Blueprint Diagnostic CARS Passage 5

Session 274

Today we review CARS Passage 5 talking about doctor-patient conversations around exercise. This is the last passage in this CARS section of the diagnostic exam. Join us as we dissect it!

We’re joined by Evan from Blueprint MCAT. If you would like to follow along on YouTube, go to premed.tv.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[02:02] Go Back to the Basics

As you move on to the next passage, Evan recommends taking a second to refresh and recalibrate. Go back to the basics. Look for the main idea. Look for the author’s opinions. Try to figure out any important main arguments that are made.

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If you can really hammer on those things and critically read those three or four ideas, you’re going to be in really good shape, no matter what subject the passage is on.

[04:38] Passage 5 (Questions 21 – 25)

Paragraph 1

If a drug company could take all of the positive effects of exercise and put them into a pill, they’d be the most successful company in history. It is, in fact, nearly impossible to overstate the positive effects that regular exercise has on nearly every facet of the body’s physiological and the mind’s psychological state. Exercise has been demonstrated to not just slow the progression of, but to reverse, many of the symptoms of type 2 diabetes, heart disease, high cholesterol, and hypertension. It can delay the onset of dementia, reduce symptoms of anxiety and depression disorders, and aid in smoking cessation programs.

Notes:

The main idea of this first paragraph is how it’s nearly impossible to overstate the positive effects that regular exercise has on the body and mind.

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[06:49] Paragraph 2

And yet when patients meet with their physicians, the overwhelming majority of primary care doctors fail to discuss the importance of exercise with patients. To the extent that the topic is discussed at all, the doctor will make, at best, passing remarks about the importance of an exercise program. Even more perversely, there is a strong correlation between lower economic class and decreased likelihood of physician-recommended exercise programs, despite the even stronger correlation between lower economic class and many of the diseases that exercise would most directly benefit (most notably obesity and type 2 diabetes). That is to say, those patients who most need regular exercise are the ones least likely to have a doctor that strongly recommends such a program.

Notes:

The phrases highlighted in bold above show the author’s argument that physicians are not doing an adequate job of addressing exercise and its importance. And it’s showing us their opinion because it’s in their own words and flavor here.

[09:06] Paragraph 3

Why this connection exists is still somewhat unclear, although research is slowly shedding light on the topic. Fundamentally, public health scientists examine two different facets of the correlation: patient-sided factors and healthcare provider-sided factors. Thus, working and lower class patients may not have access to the kind of doctors that will recommend exercise, or doctors may change how they treat patients based on perceived economic class.

Notes:

It seems like nobody knows why this happens and we’re trying to figure this out. The author is straightforward on that. And in a way, they’re speculating on some explanations.

[10:32] Paragraph 4

To date, research seems to suggest both of these factors work in concert. In a groundbreaking study at the University of Arizona College of Medicine, experimenters created audio recordings of over 5,000 patient-physician interactions for patients that were classified as obese. The patient population was categorized into three broad categories of economic class based on income. Researchers found that physicians were 22% more likely to discuss exercise regimens with the high-class patient group than the lowest, and that when exercise was discussed, doctors spent a staggering 420% more time in conversation about exercise with the high economic class group than either the middle or low-class group. Despite these stark findings, the researchers’ failure to control for factors of ethnicity and gender have created large enough concerns about methodological validity to lead some critics to dismiss the study entirely.

Notes:

It seems like doctors treat patients differently based on how much money they make.

[14:35] Paragraph 5

More promising are results obtained from examining the patient-sided factors, including frequency of patient-initiated discussions about exercise programs and patient access to high quality primary care. Here, surveys of both patients and healthcare workers have demonstrated a strong correlation between a patient’s economic class and their likelihood of initiating a conversation about exercise with their healthcare provider. This correlation seems to exist regardless of the health status of the patient, and any similarities between the patient and provider in terms of demographic categories. The findings suggest, perhaps, that patients from higher economic classes are simply more comfortable initiating conversations with their healthcare professionals.

Notes:

It’s a little bit more explicit here. This one is talking about the patient-cited factors. Maybe our author thinks that the prior paragraph was more about the health care provider cited factors.

[16:56] Paragraph 6

A final irony was revealed in the most recent major study published on the topic, which found no correlation between a patient’s ability to start and stick with an exercise regimen and how frequently such programs were discussed with healthcare professionals.

Notes:

The author says that those conversations don’t really matter and patients are going to do what they want. How long or how much we talk about exercise with the healthcare professionals doesn’t really make a difference.

[20:20] Question 21

In the study discussed in the fourth paragraph, the researchers created audio recordings of the doctor-patient interactions in order to:

A.prove that physicians unconsciously discriminate against lower class patients by not discussing exercise with them.

B.determine differences in doctor-patient interactions when the doctor and patient are of the same or of different ethnicities.

C.ascertain whether doctors were more likely to discuss exercise regimens with obese male patients than with obese female patients.

D.assess both how often exercise was discussed and for how much time it was discussed.

Thought Process:

The answer is found in the paragraph provided by the question.

Correct Answer: D

[21:47] Question 22

Which of the following studies would provide the best evaluation of the author’s speculations at the end of the fifth paragraph?

A.A study examining how frequently patients ask physicians about medications other than the ones initially recommended by the doctor

B.A cross-sectional study that correlates ethnicity and gender with frequency of implementation of doctor-recommended exercise plans

C.A survey asking patients how many members of their immediate family are healthcare workers that specialize in exercise-based fields such as physiatry or physical therapy

D.A longitudinal study that follows three different groups who are given three different doctor-prescribed exercise regimens to determine whether they are able to stick with the plan and if not, why not

Thought Process:

The whole time in this passage, they’re talking about exercise. And this one little snippet, they’re very specifically referring to us here doesn’t make any mention of exercise specifically. They’re trying to trick us into picking an answer that’s talking about exercise. And A is the only one that’s talking about a patient bringing up a topic of conversation to their doctor. And that’s why it’s the right answer.

Correct Answer: A

[25:48] Question 23

For which of the following statements does the passage provide the least explanation or support?

A.A patient with type 2 diabetes who is trying to quit smoking may be able to improve both of these health factors with regular exercise.

B.Patients who discuss exercise plans with their physician are unable to stick with the plan due to how infrequently they are able to get check-ups with their doctor.

C.Even studies that include a very large amount of data may nonetheless lead to questionable conclusions.

D.Patients’ own behavior can influence the likelihood that their doctor will discuss exercise plans with them.

Thought Process:

If something is least explained, or at least supported, it could either just have no support, or it could even contradict something that’s in the passage here. And B is contradicting so it’s the correct answer here.

Answer choice C is something we have to infer a little bit. If you read the fourth paragraph, it talks about the study getting audio recordings from 5,000 interactions. And despite it being such a great sample size, they still said that there are concerns about the methodological validity. So C is through that one example, supported or explained in some way. So we can rule out C because it does get some support there.

Correct Answer: B

[28:03] Question 24

The passage author would be most likely to agree with which of the following assertions?

A.Patients in the lowest economic classes are just as likely to be able to stick with a doctor-recommended exercise plan as patients in the highest economic classes.

B.A female doctor is more likely to discuss an exercise regimen with an obese female patient of lower economic class than a male obese patient from a higher economic class.

C.The positive effects of exercise are overwhelming in the scope and profundity of effect on physiological conditions but are very limited on psychological ones.

D.Had the study described in paragraph 4 been conducted at a different institution, the researchers would have been more likely to use more robust controls.

Thought Process:

We can infer then that patients, no matter what socioeconomic class they come from, are not going to matter whether or not they stick with the plan. And this is where answer choice A is coming from.

Correct Answer: A

[33:46] Question 25

Which of the following could serve as an appropriate title for the passage?

Physician-Recommended Exercise Plans: Disparities in Action
The Benefits of Exercise in Addiction Recovery

III. Doctors and Patients Both Fail to Adequately Address Exercise

A.I only

B.III only

C.I and II only

D.I and III only

Thought Process:

Answer choice A makes sense because it’s showing the disparities that physicians aren’t recommending exercise enough to enough people, and they’re not talking about it enough to specific groups of people. And III is also correct.

I and III are actually hitting slightly different aspects of the central route that we’re going through in this passage, but they’re both hitting it pretty well.

They must talk about something about there being a difference in the way that physicians treat some patients. And I and III are hitting on those different elements in slightly different ways. But they’re both talking about that. Hence, they’re the most appropriate titles.

Correct Answer: D

[27:31] What to Do at the End of Each Section

Evan believes there is a right way to flag and a wrong way to flag in my opinion.

One of the most useful ways to flag questions is if you’re not confident in it, but it has to meet the second condition where you think you could get right with extra time.

And so, it can’t be a complete guess. It can’t be one that you’ve just been staring at forever, going back and forth between two answers. More time is probably not going to help you there.

But if it’s one where you think an extra 30 seconds or 45 seconds would allow you to have a fighting chance to get the right answer, those are the ones Evan recommends you flag.