2. The Practice of Medicine Flashcards
1
Q
Can include suspension and revocation of license
A
Administrative Law
2
Q
Deals with licensing and regulation
A
Administrative Law
3
Q
Can include fines, restitution, community service, and incarceration
A
Criminal Law
4
Q
Addresses wrongs against the state
A
Criminal Law
5
Q
Can include monetary damages to compensate for loss and to punish
A
Civil Law
6
Q
Addresses wrongs committed by one party harming another
A
Civil
7
Q
is a body of rules of action or conduct prescribed by controlling authority and
having binding legal force
A
The law
8
Q
The basis for the controlling authority of the law in the
United States includes common law from _______ but has been molded by statutes and
judicial decisions (case law) since the birth of the United States.
A
England
9
Q
encompasses
principles and rules based on ancient usages and customs
A
Common Law
10
Q
is the only state in
which English common law does not form the basis for current law.
A
Louisiana
11
Q
is all the laws
and statutes put into place by elected officials in federal, state, county, and city governments
A
Legislation
12
Q
may interpret the statutes and therefore further refine their application.
A
Judicial decisions
13
Q
may reinforce common law principles or change them to match
the changes in society
A
Judicial decisions
14
Q
Common law + Statutes and judicial decisions
a product of common law, statutory law, and judicial decisions
A
Current Law
15
Q
may create such a duty
A
Statute
16
Q
includes all laws enacted by federal, state, county, and city governments
A
Statutory law
17
Q
are previous cases that either interpret statutes or adopt and adapt common law principles
A
Judicial Decisions
18
Q
the standard that a physician must disclose to a patient information that a reasonable medical practitioner similarly situated would disclose.
A
Physician-based standard
19
Q
the physician must disclose information that a reasonable patient needs to make an informed decision
A
Reasonable patient standard
20
Q
are components of the legal system that have an impact on the medical imaging sciences
A
Administrative law, criminal law, and civil law
21
Q
determines the licensing and regulation of the practice of imaging professionals and regulates some employer-employee relations
A
Administrative law
22
Q
seeks to redress wrongs against the state
A
Criminal law
23
Q
attempts to compensate for wrongs committed by one party resulting in harm to another party
A
Civil law
24
Q
Lawsuits involving the medical imaging sciences are generally brought under _____,
a subdivision of civil law
A
tort law
25
is filed to recover damages for personal injury or property damage occurring from negligent conduct or intentional misconduct
tort action
26
The types of torts that imaging professionals might encounter include
```
assault,
battery,
false imprisonment,
defamation,
negligence,
lack of informed consent, and breach of patient confidentiality
```
27
The tort most often involving imaging professionals is
Negligence
28
is generally composed of a pleading phase, discovery phase, and trial
Lawsuit
29
statute of limitation set forth the time periods after the cause of the complaint in which lawsuits can be brought against a physician or other health professional
Lawsuit
30
a complaint is lodged and an answer is given
Pleading Phase
31
the attorney seeks facts of the case by questioning the involved parties
Discovery Phase
32
case is presented to a judge or jury for decision
Trial Phase
33
Facts sought in several ways,
Written questions: requests for information, including interrogatories, request for admissions, request for production of documents, e-mail, audio and video information
Discovery Phase
34
Decision may be reversed or reviewed
Post decision appeal process
35
can only be found if a duty exist
Negligence
36
that interpret the statues may further refine the details surround physician disclosure
Judicial decisions
37
in a state’s courts form the basis of physicians in that state
Previous Judicial decisions (or precedents)
38
a person may perform an act that has evil effects or risk such effects as long as 4 conditions are met
Principle of double effect
39
4 conditions of the principle of double effect
1) The action must be good or morally indifferent in itself.
e.g. proposed imaging procedure must help the patient or at least not cause harm.
2) The agent must intend only the good effect and not the evil effect. That is,
the imaging technologist must intend for the imaging to aid in the health care
process, not injure the patient or cause pain.
3) The evil effect cannot be a means to the good effect.
e.g. patient thinks the procedure is evil but has good effects.
4) Proportionality must exist between good and evil effects. The good of the
procedure must at least balance with the unintended pain or discomfort.
40
Performance of Good Acts
Beneficence
41
May encompass many aspects of goodness, promoting good action &
preventing evil or harm
Beneficence
42
Requires the action of an imaging professional to do good or prevent harm
Beneficence
43
avoidance of evil
Non maleficence
44
hinges on a system of weighting
Non maleficence
45
Goal is to do good
Beneficence
46
Achieved through active process
Beneficence
47
Secondary in importance to Non maleficence
Beneficence
48
Goal is to do no harm
Non maleficence
49
Achieved through passive omission
Non maleficence
50
Primary responsibility of the heath care provider
Non maleficence
51
Medical Indications Involving Principles of Beneficence and Nonmalefiecence
1. What is the patient’s medical problem (what brings the patient to the imaging department)? History? Diagnosis? Prognosis?
2. Is the problem acute? Chronic? Emergent? Reversible? How will this affect the imaging procedure?
3. What are the goals of the treatment or imaging procedure?
4. What are the probabilities of a successful imaging exam?
5. What are the plans in case of therapeutic failure or the inability to complete the exam?
6. In sum, how can this patient benefit by the medical and imaging care? How can the imaging professional avoid harm to the patient?
52
Principle of fairness
Justice
53
performance of an appropriate procedure only after informed consent has been granted
Justice
54
is permission, usually in writing given by a patient agreeing to the performance of a procedure
Informed consent
55
Resources + Needs
Limited choices
56
If the patient is incompetent, either the best interests of the patient or the rational choice principle should be used
Surrogate obligations
57
help provide for patient autonomy
Verbal and Contractual Agreements
58
commands that the surrogate choose what the patient would have chosen when competent and after having considered all available relevant information and the interests of the relevant others
The rational choice principle
| Contractual Agreements
59
They are general agreements; other
| processes of informed consent may be required as specific procedures are scheduled.
Contractual Agreements
60
the imaging professional must be aware of the obligations to do good and avoid harm
Imaging Professional’s Role
61
Patients participate in protecting their own good and avoiding their own harm by gathering information about the imaging procedure they will be undergoing
Patient’s Role
62
The degree of skill or care practiced by a reasonable professional practicing in the same field.
Standard of care
63
is a function of the
whole person in which
concern for the growth and well-being of another is expressed in an integrated
application of the mind,
body, and spirit that seeks to maximize positive outcomes
Caring
64
Refer to the therapy and other services they (Health Care Professionals) provide in their practices
Care
65
is shown to the patient through appropriate communication
Care
66
is compassion arising from an awareness of common bonds of humanity and common expressions, fates, and feelings
Existential Care
67
is the ability to recognize and to some extent share the emotions and state of mind of another and to understand the meaning and significance of that person’s behavior
Empathy
68
is not sympathizing or feeling sorry for the patient. It is a constructive and objective
response that allows the imaging professional to provide high-quality patient care
Empathy
69
is a symbolic interaction: when one person says something to another and that person responds
Communication
70
There has to be at least one response to ___ initiation, creating
a tie of communication
one
71
is a subset of human communication that is concerned with how individual in a society seek to maintain health and ideal with health-related issues
Health Communication
72
Transactional and affective in nature.
Communication
73
Obstacles To Caring
* Scarcity of time
* Technical priorities
* Impact of personal life
* Lack of training in caring for patients who are critically or terminally ill
* Lack of communication
* Lack of faith in self
* Societal pressures
74
are intertwined with the obstacles to caring
Obstacles to Communication
75
Obstacles to Communications
* May come from the sender or to the receiver
* Patient or imaging professional is thinking about other things
* Noise temperature or other distractions in the imaging environment distance and the inability to see or hear
* Relationship between the patient and imaging professional as it is affected by roles, personalities, values, and ethical differences.
76
is characterized by the application of the knowledge of a professional discipline, including its science, theory, practice, and art
Professional care
77
It is complementary to human caring
Professional care
78
involves an appreciation of the universal patterns of human experience
Caring in the imaging science
79
caring, values, and ethical problem solving give meaning to professional practice, create the possibility of ever-improving care, and enhance patient comfort and feeling of safety
Caring in the imaging science
80
is an important key to improving communication between the imaging professional and the patient
Active listening
81
requires not only hearing the patient, but also watching the patient’s body language, observing the patient’s physical presentation, asking open-ended questions, and waiting for responses
and feedback from the patient
Active listening
82
Steps in Improving Communication
* Must want to objectively evaluate and change their communication styles.
* Trying to change
83
Clinician-Patient Communication Problem Involved in Malpractice Lawsuits
* Explanation of diagnosis is inadequate
* Explanation of treatment is inadequate
* Patient feels ignored
* Patient feels rushed
* Clinician fail to understand perspective of patient or relative
* Clinician discounts or devalues views of patients or relative
84
set forth the time period after the cause of the complaint in which lawsuits can be brought against a physician or other health professional
Statutes of limitation
85
is begun when a plaintiff files a complaint against a defendant with the court
Lawsuit (Pleading Phase)
86
this complaint may allege that the defendant has failed to provide
treatment, has provided inadequate treatment, or has committed misconduct.
medical negligence lawsuit
87
is to ascertain the truth concerning the incident
The purpose of discovery
88
questions may be asked of any of the parties (including employees and students of a party) either in writing (interrogatories, requests for admission, and requests for production of documents) or orally (depositions)
Discovery phase
89
After the discovery phase is complete, the lawsuit advances to
Trial
90
Negotiations can be through correspondence, telephone calls, and informal or formal meetings
Trial phase
91
is the system for identifying,
| analyzing, and evaluating risks and selecting the most advantageous method for treating them
Risk management
92
Its goal is to maintain high-quality
| patient care and conserve the facility’s financial resources
Risk management
93
An effective risk management program has three primary goals:
1. Elimination of the causes of loss experienced by the hospital and its patients,
employees, and visitors
2. Reduction in the operational and financial effects of unavoidable losses
3. Coverage of inevitable losses at the lowest cost
94
seeks to maintain high-quality patient care and the safety and security of the facility’s patients, employees, visitors, and property
Risk management
95
is a process to assess quality of patient care that uses hospital committees to
oversee the quality of various hospital functions
Quality assurance
96
focuses more narrowly on patient care than does risk management
Quality assurance
97
It is broader than risk management, however, in that it considers a wide
range of quality concerns and uses hospital committees to oversee the quality of various hospital functions
Quality assurance
98
the action should not infringe against
| the good of the individual. There also has to be a proportionate good to justify the risk of an evil consequence
principle of proportionality
99
The following questions may be used to define proportionality:
Are alternatives with less evil consequences available? Might another procedure produce the same diagnosis with less pain? For example, might magnetic resonance imaging (MRI) be used instead of mammography?
What are the levels of good intended and evil risked? What will be gained from the procedure? For example, can a contrast media fluoroscopic examination of a first trimester pregnant woman be justified?
What is the probability that the good or evil intended will be achieved, and what action and influence do the health care team and patient have? What gains to the patient are possible, and will the imaging specialist have to convince the patient or
surrogate that the patient should undergo the procedure?
100
Beneficence and nonmaleficence differ in the degree of force each possesses. The stronger action of the two is ______, or the avoidance of harm; ______, or the
performance of good, is weaker
nonmaleficence,
| beneficence
101
states that, “granted informed
consent, the physician should do what is medically indicated such that from a medical
point of view, more good than evil will result.”
medical indication principle
102
help provide patient autonomy
Verbal and written contractual agreements
103
the doing of good and avoidance of harm —are incorporated into the duty of a health
professional to do no harm and ______
provide reasonable care to the patient
104
encompasses the obligation of health care professionals to do no harm and their duty to provide reasonable patient care
standard of care
105
The most basic legal parameter in health care is the _____
standard of care
106
Each profession establishes _____ to define the parameters within which that profession is obligated to practice
standards of care
107
is the degree of skill or care employed by a reasonable professional practicing in the same field
legal standard
108
are important because they are recognized as the authoritative basis of a profession
Practice standards
109
On ______, JCAHO approved the 2006 National Patient Safety Goals.
Almost every one of these goals has a place in the imaging profession.
May 25, 2005
110
In addition to the professional standard of care to which imaging professionals are held, other standards apply that come from a variety of sources. One source is _______
institutional and departmental policies and procedures
111
can be found based on the failure
| to follow the written policies of the institution
Liability
112
provided guidelines governing almost every aspect of hospital operation which is another source for standard of care
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
113
National Patient Safety Goals examples:
• Patient identification
• Communication among caregivers
• Medication safety (with regard to contrast media, radiopharmaceuticals, and other medications used in the imaging department)
• Elimination of wrong site, wrong patient, wrong procedure surgery (this goal
was designed for surgeries, but the principles apply to imaging, particularly digital
radiography, since marking of orientation is sometimes done after exposure,
although this is not recommended)
• Reduction in the risk of health care –associated infections
• Reduction in the risk of patients’ falls
• Encouragement of the active involvement of patient care as a patient safety
strategy
114
NATIONAL PATIENT SAFETY GOALS
Goal 1 Improve the accuracy of patient identification.
Goal 2 Improve the effectiveness of communication among caregivers.
Goal 3 Improve the safety of using medications.
Goal 4 Eliminate “wrong site, wrong patient, wrong procedure” surgery.
Goal 5 [Goal was retired in 2006]
Goal 6 Improve the effectiveness of clinical alarm systems.
Goal 7 Reduce the risk of health care –associated infections.
Goal 8 Accurately and completely reconcile medications across the continuum
of care.
Goal 9 Reduce the risk of patient harm resulting from falls.
Goal 10 Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.
Goal 11 Reduce the risk of surgical fi res.
Goal 12 Implement applicable National Patient Safety Goals and associated
requirements at the component and practitioner site levels
[Networks].
Goal 13 Define and communicate the means for patients to report concerns
about safety and encourage them to do so [Assisted Living, Disease Specific Care, Home Care, Laboratory].
Goal 14 Prevent health care –associated pressure ulcers (decubitus ulcers).
115
An unintentional tort involving duty, breach of
| duty, injury, and causation
Negligence
116
is the degree of care a reasonable person, similarly situated, would use.
Reasonable care
117
Reasonable care may be determined by
| the applicable standard of care, by statute, or by previous judicial decisions, called _____
precedents
118
A breach of the health care provider’s duty to follow the applicable standard of care, which results in harm to the patient
Medical Negligence
119
A health care provider’s failure to follow the
| appropriate standard of care is therefore a special type of negligence called _____
medical negligence
120
medical negligence is sometimes referred to under the general term
medical malpractice
121
Latin term meaning “the thing speaks for itself.”
res ipsa loquitur
122
It is a legal concept invoked
in situations in which a particular injury could
not have occurred in the absence of negligence.
res ipsa loquitur
123
complaint also called
a claim or a petition, depending on the court in which it is brought
124
Expressions of caring include:
```
feelings of compassion and concern,
a philosophy of commitment,
an ethical approach to problems,
altruistic acts,
conscious attention to the needs and wishes of others,
protection of the well-being of others,
nurturing of growth, and
empathy and advocacy
```
125
Such activities as _______ are expressions of caring.
listening, providing information, helping, communicating, and showing respect
126
is a universal phenomenon,
| although expressions, processes, and patterns may vary among cultures.
Caring
127
Other caring activities include
touching, nurturing, supporting, and protecting
128
EXPRESSIONS OF CARING
```
Advocacy,
Altruism,
Commitment,
Compassion,
Concern,
Courage,
Ethical behavior,
Monitoring,
Nurturing,
Protection
```
129
is how an individual interacts with
| another
Human communication
130
This may be through symbolic interaction or language or both. It is transactional
and affective in nature.
Communication
131
is not static, and it involves human feelings and attitudes, as well as the delivery of information.
Communication
132
Philosophically, ____ is an ideal analogous to beauty, truth, and justice; although it is
sought after, it can never be fully attained or perfect in human expression.
Care
133
One danger in discussing ideals is viewing them as achievable and measurable commodities; this leads to the idea that those who fall short of achieving ideal care should be _____
ashamed
134
is the application of the knowledge of a discipline, including its science, theory, practice, and art
Professional care
135
Imaging programs can use a variety of means to instill a desire to increase caring
skills in students:
• Communications classes that address body language and the importance of listening
• Critical thinking classes that focus on recognizing, analyzing, and evaluating ethical
dilemmas
• Discussions of films that illustrate caring scenarios (e.g., The Doctor )
• Empathy rotations that require students to become patients for a day and participate in a variety of imaging patient activities
• Role modeling by instructors and staff technologists, including student evaluation
• Discussions among classmates about experiences with hospitalization and health
care providers, emphasizing the ways in which caring influences outcomes
• A review of patient interviews in which care needs are identified and the department’s response to those needs is evaluated
• Review and discussion of educational and professional materials dealing with issues
of caring
136
strives to recognize and understand the patient’s needs
true active listener
137
is imperative in the ongoing
| improvement of communication in imaging
Investment of time and effort
