Medical Judgement and customer service response

I am applying to a job that requires a lot of writing as it’s asynchronous communication. I have the responses of a previous candidate that got past the interview phase but was refused because of the written responses. I felt that response were appropriate but apparently not. They got back the following feedback from the hiring team: “Your responses to the writing sample were not as solid as we had hoped. There were also grammar and punctuation issues that stood out. So much of the communication with patients is done via email and for this reason, we have a hard time overlooking typos and punctuation issues. I’m sorry”. This is looking heavily at clinical judgment and writing style I don’t need references but obviously, that will help justify responses. See instruction below.

Instruction for responses: Please answer the questions below in 3-5 sentences. We are looking at

two key components in your responses, #1, your clinical thought process, and #2, your

writing style. Please ensure your responses come across professional and patient

friendly and please proofread prior to send back for any typos or punctuation issues.

1. A diabetic patient with hypertension and hypercholesterolemia comes to you via asynchronous telemedicine for Erectile Dysfunction. How would you approach treatment for a patient with a moderate cardiovascular risk profile such as this?
I would need to know their blood pressure to confirm that BP is currently well controlled (80/60-160/95 range). Next, review medications to confirm ongoing treatment with PCP and ask the patient if they know their most recent BGL reading and/or HGA1C (looking for BGL< 160 and/or HGA1C < 8.5). I’d confirm they haven’t had elevated blood pressure in the past six months or if they are taking contraindicated medication such as: Clarithromycin, Diltiazem, Erythromycin, Itraconazole, Ketoconazole, Ritonavir, Verapamil, Doxazosin, mesylate (Cardura), Prazosin hydrochloride (Minipress) or Terazosin hydrochloride (Hytrin), or if they haven’t been prescribed nitrates/nitroglycerin. Also, confirm they hadn’t recently experienced chest pain, passed out, experienced dizziness, recent seizures, heart disease, or family history of sudden unexplained death. Next I would confirm if the patient is on a statin as well. If all is well managed, I would start the patient at Sildenfil 25 or 50 mg depending on treatment history since diabetics often requires higher dosage due to cardiovascular issues, then I would lean closer to 50 mg. I would contact the patient and inquire that they provide me all the above if not already provided.

2. How would you manage a 38 year old woman who currently smokes 1 pack of cigarettes a day who comes to you (via asynchronous telemedicine) for oral contraception- either combined hormonal contraception or progestin-only pills?

I’d put her on Progestin-only pills such as Errin, Camila, etc. I’d contact the patient and educate them on the reason for this treatment choice such as that they are not associated with Cardiovascular increase risks and are a safer choice for a patient that currently smokes.

3. When starting a patient on Addyi, how would you counsel her about consuming alcohol while taking the medication? (Please refer to the FDA’s press release from 4/19 re: alcohol consumption and use of Addyi prior to answering this question)

Ma’am, the guidelines recommended for Addyi is that you discontinue alcohol use at least 2 hours before taking Addyi or that you skip that evening dose. The reasons behind this is that it can lower your blood pressure and make you dizzy, which can cause nausea or cause you to “pass out” or fall. Although a low percentage of women experience this side effect, you should be aware. The medication usually takes full effect in 8 weeks so if you can, it would be ideal if you avoid alcohol use for those eight weeks or discontinue 4 hours prior to medication to be on the safe side. If you have any questions or concerns, please feel free to contact us here at forhers.com, our staff will quickly connect you with a healthcare professional to answer your questions.

4. When starting a patient on Finasteride, how do you counsel them on possible adverse effects?

Hello, although a low percentage of men experience side effects when taking Finasteride, you should know what they are: Chest wall/breast tenderness, rashes, depression, anxiety, testicular pain, and/or neurological issues. If you experience any of these side effects, please consult with us at forhims.com, our staff is trained to provide you guidance and will assign you a provider to assist you or consult your primary care provider.

5. A patient on our platform was issued a prescription medication. You disagree with this treatment decision and think they should not have received the medication. How would you handle this?

It depends on what we’re talking about. If I am seeing the patient now and I review their medications and see this, I’d asked the patient how they are doing on the medication and if they have any side effects. If there are no issues and there is no serious risk, I wouldn’t bring it up any further, and I would discuss it with the provider that ordered the medication and ask them how they would like to proceed. If I am seeing the patient for side effects secondary to this reason, I think they shouldn’t have received the medication. I would console the patient regarding the risk and side effects and ask them to discontinue the medication if it’s warranted. For example, if it’s a direct contraindication, for example, a patient is on nitrate. I’d inform the patient and advise them to stop the medication immediately. But if the patient BP 159/95 and they aren’t having any issues, I won’t intervene; I would discuss it with the ordering provider.

6. A patient was denied propranolol because he shows symptoms of generalized anxiety disorder rather than performance anxiety, and he is angry. What would you communicate to the patient? [write a sample note to the patient].

Mr. John Doe,
Your health is our top priority and we want to choose the most appropriate treatment for you. Unfortunately, the treatment we provide isn’t appropriate for your symptoms. We would like you to be seen in-person by your primary care provider to better provide the appropriate treatment for your condition. If you don’t have a primary care provider, you can go to a local walk-in clinic and further discuss your health history and symptoms.
Best regards,

7. What other products or services would you like to see offered on the hims & hers platform?

Smoking cessation with Welbutrin is one that comes to mind. HSV treatment is also that I see fitting into this model.