: Once a sufficient
proportion of individuals are vaccinated, then this prevents outbreak from occurring
which protects the community.
COVID-19 has caused severe shortage of hospital beds, staff and medical resources.
Increasing vaccination rates lead to lower infection rate, which would alleviate burden on
our healthcare system, reduce delays and disruptions in healthcare that covid-19 has
caused.
Cons:
Vaccine mandates are unpopular for a large proportion of U.S. population. If you enforce
vaccine mandates in workplace for example, this may lead to a large number of workers
quitting. This can lead to very negative consequences, especially if the worker is an
essential worker (truck driver; significantly impact transportation of supplies)
Vaccine mandates may infringe upon religious freedoms. Some individuals are against
vaccinations due to certain cultural or religious reasons. (E: against COVID-19 vaccine since
fetal cell lines were used during its development)
Vaccine mandate may exacerbate discrimination against marginalized groups. In the
workplace, if an employee uses religion as the reason for not getting a vaccine, then they
may be discriminated against by his/her employer or coworkers.
Overall, I do believe in a vaccine mandate (with religious and cultural exemptions if a
person sincerely has these beliefs). I do believe that the pros outweigh cons in this case.
E: Should there be mask mandates?
Pros: masks have been shown to reduce the spread of Covid-19. Masks protect the wearer
from being infected with covid-19, and in addiction masks prevent other people from
getting infected (people who are asymptomatic and can spread disease to others)
High proportion of asymptomatic individuals.
In fact, wearing masks is probably one of the best ways of reducing covid-19 transmission
with limited effects on the wearer.
Workplace: not having mask mandates would result in increasing number of people being
infected, more employees stay at home, lost productivity
Schools: more teachers getting sick leads to poorer education. Children get sick would also
impact their education as well.
People feel safer working environment if other people have masks.

Cons: Wearing a face mask may give a false sense of security and may make people less
compliant with other infection control measures. people may move closer together since
masks muffle noise, increase infection risk Solution: Ensure that other infection control
measures are followed such as social distancing.
Another con: some people are opposed to mask mandates; mask mandates political, may
lead to resentment against the employer. Fewer employees want to join a workplace due
to mask requirements

Vaping and E-cigarettes

Q: On September 9, 2021, the FDA said it needed more time to decide whether e-
cigarettes and vaping products can remain in the U.S. market. Do you think e-cigarettes
should be made available to public? Should there be restrictions?
Background: E-cigarettes are devices that simulate tobacco smoking. Instead of smoke
however, the user inhales vaper. The use of e-cigarettes is called vaping. E-cigarettes is
 on the rise, especially among teens. This leads to concerns as to whether e-cigarettes
should be available to the public and what restrictions, if any, should there be on e-
cigarettes.
Pros: Vaping is definitely a safer alternative than regular smoking. Smoke from regular
cigarettes contain many toxic chemicals; however, e-cigarettes produce vapor and not
smoke, so they do not have a lot of these toxic chemicals.
Vaping can help quit smoking, good way to manage nicotine cravings, more effective
than other methods such as nicotine gum or patch.
Vaping also does not produce secondhand smoke. Secondhand smoking is a major
health issue that causes tens of thousands of deaths per year.

Cons: Vaping can still cause multiple health issues. Vaping still contains nicotine, a toxic
and addicting chemical. Vaping causes hypertension, increased risk of heart attack as
well as various lung diseases
Vaping is still addictive since nicotine is addictive. Some researchers suggest that vaping
is even as addictive as smoking!
Vaping use has increased in teenagers. Several reasons for this: misconception that
vaping is totally safe; lower cost to vaping; peer pressure. This is problematic since
vaping can health issues, as well as negative development to teenage brain (impulse
control).

I believe that vaping should be available to the public, but with restrictions. Should only
be used for those 19 and older (18+ because vaping is harmful to teenage brain and
teenagers are not fully mature, 19 because seniors in high school (those that are 18) can
buy and distribute vaping products to younger teens).

Drugs, Recreational Use, Drug Epidemics

E: If you could implement one strategy to curb the opioid epidemic in our community,
what would it be and why?
Opioid epidemic is a major epidemic in the country: hundreds of thousands of people
misuse prescription opioids, thousands of people abuse illicit opioid drugs such as heroin
and fentanyl. This is causing tens of thousands of deaths per year and billions of dollars in
healthcare cost.
Methods to curb opioid epidemic:
Reduce or limit prescription opioids: Prescription Drug Monitoring Programs that allows
physicians to see if patients have received opioids from other providers
Improve photo identification in pharmacies.
Educate physicians on alternatives to opioids for pain medication
Guidelines/laws that limit prescription of opioids to certain amount/week for examples.

Reduce flow of illegal opioids: more funding for law enforcement agencies to track down
drug distributors and traffickers.
Naloxone is a drug that effectively reverses opioid overdose. Having naloxone be available
to first responders as well as high-risk communities and individuals would help reduce the
risk of opioid overdose deaths.
E: What are your thoughts on legalizing recreational marijuana?
Legalizing recreational marijuana has been a very controversial issue in American society.
Over the years, there has been changing public stance over this issue, with more people
favoring legalization of recreational marijuana. Recently, there has been several states
that have decriminalized marijuana for recreational use, however there is still much
opposition. There are many pros and cons to this policy.
Pros:
1. Marijuana arrests account for over half of all drug arrests in the United States.
Most of these individuals leave prison in a worse state since they are exposed to
more serious criminals. Legalizing recreational marijuana would reduce
incarceration rate, which significantly frees up prison resources. It would also
decrease governmental costs of maintaining these prisons.

(Also note that marijuana arrests disproportionally affects people of color. Even
though white and black people use marijuana at roughly the same rate, a black
 person in much more likely to be arrested for marijuana possession on average.
Marijuana legalization would reduce racial discrimination against people of color)

2. Marijuana legalization boosts the economy. The legal marijuana industry already
generates billions of dollars in governmental revenue per year. The revenue
generated by the government can be used towards other things: helping the
underserved community.
3. If recreational marijuana is legalized, then it can be regulated. This helps protect
consumer safety. Buying recreational marijuana illegally from drug deals is risky
because it is not regulated, so consumers do not know if the marijuana is spiked
with toxic chemicals)
Cons:
1. Marijuana is addictive, and there are health consequences of ingesting marijuana.
Ingesting marijuana increases risk of heart attacks and stroke.
2. Marijuana legalization would increase teenage use of this drug. Marijuana is
especially for minors since the brain is not fully developed until the mid 20s, and
marijuana has been shown to adversely impact brain development.
3. In states where recreational marijuana is legalized, several research papers have
shown that legalizing marijuana increases car accident and fatality rates. Legalizing
marijuana would not only harm user but also community as well.

E: (Follow up to above question): How does legalizing marijuana impact a physician’s

present ability to write out a prescription for ‘medical marijuana’?

Mental Health

E: Especially because of the coronavirus pandemic, mental health issues – including

anxiety and depression – are increasing at a rapid rate in the United States. How do you
think we can tackle the mental health epidemic in the United States?
R: improve access to mental health resources.
-high cost of mental health care: improve insurance coverage for mental health issues.
Medicare and Medicaid are insufficient for covering all mental health issues. Having free
emotional health clinics for individuals who otherwise would not be able to afford mental
health care.
-lack of mental health care providers; encourage more people to seek career in providing
mental health; recruiting psychiatrists, but also psychologists, therapists and social
workers as well.

Destigmatize mental health

Public stigma around mental health; many Americans are worried that other people will
have negative perceptions of them. Worried that employers know, then they would not
be employed.
Encourage influencers and celebrities to talk about their mental health issues
Make mental health a more frequent conversation topic between medical professionals
and patients, between employers and employees.
Provide better accommodations for mental health in workplace: someone with ADHD may
receive written feedback instead of oral feedback due to their difficulty in following
multiple instructions.
Encourage employees to take days off if they have mental health issues.

Physician’s Rights (and Physician’s Health)

E. Burnout is a very real possibility in the medical field. What do you think we should do
to prevent physician burnout?
Increase efficiency of patient care through teamwork between physicians and other health
professionals: improving communication and teamwork skills between nurses, medical
assistant, physicians. Hiring other trained hospital workers who can ease burden of
physician workload: ED scribes.
Improve work hours: impose restrictions on number of hours worked per week,
restrictions on number of hours worked continuously, overall let physicians have more
flexibility on the work schedule.
Emotional Support: organize more support groups for physicians; more funding for
physician mental health; spread awareness and reduce negative biases about these
services in the workplace.
Physician burnout is “a combination of physical and emotional exhaustion that can lead to
reduced effectiveness
Physical burnout is caused by overwhelming workloads, long-hours per week, increasing
demands of the number of patients that needed to be seen,
Emotional burnout is caused by psychological stress caused by seeing patient suffering
and death can lead to emotional exhaustion and physician burnout
Burnout is bad for physicians, as proven by increased alcohol and drug misuse rates, not
to mention suicide. Burnout is also bad for your patients because it is associated with
lower quality of care, lower patient satisfaction, higher physician turnover rates, and
increased chances of medical errors.
21. Is it ethical for doctors to strike? If so, under what conditions?
Doctors have stress environment; physician burnout; lead to health issues for doctors
(including drug-abuse; risk of heart disease and stroke, increasing rates of depression and
other psychiatric disorder). Lead to decreased quality of patient care; having doctors strike
would lead to better working conditions for doctors that would lead to less physician
burnout, benefit both doctors and patients.
Doctors striking could also be due to law or policy that doctors would perceive to harm
patients. In that sense, doctors striking could lead to reversal of that policy which can
benefit patients.
Doctors are essential employees; without doctors, healthcare system would significantly
negatively affected. ED physician striking. Particularly relevant today. One oath that
Hippocratic oath which states among other things to do no harm. Going on strike would
violate the Hippocratic oath.
I do believe that physicians are able to go on stroke, they should do so by first exhausting
all other avenues of negotiation; they should try, if possible, limit the negative effect on
patients.

E. In 2007, the American Family Physician Journal published an article exploring the
issue of physicians as role models, using a scenario in which an obese physician is
offering nutrition and exercise counseling to his obese patient. According to the author’s
research, patients have more confidence in health-counseling advice from non-obese
versus obese physicians, and physicians with poor personal lifestyle habits are less likely
to counsel patients about a healthy lifestyle. Based on these research findings do
physicians have a responsibility to act as healthy role models to their patients? Please
elaborate.
The trust that patients have for physicians is crucial for effective patient care. In several
studies such as the 2007 one, it has been found that patients have more confidence in
health counseling advice from non-obese as opposed to obese physicians. Due to these
studies, some people believe that physicians have a responsibility to act as healthy role
models to their patients, while others disagree that physicians have this responsibility.
Overall, I think there are merits to both arguments.
Pros: It has been shown by many research studies that individuals who have an outward
appearance of good physical health are more trustworthy. (This is true not just for medical
profession: most celebrities who achieve fame are fit and good looking; in a beauty salon,
stylists who are physically fit and well-groomed receive higher satisfaction from their
customers). Thus, physicians who practice good personal habits and are physically healthy
are most trustworthy.
Physicians who practice healthy lifestyle and are physically fit provide better care for their
patients. Physicians who suffer from medical conditions such as obesity, or engage in
unhealthy behaviors such as smoking, are more fatigued and have poorer psychological
health, which can negatively affect patient care.

Cons: It may be very difficult or out of physician’s hands to practice these healthy
behaviors. Some physicians work long continuous hours in stressful conditions, which
means that they don’t have the opportunity to practice healthy behaviors such as getting
enough sleep, healthy eating or physical exercise. There is a high rate of physician burnout
due to the stressful nature of the job and poor working conditions.
Some people argue that physicians have the right to be unhealthy. In the U.S, we value
our personal freedoms, including the right to engage in unhealthy or dangerous behaviors.
Furthermore, I think it is unclear as to how much unhealthy behaviors should be tolerated.
For example, if physician occasionally splurges on pizza in the hospital break room, should
that be tolerated? How much unhealthy food can a physician eat per week? If you try to
be too restrictive, then you are taking personal rights from physicians.

Overall, I do believe that physicians bear some responsibility for engaging in the healthy
behaviors they inform to their patients. However, we need to be careful not to put too
much responsibility, since you are taking personal rights away from physicians. In addition,
we need to introduce reforms to improve physician work conditions, reduce burden on
physicians, improve physician mental health and reduce physician burnout.
E. The nursing workload is a significant problem that needs to be addressed. Often
nurses find they do not have adequate time to complete the tasks that are required of
them in the time given each shift. How does this impact patient care? What are the
implications for the nurses and the work culture and environment? What are the
potential policy changes that can help alleviate some of this workload pressure?

Vaccinations
E. What are your views on mandatory vaccinations within the public school systems?
Benefits: Vaccination is extremely safe, very few individuals also have adverse reaction to
vaccinations.
Vaccinations are also very effective for many serious illnesses (such as measles, mumps,
rubella, smallpox, polio etc); without vaccinations, we would have a greater risk of
children dying from these diseases. Note that pros outweigh cons even for less effective
vaccines such as flu vaccine
Vaccines saves time and money. It costs a lot less time for parents and money for
government to maintain the vaccine than the medical costs associated with treating
individuals who have the disease.
Herd immunity. Sufficient proportion of Population is vaccinated against a contagious
disease, then it is unlikely that an outbreak of the disease will occur. So having a child
vaccinated will not only help protect person, but also their classmates and teachers as
well.
Disadvantages:
Mandatory vaccines infringe upon personal choice as well as religious freedom. Some
vaccines are developed using human fetal cell lines. Some vaccines are derived from
animal products. Some individuals are against this method either for religious or moral
reasons.
Certain individuals that do not have adequate access to health services (the underserved),
and may not be able to get the mandatory vaccinations they need.
Small chance of adverse reactions and death; some individuals are more vulnerable than
others; Guillen Barre syndrome from flu vaccine: person's own immune system harms
their body's nerves.
E: A biotech company was hired by the Military to develop a cure for Ebola. They
successfully developed a vaccine to treat the symptoms of the virus and lowered the
mortality rate for infected patients. Discuss the implications of this on a global scale.

Alternative Medicine
E. What are your views on alternative medicine?
Alternative medicine is basically a medical product or practice that is not part of standard
medical care. This includes Herbal Remedies, massage, acupuncture, Chiropractic
medicine.

Pros: Alternative Medicine practitioners generally offer greater personal attention to their
clients as opposed to traditional physicians. Traditional physicians in particular are
pressured for time either by insurance companies or by number of patients in the clinic.
Natural substances like herbs and oils, alternative medicine is gentler than traditional
medicine and typically doesn’t cause side effects that damage your body.
Treatments are also less expensive than traditional medicine counterparts.

Cons: Minimal scientific research. When it comes to scientific proof, evidence is still
limited. Evidence that these alternative medicine therapies actually work is limited.
Not useful in emergency cases. Many traditional medical therapies work in emergency
cases;
No Regulation. Alternative Medicine isn’t approved by the U.S. Food and Drug
Administration. Poor quality control standards (doses between herbal remedies may be
variable); possible harms of alternative medical therapy is not evaluated.
Harmful effects of using alternative medicine and conventional treatments
simultaneously; harmful interactions are not well researched; many traditional physicians
are not familiar with them.

Alternative medical treatments some benefits; some therapies that are effective for
certain medical conditions; advantage of being less expensive, not as toxic as traditional
therapies. Unfortunately, most of them treatments are not well researched and
effectiveness is unknown. More regulation and research on these treatments necessary.
E: How would you advise patients who are interested in visiting an acupuncturist or a
chiropractor?
E: A Kootenay town runs a health-collective that provides various alternative and
traditional forms of medicine. The physicians there encourage parents of small children
not to vaccinate their children. Discuss the positive and negative impacts of this opinion.

End of Life Care

E: When is it appropriate to participate in the assisted suicide of a patient? Why or why
not?
E. The American Medical Association (AMA) describes medically futile treatments as
those having “no reasonable chance of benefiting the patient.” Even when it is clear that
continued medical interventions for a dying patient will be futile, it is not easy to stop a
determined family from insisting that care for a patient be continued. In some states,
futility laws authorize doctors to overrule the patient's family. Do you believe that a
physician should have the authority to overrule a family’s wishes if treatment is
medically futile? Discuss your opinion with the interviewer.
E: How would you treat a patient who wants to die?

Obesity
E. What are your thoughts on the steadily increasing rates of obesity? Mention any
policies that you may be aware of, and/or discuss potential ones that you can think of.
Obesity serious epidemic: can cause hypertension, diabetes stroke and other health
conditions and overall increases mortality rate of individuals.
Lack of healthy diet: some individuals are not properly educated on what consists as a
healthy diet; other individuals, particularly the underserved lack access to healthy food
options (food deserts, where there are very few grocery stores and only fast food stores);
some individuals also cannot afford healthy food options; several options: health
education how to eat healthier; improve access to healthy food options by increasing
number of grocery stores and healthier restaurants in underserved areas; governmental
food stamps such as SNAP, which allows low income families to afford healthy foods)
Physical exercise: increase number of PE courses and promote athletic programs for
students in schools; educate community members on benefits of exercise as well as
physical exercise techniques such as doing squats and push-ups; improve access to gyms
and fitness centers to members of community (providing free access or discounts to low-
income members); long hours that low-income members have to work to support their
family; increasing minimum wage or improving working conditions would allow people to
have the time necessary to exercise.

Underserved Communities:

E: Due to a shortage of physicians in rural communities, some policy-makers have

suggested that medical programs preferentially admit students who are willing to
commit to a 2 or 3-year tenure in rural areas after graduation. Consider the broad
implications of this policy for health care and the costs associated. Will this policy be
effective?
rural areas underserved; many individuals lack access to medical care due to lack of
hospitals/clinics around them and distances have to travel to receive medical care. Having
a 2-3 year tenure in rural areas would help the rural community
medical students who are interested in this policy are often interested in working in rural
community. This opportunity a good way to see if they are interested in rural health
physician after residency. Also good way for physicians in general to better understand
problems in urban community.
Costs: Also a lot of health issues in urban communities. Preferentially admitting these new
physicians would divert health resources from urban communities to rural communities.
It is a band-aid solution, as after the 2/3 years there will be a revolving door of future
physicians... which can compromise care, and most importantly doesn't guarantee that
they stay.
Having an increased physician count doesn't address other resource elements in medicine
(less beds, MRIs etc)
E: How would you fix the growing homeless problem?
E: What role do social determinants of health play in the practice of medicine?

Healthcare Systems
E: There are currently talks of implementing a $10 patient fee, not covered by any
insurance nor government health plans, for those going to their family doctors and
those seeking care at the ER. What are your views about this idea?
Today, the COVID-19 pandemic has placed a major stress on the healthcare system.
Nationwide, there has been a shortage of hospital meds, medical staff and hospital
equipment. There are currently some talks of implementing a $10 patient fee for everyone
that is not covered by insurance or governmental health plan. There are several pros and
cons of this policy.
Pros:
- Some patients seek care when it is not necessary, particular true in the ED when a
lot of cases are nonemergent in nature. Implementing $10 fee would make people
reconsider as to whether they need to seek medical attention or not. Furthermore,
symptoms such as fever, runny nose, congestion can be treated at home with OTC
meds.
- Implementing patient fee would collect revenue that can be used to fund the
healthcare system
Cons:
- The flat fee may serve as a barrier to healthcare access for the underserved
community. $10 could be quite a bit of money for low-income individuals, so they
may not seek help from doctors even in times when it is necessary. This is
especially important since underserved communities suffer from more chronic
health issues (on average), so they are the subpopulation that need health care
services the most
- $10 fee will generate revenue in short run, but it may end up costing the
healthcare system in the long run. If fewer people seek care for their health
conditions (such as hypertension), then this will lead to more severe health
complications later on (heart attack or stroke). Addressing these severe health
complications require much more resources, and would burden our healthcare
system in the long run.
Overall, I disagree in implementing the $10 flat fee. There are other ways to reduce the
stress on our healthcare system
1. Educate public about appropriate use of healthcare resources, such as when is it
and when is it not necessary to go the ED.
2. Can also focus on preventive measures so that people can live healthier lives.
Many ways to do this: promote health literacy in community, increase affordability
and access to nutritious foods for underserved, let people have free access to gyms
so they can exercise etc.
I do believe that recreational marijuana should be legalized. There are several ways to
address the negative effects
1. Similar to tobacco and alcohol, impose age restriction for buying marijuana. This
would help to decrease marijuana use in teens.
2. Educate the public about the safety risks of ingesting marijuana.
3. Impose restrictions on maximum amount of marijuana that can be purchased by
an individual.
4. Similar to BAC limits for alcohol, impose limit on blood THC concentration for
driving.

E: What are your views on single payer healthcare systems? Discuss the benefits and
drawbacks with the interviewer.
Single-payer system is a health care system in which one entity – a single payer – collects
all health care fees and pays for all health care costs.
because there are fewer entities involved in the health care system, the system can avoid
an enormous amount of administrative waste.
Within a single-payer system, all citizens would receive high-quality, comprehensive
medical care PLUS the freedom to choose providers to a greater extent than most
network-based health plans allow. Paperwork would also be dramatically reduced.

E: What is the difference between HMOs and PPOs? Discuss advantages and
disadvantages of HMO vs PPO plan.
HMO stands for Health Maintenance Organization. A Health Maintenance Organization is
a network of doctors, hospitals and other health care providers who agree to provide care
at a reduced rate. To keep costs low, HMOs may require you to select a primary care
physician (sometimes called a primary care provider or PCP), who can refer you to
specialists when needed.
HMO plans are generally less expensive than PPO plans, with lower monthly payments,
making them ideal if your favorite doctors are already in the network, or if you receive
most of your care close to home.
PPO stands for Preferred Provider Organization. Like an HMO, a Preferred Provider
Organization is a network of doctors, hospitals and health care providers who agree to
provide care at a certain rate. Unlike an HMO, you are not limited to providers who are in-
network, though your copay or out-of-pocket cost for out-of-network visits may be higher
than for in-network providers.
PPO plans typically require higher monthly payments in exchange for increased flexibility.
With a PPO, you do not need to maintain a primary care physician, and can see a different
doctor of your choice at any time, including specialists. This also means when you are
traveling, you can receive care wherever you are.
PPO plans offer more options for laboratory service providers. When you need lab work
done, you can choose the most convenient location under a PPO network.
PPOS: More flexibility to use providers both in-network and out-of-network.
You can usually visit specialists without a referral, including out-of-network specialists.
HMOS: Lower monthly premiums and generally lower out-of-pocket costs. Generally
lower out-of-pocket costs for prescriptions.
Claims won’t have to be filed as often since medical care you receive is typically in-
network.
E: If the Prime Minister/President were to ask your advice on one change that could be
applied to the healthcare system that would improve it enormously and have the
greatest positive effect, how would you answer?
E. Recently, certain hospitals have been charging patients $29/day for their hospital fee
on top of the fees charged to MSP. What are the implications of this policy? Discuss both
positive and negative impacts with the interviewer.
E: Do you think medicine should be more about changing behavior to prevent disease or
treating existing disease?
E: How does Canadian health care system compare to that of Britain’s system vs. the
American system?
E: Describe your knowledge of Medicare and Medicaid.
E. What country has the best system of medicine? Why?
E: What are the strengths and weaknesses of the Canada/US health care system?
E: What is your opinion about what we can do about the high cost of healthcare?
E: Do physicians have the right to deny care to patients on Medicaid?
E: What are the top three issues currently facing the U.S. health care system?
E: Imagine your friend’s father is 70 years old and has lived in major North American City
his whole life. He is taken to the emergency department at the local General Hospital.
He has had good health until now and this is the first time he has been to a hospital of
any kind since he was 20 years old. What changes in the healthcare system and
environment in the hospital do you think he would notice?
E: Discuss any topical health care issue that is unique to the region for Med School you
are applying to?

Genetic Engineering (and other Research topics)

E: Discuss the pros and cons of the Human Genome Project
E: Discuss the pros and cons of genetic engineering.
E: What is your opinion about stem cell research using fetal tissue?
E. You are a PhD student and your supervisor, Prof. Harry, has recently published the
results of his publicly funded research project with the intention to commercialize his
discovery. What are your views about university professors that use public funding to
create for-profit solo ventures?

Pharmaceutical Industries:

E: It is well known that big Pharmaceutical companies along with their expansive lobby
have a huge influence on the medical profession and its education. In your opinion what
are the positives and negatives of having the Pharmaceutical companies play a role, if
any, within medical educational institutions?
Pharmaceutical companies spend billions of dollars every year advertising their products.
A lot of this money goes towards advertising medical students. Since these companies are
ultimately profit driven, there are concerns that Pharm industries can negatively impact
medical education or even the medical profession itself. Personally, I believe that Pharm
companies play both positive and negative roles within medical educational institutions.
Pros:
1. Pharmaceutical companies develop new drugs every year. These new drugs may
be more effective compared to the standard of care. Having Pharm companies
interact with medical students and residents would mean that they would be Some
 physicians also report the substantial benefit to patients in the form of free sample
medication.
2. Pharm companies can also provide residents with free samples of drugs that they
can give to patients free of charge. This can benefit the patient, especially if they
have difficulties affording the treatment.
Cons:
1. Pharmaceutical industries oftentimes present biased data to tout their
products. Furthermore, they may give medical students free meals, free
transportation and other small gifts, which can make these students feel like
they are indebted to these industries. All of this leads to negative influence of
Pharm industries. This may hinder their ability to practice evidence-based
medicine in the future. (Which means that they will not prescribing
medications objectively)
2. Pharm industries already have a substantial influence over the medical
educational system. The public does not see this positively. They may view
physicians as being tainted by industry influence, leading to loss of trust of
physician patient relationship. In fact, this may lead to erosion of public faith
on healthcare system.

Overall, I do believe that Pharm industries has had an overall negative effect on medical
institutions, we need to implement ways to reduce their influence on medical educational
system.

E: (part of previous question) What steps would you take to limit influence of big
interest groups such as Big Pharm out of the education system if given the opportunity.
There are many ways to limit or remove the influence the influence of big interest groups
such as Big Pharm out of the education system.
1. Restriction of gifts from pharm industries to medical students and residents: limit
the amount of money, meals, travel compensations that students and residents
get from pharm industries.
2. Have a third party review the information that Pharm industries give to medical
students/residents to ensure accuracy and limit bias
 3. Ensure that different pharmaceutical industries have the equal opportunity to
present to medical student/residents so as to not have favoritism towards one
company.

E: Do you think drug patents should last for fewer years so that cheaper, generic drugs
can be made available?
The cost of drugs has increased substantially over the past few years. Pharmaceutical
companies have used drug patents to ensure high prices for a new drug, since patents
ensure a monopoly on drug manufacturing, marketing and profits. Because of this, some
people believe that drug patents should last fewer years so that cheaper, more generic
drugs are available. Overall, I believe that there are several pros and cons to decreasing
the length of drug patent.
Pros:
1. Decreasing length of drug patent would reduce the drug prices sooner. \
2. Decreasing length of Patent would lead to more innovation.

Cons:
1. New drugs are expensive to develop, and pharm companies often spend hundreds
of millions of dollars to bring a new drug into market. (This accounts for research
and cost of failed trials). Reducing length of drug patent could cripple drug
companies’s funds and prevent them from research on new medications
2. Reducing drug patent’s length would incentifize Pharm companies to only research
on medications that provide high probability of profit. In other words, research for
treatments for rarer diseases would decrease as a result.

New drugs are expensive to develop. The average research and development investment
required to bring a new drug to market has recently been estimated to be over $1.3
billion, after accounting for the costs of failed trials
However, once created, new drugs are fairly easy for generic firms to imitate.
Patent policies aim to overcome this market failure by providing inventors with temporary
exclusive rights. By making the inventor’s market power temporary, patent policies ensure
access to affordable generic medicines and health care after patents expire.
Decreasing length of patent would also lead to more innovation.

Generic manufacturers, and the newly developing biosimilars market, are then provided
an opportunity to make the same medicine once the exclusivity period expires and the
drug is off-patent. Once competition enters the market, the price of medicine reduces
significantly and patients benefit with increased access to more affordable, FDA-approved
drugs. al industry faces serious financial challenges.
Abuse of the patent system: But the expansive use of the patent system to build barriers
to generic and biosimilar competition results in patients paying higher drug prices for
longer.
drug companies file patent upon patent to try to extend the life of a single drug--
Such patent shenanigans slow medical innovation. The knowledge that current drugs will
go off patent should in theory help spur big pharmaceutical companies to license or
develop new and better drugs. But long battles over dozens of patents can simply distract
pharmaceutical companies from their job: making new medicines.

An originator of a drug may have little incentive to improve his product while it is
benefiting from patent protection.
To the extent that patent-term extension affects the potential rate of return, drugs that
might otherwise be economically marginal may become economically attractive.
5. Drug patents help recoup investments that are incurred during the research and
development stage.
Patent protection is particularly important for the pharmaceutical industry. As the
development of a drug is very expensive and time-consuming, pharmaceutical companies
require sufficient protection to recoup their investments and earn profits, which in turn
would allow financing further R&D.

E: “Liberation Therapy” (LT), a vascular operation developed to potentially cure multiple

sclerosis (MS) in certain patients, has recently come under very serious criticism –
delaying its widespread use. Among other experimental flaws, critics cite a small sample
size in the original evidence used to support LT. As a healthcare policy maker, your job is
to weigh the pros and cons in approving novel drugs and therapies. Please discuss the
issues you would consider during an approval process for LT.

Public Health Issues

E. What is the most important issue in healthcare to you right now?
E: Statistics have shown that effects of advanced age such as changes in vision and
response time may adversely affect elderly drivers' ability to drive safely. As a matter of
fact, many doctors discuss the issue of stopping driving with their older patients as a
precaution for the safety of theirs as well as the public's. Do you think older drivers have
to give up driving when they reach a certain age?
E. Doctors are encouraged to report elderly patients who might have impaired vision, as
they could be a danger to other drivers and themselves. However, reporting this
information can be seen as a breach of patient confidentiality. What is your view on this
matter?
Motor vehicle accidents is one of the leading causes of death in the US. Furthermore,
there are more older drivers driving today than ever before. A particular concern is that
vision decreases with age, and elderly patients who have impaired vision might be a
danger to other drivers and themselves. As a result, there is a debate as to whether
doctors should report elderly patients with impaired vision.
Consider both pros and cons:
Pro: Elderly patients with vision problems are more likely to cause accidents due to their
inability to see. Reporting these patients could restrict their ability to drive, which would
reduce accidents caused by elderly drivers. This improves public safety, but also improves
safety of these elderly patients as well.
Vision loss can occur very gradually, to the point that elderly patients may not even realize
that their vision is declining. For example, cataracts occur gradually, and many people are
not even aware that it is developing. Having info about these patients reported to public
health agency would give a much stronger reminder for these patients about their
restrictions in driving.
Cons: it breaches patient physician confidentiality. Physicians should keep
In addition, driving a motor vehicle plays a major role in an individual’s lifestyle, and when
a driving license is restricted for medical reasons, it can lead to social isolation and
depression. A driver’s license is intrinsically tied to quality of life.
Overall, I believe that if elderly person’s visual loss is minor, and that he/she passes basic
vision tests necessary to obtain driver’s license, then reporting this information is
unnecessary. However, if elderly person’s visual loss is significant, then I do believe that
reporting this information is necessary for public safety (reduce harm of the public as well
as that of the individual). Reporting this info to public agency, which can then provide
appropriate restrictions on driving.

E: As a healthcare policy maker, your job is to weigh the pros and cons of approving a
new policy that would require companies to give employees paid parental leave. Please
discuss the issues you would consider during the approval process.
E: In Sweden, daycare is tax-subsidized making public daycare available and affordable
for all. No matter how many children you have, no matter how many hours they spend
in daycare, and no matter what your income is, you never pay more than a fixed
amount. Discuss your view on this policy with the interviewer.
Daycare is extremely expensive and a possible major financial burden for new parents.
Daycare costs have also been on the rise due to inflation. As a result, some countries like
Sweden have public daycare tax-subsidized, so that no matter how many children you
have or how many hours are needed to be spent on daycare, people will never pay more
than a fixed amount. I believe this policy has both its pros and cons:
Pros: Childcare is extremely expensive and puts a large financial burden on families,
particularly low-income families. Having tax-subsidized daycare would mean that these
families are able to afford quality daycare services, which would free up their income so
that both the parents as well as the child would have a higher quality of life.
Low-income families may go to unregulated and often times substandard child care
services as a result of not being able to afford established daycare services. Having
subsidized daycare would solve this issue.
Cons: There may need to be substantially increased governmental spending in order to
provide tax-subsidized public daycare service. This may result in increased taxes for the
citizens in Sweden. The issue with this is that not everyone has a child, some individuals
are not putting their children in daycare for many reasons (religious/cultural, or the fact
that daycare center is too far away). Sharing the burden of increased income tax would be
unfair to these individuals.
E: What is your stance on universal basic income?
Poverty is one of the biggest socioeconomic issues in our society. To combat poverty and
inequality, several individuals are suggesting a universal basic income, a basic level of
income to ensure that everyone has access to basic needs such as food, housing and
clothing. There are several pros and cons to this policy:
Pros: It could reduce poverty in the U.S. If you give everyone enough money to survive
and obtain basic necessities, then no one will live poverty level.
It could also reduce income inequality. In particular, it is extremely difficult to get out of
poverty. This is because many changes that would allow them to do so require money
they don't have. E: sufficient education to get a good job. However, providing universal
basic income could help these individuals get out of cycle of poverty.
Finally, it would reduce the need for governmental programs. Right now, hundreds of
benefits programs run by the federal government and the states. Includes social security,
Medicaid, food stamps etc. Unfortunately, getting aid from these programs are not easy.
Due these program restrictions, several people slip through the cracks. Although people
who are eligible need to jump through a lot of hoops. With a universal basic income, these
problems would just be eliminated.

Cons: It costs a lot of money for the federal government to support UBI. Andrew Yang
proposed policy where $1,000 per month to every adult citizen — almost 260 million
people. That adds up to over $3 trillion per year, more than half the federal budget for
2022. Existing social welfare programs only cost a fraction as much. This high
governmental cost means increased income taxes, which can hurt the poor.
It gives people aid to those who don’t need it. Some people need more financial aid than
others (personal living circumstances, geographical location etc). The people who are
middle or upper class do not need additional income to support themselves.
May reduce the incentive to work. if you give people money for doing nothing, they have
less incentive to engage in productive work, results in suffering of economy. Similar note,
employers may also reduce wages. if UBI gives workers enough money to live on,
employers will be able to get away with paying them less than a living wage.
E. Do you think general practitioners have an obligation to report their patients' health
status to a public health agency if their patients have active infectious diseases?
E. The government wants to track citizens across the country in order to maintain public
safety in the face of a pandemic. How would you advise the government to do this?
E: 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.
E: In recent years, there has been an increase in the popularity of full-contact sports,
such as Ultimate Fighting Championship (UFC) and boxing. Should doctors have a role in
regulating such sports?
E: Your local Pediatric Association has recommended that circumcisions 'not be
routinely performed'. They base this recommendation on their determination that 'the
benefits have not been shown to clearly outweigh the risks and costs'. Doctors have no
obligation to refer for, or provide, a circumcision, but many do, even when they are
clearly not medically necessary. BC Medicare no longer pays for unnecessary
circumcisions. Consider the ethical problems that exist in this case. Discuss these issues
with the interviewer.
E: If the Prime Minister/President were to ask your advice on one change that could be
applied to the healthcare system that would improve it enormously and have the
greatest positive effect, how would you answer?

Miscellaneous
E: Some medical schools have a preference for selecting medical candidates from certain
geographical locations. What are your views about such selection policies? Please
discuss your answer with the interviewer inside the room.
The selection policy for prospective medical students by medical schools can be a
controversial topic. This issue is particularly relevant since medical schools are selecting
future physicians that will be taking care of patients. One controversial policy is whether
medical schools can preferentially admit students from certain geographical locations. I do
believe that there are pros and cons to this policy.
Pros:
1. Some Medical Schools have a specific mission: E: train their students to engage in
rural health issues and serve rural communities. Thus, selecting medical candidates
from rural areas will be beneficial (they may be more interested in rural health
issues; they may be more familiar with rural issues etc.)
2. Medical Candidates are oftentimes more interested in choosing medical school
that are close to where they live (multiple reasons: familiarity with region;
connections with friends and family nearby, lower tuition costs (at least for public
schools). Medical schools have in state or regional preference  students they
select are more likely to accept the offer to attend that medical school. Many
benefits to this: need to interview less candidates, save money and time
Cons:
1. By preferentially selecting candidates from certain geographical locations, the
medical school is excluding many excellent prospective candidates. (If an excellent
pre-med student sees that a medical school has heavy geographical bias and they
are not from region, they will likely not apply)
2. Lack of diversity within med school class; medical school students lack opportunity
to interact with people from different cultures; leads to them becoming less
culturally competent.

Overall, I believe that it is better for medical schools to not have extreme geographic bias.
You may be excluding many excellent medical candidates, leads to lack of cultural
diversity, may lead to discrimination against particular group. However, there are times
when geographical bias is beneficial. I do recognize that if school has specific mission, and
having geographic bias is best way to select students who are fit for mission, then I would
be ok with geographic bias.
E. A proposed bill would require all individuals to vote in federal elections or face a $100
fine. What do you think about this bill?
Voter apathy
Pros: combat voter apathy; people are more motivated to vote so that they don’t get
fined; it means that all eligible individuals vote, which means that choice of candidate
selected better represents the will of population; Higher Turnout Elections. politicians are
supposed to represent the interests of all citizens.
May lead to voters being aware of political issues; the policy motivate individuals to better
understand the people who are in charge federal government as well as policies they
represent; more politically savvy.
minimize political polarization in the United States. People are politically neutral; Lower
turnout, it is argued, enables more hard-core partisans and ideologues to dominate
elections.
Cons: Discriminates against low-income individuals. Low-income individuals need to work
and may not be able to find the time to research the candidates and vote the candidates.
A sizable number of politically neutral or apathetic individuals may be voting only for the
purpose of avoiding the punishment (fine) rather than for support of a candidate. This is
problematic since these votes don’t actually represent willingness to support a candidate,
but only to avoid punishment. people who are uninformed (or simply do not care about
the outcome of an election) may end up voting randomly, problematic skews result of
election.
infringes upon individual liberty by denying people the ability to choose not to vote.
Compulsory voting in some sense is seen as “endorsing” the current politicians and
political system, abstaining from voting se

E. Universities are commonly faced with the complicated task of balancing the
educational needs of their students and the cost required to provide learning resources
to a large number of individuals. As a result of this tension, there has been much debate
regarding the optimal size of classes. One side argues that smaller classes provide a
more educationally effective setting for students, while others argue that it makes no
difference, so larger classes should be used to minimize the number of instructors
required.
Discuss your opinion on this issue with the interviewer.
Several studies have shown that reducing class size increases overall student
achievement, especially for younger, disadvantaged children. The following are some of
the benefits of fewer students in a classroom.
• Students receive more individualized attention and interact more with the teacher.
• Teachers have more flexibility to use different instructional approaches.
• Fewer students are less distracting to each other than a large group of children.
• Students are more likely to participate in class and become more involved.
• Teachers have more time to cover additional material and use more supplementary
texts and eA smaller class is less likely to represent a diverse cross section of society.
Students benefit from being members of diverse classes because they have the
opportunity to hear viewpoints that differ greatly from their own.
A smaller class is less likely to represent a diverse cross section of society. Students benefit
from being members of diverse classes because they have the opportunity to hear
viewpoints that differ greatly from their own.
Some individuals: Some students enjoy the anonymity associated with being a member of
a large class. These pupils are uncomfortable in the spotlight and prefer to blend in with
the crowd as they move
One: of the largest disadvantages to small classroom size is cost. Smaller classroom sizes
in a school district means adding additional teachers and building additional classrooms,
and few school districts have the resources to fund additional classrooms or teachers.

E. The City of Vancouver has taken great measures to increase access to alternative
forms of transportation (Canada Line, Hornby, and Dunsmuir Bike Lanes, Proposed
Evergreen Line, and Burrard Street Bridge closures). Discuss the impacts (both positive
and negative) of these decisions?
E: In June 2011, the Vancouver Canucks lost the Stanley Cup and riots broke out in
Downtown Vancouver. Discuss the impact on the community and the range of health
care professionals at St. Paul’s Hospital.
E. In June 2011, the infamous Vancouver riots took place after their hockey team lost in
the Stanley Cup Finals. Stores were ransacked and cars were burned. Hundreds of
people were injured and sent to overcrowded hospitals. As the police chief in
Vancouver, what measures or policies would you put in place to make sure this does not
happen again?
E. In 2007 the Journal of Dental Education surveyed over 1000 dental students and
found that 74.7% admitted to some form of cheating during their undergraduate career.
The university has asked you to be part of a student focus group to determine how to
reduce the incidence of cheating. You are well aware of this behavior as you have
observed the reusing of old assignments on many occasions. What suggestions would
you make to help reduce the incidence of cheating and improve the academic integrity
of students?
66. A YouTube video of a group of junior high-school boys verbally abusing bus monitor
Karen Klein went viral in July. The abuse included taunts, profanity, physical ridicule,
and even threats to Karen’s person and home, ultimately resulting in her breaking down
and crying. The video prompted an investigation on the part of school officials and local
police. The boys were suspended from school and given 50 hours of community service.
Klein stated that she would not press charges, partly because of the flood of criticism
aimed at the boys. Do you believe the boys’ punishments were just, or what could have
been done differently?