Empathy and Compassion · Ranking sample

Dr. Callie Muir, a family medicine resident, is conducting a scheduled 30-minute home…

Read the scenario, answer it, then compare yourself to the answer key. Every option includes a rationale and a transferable principle.

b10Empathy and CompassionRankingapproachableCommunicator + Health Advocate

Rank in order the following actions for Dr. Muir to take in response to this situation (1 = Most desirable; 5 = Least desirable).

Dr. Callie Muir, a family medicine resident, is conducting a scheduled 30-minute home visit for Mrs. Okonkwo, a 78-year-old patient with multi-morbidity and declining mobility. Dr. Muir planned to introduce advance care planning today, but each time she broaches the topic, Mrs. Okonkwo politely deflects with 'not today, doctor'. Meanwhile, her adult son, Chidi, repeatedly speaks on her behalf and answers clinical questions before she can respond. Dr. Muir has approximately 20 minutes remaining in the visit. She wants to respect Mrs. Okonkwo's autonomy and comfort while addressing her care needs effectively.

Ranking scale: 1 is most desirable and 5 is least desirable. Use each rank exactly once. Pick one rank per option.

A. Thank Chidi for his support, then redirect the conversation to ask Mrs. Okonkwo for her direct input.

B. Ask Chidi to leave the room to determine if Mrs. Okonkwo feels pressured by his presence.

C. Validate Mrs. Okonkwo's boundary on advance care planning and gently explore what matters most to her today.

D. Proceed with discussing advance care planning goals with Chidi, accepting his answers on his mother's behalf.

E. Provide written advance care planning materials to review together, offering to discuss them at a later visit.

Use each rank exactly once

Samples are graded anonymously. Nothing is saved.

Show answer and rationale

A. Thank Chidi for his support, then redirect the conversation to ask Mrs. Okonkwo for her direct input.

Key: 2

This is a desirable response as it gently reclaims space for the patient's voice while constructively acknowledging the son's caring intentions rather than alienating him. However, it ranks below Option A because it does not explicitly acknowledge Mrs. Okonkwo's stated reluctance to discuss advance care planning today. It would rank higher if it paired this communication realignment with a clear pivot away from the stalled topic.

Acknowledge supportive family while intentionally protecting the patient's central voice.

B. Ask Chidi to leave the room to determine if Mrs. Okonkwo feels pressured by his presence.

Key: 4

This option is somewhat undesirable because abruptly asking a family caregiver to leave their own home without prior gentle redirection can alienate both patient and family. While ensuring the patient is free from coercion is a legitimate consideration, jumping to exclusion before attempting inclusive conversational management is disproportionate and disruptive. It would rank higher if there were clear indicators of abuse or if Mrs. Okonkwo had requested privacy.

Avoid abrupt exclusion of family without first attempting inclusive conversational redirection.

C. Validate Mrs. Okonkwo's boundary on advance care planning and gently explore what matters most to her today.

Key: 1

This is the most desirable response because it respects the patient's autonomy, validates her reluctance without pressure, and centres the remainder of the visit on her self-identified needs. In advance care planning, pushing past explicit patient boundaries damages trust, whereas following the patient's pacing preserves the therapeutic alliance. It would be ranked lower if it entirely ignored the son's tendency to answer for her in subsequent exchanges.

Respect patient pacing and boundaries while exploring immediate patient-centred priorities.

D. Proceed with discussing advance care planning goals with Chidi, accepting his answers on his mother's behalf.

Key: 5

This is the least desirable response as it completely circumvents the competent patient's autonomy and substitutes a surrogate's voice simply for administrative convenience. Advance care planning must reflect the patient's own values, and treating her reluctance as consent for her son to decide is ethically and relationally unacceptable. It could only be justified if Mrs. Okonkwo lacked decision-making capacity and had designated Chidi as her legal substitute decision-maker.

Never substitute family preferences for a capable patient's direct autonomous participation.

E. Provide written advance care planning materials to review together, offering to discuss them at a later visit.

Key: 3

This option is acceptable as a pragmatic middle ground that avoids coercive conversation while still planting seeds for future discussion. However, it is an emotionally neutral, passive approach that misses the opportunity to connect with Mrs. Okonkwo's immediate concerns or address the communicative dynamic in the room. It would rank higher if paired with active exploration of her priorities today, or lower if it closed off future discussion entirely.

Informational deferral maintains future options but lacks active empathic engagement.

Exam context: FMProC assesses empathy and compassion alongside three other attributes. This is an unofficial worked example, not a live exam item.

Educational scenario only. Not clinical or professional advice.