A patient with advanced dementia is hospitalized and requires a decision about a high-risk surgical procedure. The patient has no advance directive, and their family members disagree on whether to proceed with the surgery. How do you facilitate a decision that respects the patient's best interests and family dynamics?

Where answers to this question lose points

Our scorer marks every answer on three parts. For each of the 92 applicants who finished this question on Confetto, we took their first scored answer and counted the part that scored lowest.

• Structure: a clear order and a clear point33 of 92
• Content: covering what the question needs27 of 92
• Communication: tone, clarity and professionalism21 of 92

Confetto data as of November 8, 2026. A part is shown only when 20 or more applicants share it. Answers where two parts tied are not counted toward either. We never show anyone's answers or details.

What this question tests

• Ethics
• Patient care

How to structure your answer

1. Ask questions (25 seconds). The answer opens by seeking medical facts from the treating team about surgical risks, likely benefits, quality of life, and the consequences of not operating. It then asks family members about the patient's earlier preferences and values, rather than starting with a verdict about surgery.
2. Who is affected (20 seconds). The patient comes first, with attention to their comfort, dignity, quality of life, and previously expressed wishes. The answer then recognizes the family members who disagree and need to feel heard, alongside the clinical team and support services helping them reach a decision.
3. The conflict (20 seconds). The conflict is between pursuing a potentially beneficial but high-risk operation and avoiding burdens that may not match the patient's wishes or improve their life. Family members interpret the patient's best interests differently, so the answer seeks common ground without treating anyone as unreasonable.
4. Options (40 seconds). Proceeding with surgery may offer benefit but exposes the patient to substantial risk, while not proceeding avoids surgical burdens but carries the consequences of leaving the condition untreated. If family discussions remain unresolved, ethics consultation offers guidance, although it adds another step rather than immediately settling the decision.
5. Choose (30 seconds). The answer chooses a facilitated family meeting grounded in medical facts and the patient's previously expressed values, rather than choosing surgery without enough information. Its main reason is to reach a patient-centered decision through respectful discussion, with ethics support if disagreement persists.
6. What next (20 seconds). The answer recommends involving the ethics committee if consensus remains difficult and a social worker to explore family concerns influencing the discussion. It also commits to documenting discussions and decisions clearly, and explaining that the decision can be revisited if circumstances change.

Example answer from Confetto

Example answer from Confetto. Not a real applicant's answer.

In this challenging situation, I believe the first priority is to gather all the relevant medical facts about the patient's condition and the proposed surgery. I would want to clearly understand the risks and potential benefits, the likelihood of improving quality of life, and the consequences of not proceeding with the surgery.

I would then facilitate a family meeting where every stakeholder has an opportunity to voice their perspective. In my experience with similar family discussions, it's crucial that each person feels heard and respected. I would ask family members to share any previous conversations they had with the patient about their healthcare preferences, values, and quality of life priorities before their cognitive decline. These insights could help guide us toward what the patient might have wanted.

While mediating the discussion, I would focus on finding common ground among family members. Often, disagreements stem from different interpretations of what's best for their loved one, rather than fundamental conflicts. I would emphasize that our shared goal is to honor what the patient would have wanted and to act in their best interest.

If consensus remains difficult to reach, I would suggest involving the hospital's ethics committee. They can provide valuable guidance and an objective perspective while helping to navigate complex family dynamics. Additionally, I would recommend consulting with a social worker who can help address any underlying family concerns or conflicts that might be influencing the decision-making process.

Throughout this process, I would maintain clear documentation of all discussions and decisions. Most importantly, I would ensure that the family understands that we can revisit the decision if circumstances change, and that our primary focus remains on providing the best possible care for their loved one while respecting their dignity and wishes.

Use it for its structure. Interviewers can tell a memorized script, so tell your own story.

Keep going

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• You are the physician caring for Mrs. Miller, who has been declared brain dead and would be an excellent organ donor. When you ask her husband and son for consent, they strongly object. What would you do?
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