#12 - When a patient failed to respond to prescribed

[Administrator]

Complete Question Explanation

Method of Reasoning—CE. The correct answer choice is (D)

The doctor in this case goes through some trial and error to determine why his patient failed to respond to prescribed medication and to find the proper dosage of medication to prescribe. The doctor initially hypothesized the dosage was insufficient. However, even after he doubled the dosage, the symptoms remained.

After the doctor learned the patient had been drinking an herbal beverage that inhibits the medication’s effect, the doctor told the patient to stop drinking the beverage and to return to the original dosage. When the medication still had no effect, the doctor doubled the dosage again, this time also instructing the patient to abstain from the beverage. Finally, the patient’s symptoms disappeared. From this evidence, the argument concludes the doctor’s initial hypothesis, that the dosage was insufficient, was correct.

The stimulus is followed by a Method of Reasoning question, which specifically asks that you describe the manner in which the doctor’s second set of recommendations, and the results of its application, support the doctor’s initial hypothesis.

The second set of recommendations was to resume the initial dosage and to stop drinking the herbal beverage known to inhibit the medication’s effect. The application of this recommendation resulted in the patient’s symptoms showing no change.

By removing the herbal beverage from the situation and returning the dosage to the original amount, the doctor was able to determine whether, without the beverage’s interference, the original dosage would have the desired effect. If it did, then the dosage was appropriate, and its original failure likely was caused by the beverage. Since the application did not relieve the patient’s symptoms, the doctor could conclude it was not only the interference of the beverage causing the original dosage to fail. This result provided at least some support for the doctor’s original hypothesis that the original dosage was insufficient.

Answer choice (A): The doctor was not concerned with the general “healthfulness” of the beverage. Rather, his concern was that the beverage might be interfering with the effectiveness of the prescribed medication.

Answer choice (B): This is a tempting answer choice, but one that fails because a lack of evidence is not, in itself, evidence of lack. Here, what the doctor concluded from the application of his second set of recommendations was that the normal dosage of medication was ineffective even in the absence of the herbal beverage. This does not show that the beverage has no effect on the medication, but rather that if the beverage was interfering with the dosage’s effectiveness, it was not the only cause of the dosage’s ineffectiveness.

Answer choice (C): This choice is incorrect, because even in the absence of the beverage, the dosage remained ineffective.

Answer choice (D): This is the correct answer choice. The doctor initially thought the dosage was insufficient. The later discovery that the patient consumed a beverage known to interfere with the medication raised some doubt about whether the issue was the dosage level or the potential interference of the beverage. By demonstrating the dosage remained ineffective when the beverage was absent, the application of the second set of recommendations showed that, while the beverage may have some effect on the medication, as it is known to do, that effect was not the only cause of the medication’s ineffectiveness.

Answer choice (E): The fact that the medication, provided at the originally prescribed dosage level, but in the absence of the herbal beverage, failed to remedy the patient’s symptoms does nothing to answer the question of whether the doctor initially prescribed the wrong medication. That result demonstrates only that the presence of the herbal beverage was not the only cause interfering with the medication’s effectiveness at the dosage level prescribed. In fact, after doubling the dosage and removing the herbal beverage consumption, the patient’s symptoms disappeared.

[psybrdelic]

Hey,

So, I have major issue with this question. I understand the logic/reasoning justifying the answer, but it just isn't correct from a medical perspective in my opinion. Granted, we are not to bring in outside knowledge, but this is pretty basic cognition here.

No where in the stimulus does it state that the lower dose was a sufficient condition to remedy the malady. Therefore, it can be inferred that varying patients may need varying doses. In turn, I have issue with answer D. Yes, the beverage was eliminated and the lower dose was ineffective, however, the higher dose was effective. There is no information regarding the amount of effect the beverage had on drug functionality (and no specification with regards to dosing). I answered C. Could justification from the stimulus be provided to defend why C is not acceptable? In real life, I have experienced similar situations. The first logical assumption is not that some unknown external factor was influencing the dosing, but rather the internal mechanisms of the patient.

I just answered my own question didn't I? If the lower dose didn't work, then from my perspective, one could assume that perhaps (total example) the pt has an increased metabolic clearance requiring a higher dose. I still have issue with this concept though. The stimulus should have at least more directly stated that the lower dose would be a sufficient condition for cure.

Sorry if I'm being particular.

I'm curious as to your thoughts and thanks for for these amazing explanations.

-leann

[James Finch]

Hi Leann,

It sounds like you're missing the forest for the trees with this question, so let's look at it more abstractly and see if it makes more sense that way.

The stimulus describes a situation in which a person is trying to isolate the cause(s) of a certain effect. The person hypothesizes that one thing is the sole cause, and tests that hypothesis. Unfortunately, that hypothesis does not work out as hoped when tested, and the effect remains. The person then learns new information about another possible cause, and tests whether that alternate cause is the sole one. Once again, the effect remains after removing the hypothesized sole cause. Finally, the person tests whether both the first and second cause may cause the effect by removing both of them. The effect disappears, showing that either one, and certainly both together, are sufficient causes for the effect.

Applied to the specific situation given in the stimulus, whenever the patient either drinks the herbal beverage, takes an insufficient dosage, or both, the symptoms remain. Double the dose and refrain from drinking the herbal beverage and the symptoms disappear, which allows us to conclude that either, or both, of the stated causes in the stimulus may cause the symptoms (the effect) to remain.

The question stems asks what role does the recommendations given after the cessation of the beverage play in the argument that the initial dosage was insufficient. My long-winded prephrase:

The test of whether the symptoms remain with the initial dosage and then disappear with the double dosage serves to show that the lower dose was a cause of the symptoms recurring and thus the doctor's initial hypothesis that the dose was insufficient was correct.

Looking through the answer choices, (D) matches up well with the prephrase, and is our correct answer choice.

Hope this clears things up!

[Oneshot06]

Hi. I really struggled with this question because the style was different than other questions I’ve experienced. I ultimately went with E. because I could conclusively rule that the medication was not wrong. The dosage was wrong which does not say the medication was wrong and I thought this was stronger than selecting an answer on dosage only. Please help me understand why this answer is wrong and how I can better approach this type of question the next time.

Thx.

[Jonathan Evans]

Hi, OneShot,

This is a challenging question. Let's break apart the stimulus and the question stem so that we may analyze it more effectively.

Stimulus structure:

• Patient does not respond to medication.
• Doctor hypothesizes dosage is insufficient (First Hypothesis)
• Doubles dosage (First Recommendation), but symptoms remain.
• Doctor finds out that patients drinks herbal beverage that inhibits medication (Second Hypothesis).
• Patient eliminates beverage and returns to initial dosage (Second Recommendation), but symptoms remain.
• Doctor then advises eliminate beverage and double dosage (Third Recommendation); symptoms eliminated.
• Conclusion: The initial hypothesis was correct.

Question stem, rephrased:

• Why do the results of trying out the Second Recommendation offer support for the conclusion that the dosage was insufficient?

Let's describe again what happened with the Second Recommendation:

• We went back to the initial dosage and eliminated the herbal beverage. What happened? The symptoms remained.

Why does this offer support for the conclusion that the dosage was insufficient?

• The results of the second set of recommendations suggest that the herbal beverage by itself was not sufficient cause for the medicine not working. Even with the beverage eliminated, the symptoms remained at the initial dosage. Thus, the doctor was correct that the dosage was insufficient.

This is our prephrase. The second set of recommendations supports the doctors initial hypothesis because even when you eliminate another possible problem, the dosage remains insufficient.

This prephrase matches the credited response, (D).

What about (E)? In fact, the second set of recommendations does not rule out the possibility that the doctor prescribed an incorrect medication. When the patient eliminated the herbal beverage but still did not respond to the medication, we might have wondered whether the medication worked at all. After the second set of recommendations, it was still an open possibility whether the medication would work at all. Thus, Answer Choice E does not match because we still did not know whether the medication worked at all. All we knew is that the herbal beverage was not sufficient cause by itself to explain the medication's not working. Instead, it became more possible that the dosage was insufficient as well.

To deal with these questions successfully, try to be very methodical and precise in your analysis. Make sure that you identify exactly what the stimulus and question stem are talking about. Do not cut corners. Then, make sure that you make a strong, accurate prephrase for questions such as these. On all Method of Reasoning (and Flaw questions), it is safe to say a good prephrase is absolutely essential.

[Oneshot06]

Thanks a lot Jonathan! I see where I steered off track...I really appreciate the detailed explanation.

[lp1997]

Hello,

I narrowed the answer choices down to D and E here and correctly chose D. I wanted to see if my approach was the best one.

The question asked which one of the following describes the manner in which the second set of recommendations... support the doctor's initial hypothesis. The initial hypothesis was that the dosage was insufficent. So you were tasked with selecting the answer choice that described how the second set of recommendations supports the hypothesis that the dosage was incorrect.

I thought E was a weak answer because, even if the second set of recommendations rules out the possibility that the doctor had initially prescribed the wrong medication, that in itself does not provide any support for the idea that the initial dose was insufficient. I thought D was a better answer because, if the beverage was not the only cause of the ineffectiveness, that would imply that both the beverage and the insufficient dose were both causes of the ineffectiveness, since the symptoms only subsided when the two causes (beverage and insufficient dose) were addressed at the same time.

In other words, D provided specific support for the initial hypothesis, as the question requested, while E did not provide any clear and direct support.

Is this the correct way to approach this question? Or would it have been better to approach it with a modified Fact Test of sorts, comparing each answer choice to the stimulus to see how accurately the answer choice describes the stimulus?

If I had approached the question that way, I guess E could have been eliminated because its possible that the doctor still prescribed the wrong medication? Perhaps there was another medication that, even with the patient drinking the beverage, would have eliminated the symptoms immediately?

Thank you!

[Francis O'Rourke]

Hi lp1997,

Everything you described checks out, so it looks like you understood the question! It's hard to say what the better way of approaching this question is. If you were able to select answer choice (D) quickly, then be happy with your result.

I personally would have had a much harder time following your method on this question. For me, approaching the answer choices with the Fact Test in mind provided me with a much simpler and faster method of eliminating wrong answers than your method of assuming answer choice (E) was supported, and eliminating it on other grounds.

I suspect that you will be able to answer Method of Reasoning questions more quickly by keeping the Fact Test in mind while initially separating the answer choices into contenders and losers. If you are concerned about timing on the Logical Reasoning, then practice more of these questions this week by applying the Fact Test and see how that goes!

[AAron24!]

Hey Powerscore,
I cohse E because I felt like the stem was doubling down on the idea that this was the correct medicine to give to the patient. Im a bit confused why it would be considered wrong.

[Adam Tyson]

There are two problems that I see with answer E, AAron24! The first is that it remains possible that the doctor prescribed the wrong medication, in the sense that there may have been some better, more effective medication available. Perhaps the underlying ailment is still present, even though the symptoms are gone, and some other medicine would have actually cured the patient rather than just alleviated the symptoms? We just don't know. This answer is, in that sense, untrue.

But I think the more important reason for rejecting answer E is that even if it is true, that is not the the manner in which the evidence supports the conclusion. A Method of Reasoning question asks you about the strategy employed by the person making the argument. It's about how the argument was built, step by step, and not just about what the results were. Ruling out a problem with the medicine itself was not the strategy used by the doctor. Instead, the strategy was to show that the doctor was right about the dosage but that there was also a second contributing factor that needed to be dealt with.

Focus on how the argument was built!