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Question 1

how many people in the US have alzheimer’s?

Answer 1

4 million

Question 2

what is the chance of developing alzheimers after age 85

Answer 2

20-40%

Question 3

abdominal pain accounts for what percent of ER visits?

Answer 3

5-10%

Question 4

What is the prevalence of domestic violence?

Answer 4

36.5%

6% of women per year

Question 5

what is the prevalence of chronic kidney disease

Answer 5

13%

Question 6

what is the best treatment option for endstage renal disease

Answer 6

transplant (dialysis is only temporary)

Question 7

does racial profiling occur with dispensing of pain meds?

Answer 7

yes. opioids are more often withheld from AA patients

Question 8

what are the risk factors for kidney disease

Answer 8

HTN, diabetes

Question 9

what is the biggest risk factor for breast cancer?

Answer 9

family history or previous hx of breast ca

Question 10

definition of empathy in the context of patient care

Answer 10

empathy is a predominantly cognitive (rather than emotional) attribute which involves an understanding (rather than feeling) of experiences, concerns, and perspective of the pt, combined w/ a capacity to communicate this understanding, and an intention to help

Question 11

empathy vs sympathy

Answer 11

• empathy is entering into sufferer’s mind and understanding his pain from within as if the pain were ours, but remains his own
  
  • sympathy is sharing feelings together w/ the pt as if the pain is ours and remains so
• overabundance of sympathy can be overwhelming in pt care, thus impeded the clinician’s performance, whereas empathy needs no restraining boundaries
• “compassion fatigue” and “detached concern” are applicable to sympathetic involvement, not empathetic engagement in pt care

Question 12

jefferson scale of empathy

Answer 12

3 factors: perspective taking, compassionate care, walking in pts shoes

• physician empathy is a multidimensional concept
• can be operationally defined and quantitatively measured

Question 13

are empathy scores significantly correlated with global rankings of clinical competence in med school?

Answer 13

yes

Question 14

are empathy scores correlated with performance on standardized exams?

Answer 14

no

Question 15

are women or men more likely to receive higher empathy scores

Answer 15

women

Question 16

T/F: physicians in people-oriented specialties have higher empathy scores than procedure/tech-oriented

Answer 16

True

Question 17

higher jefferson scale of empathy scores associated with…

Answer 17

higher sociability and lower agressive/hostility

• more likely to be nominated by classmates for professionalism attributes
• higher empathy ratings on osce
• higher level of satsifaction in early relationship with mother

Question 18

T/F: pts perceptions of physician empathy is highly correlated with patient satisfaction and patient compliance

Answer 18

True

Question 19

T/F: empathy scores of medical students did not decline during the 3rd year

Answer 19

False; empathy scores do decline in 3rd year

Question 20

what are some reasons that medical students and doctors lose empathy?

Answer 20

inappropriate role models, lack of attention to “art of medicine”, “hidden agenda”, time pressure, sleep deprivation, work load, overly demanding pts, fear of malpractice, lack of autonomy, overreliance on technology

Question 21

2 key empathy studies

Answer 21

1. jefferson study: patients of doctors with high empathy scores were more likely to have good HbA1c and LDL control
2. Italian study: patients of doctors with high empathy scores had fewer acute metabolic complications of diabetes

Question 22

why is physician empathy associated with better patient outcomes?

Answer 22

1. psychosocial level: trusting relationship, more accurate dx and compliance
2. bio-neurological: activate pro-social peptides/hormones; “mirror-neuron system”

Question 23

worldwide how many women experience intimate partner violence? in the US?

Answer 23

worldwide: 1 in 3
US: 1 in 4

Question 24

consequentialist ethics:

Answer 24

utilitarianism: the ends justify the means
limiations: codones potentially harmful actions

Question 25

deontological (kantian) ethics

Answer 25

• adherence to universal moral roles
• it is always wrong to lie, regardless of the consequences
• limitation: when there are conflicting obligations, unable to reconcile which approach takes priority

Question 26

casuistry ethics

Answer 26

• avoid relying on ethical theories
• reach moral conclusions by: looking at details of case; using case comparisons/paradigms for cases to reach moral conclusions
• try to resolve dilemma by examining how similar cases were resolved
• limitation: challenge of finding similar case

Question 27

virtue ethics;

Answer 27

the characteristics of the physician are more important than the doc’s specific action and congruence with specific principles (compassion, discernment, trustworthiness, conscientiousness)
-limiation: virtuous doctors still make bad decisions

Question 28

What are 3 ways that physicians are deceptive?

Answer 28

1. giving false info to third-party players/insurance companies
   - 39% manipulated reimbursement rules
   - 68% lied about a pts Dx to get it paid for
2. false info after medical errors
   - only 40% of medical errors were disclosed to pts
   - 31% of these were preventable, and 75% were considered to be severe
3. minimizing bad news
   - concealing info regarding the Dx and prognosis of Ca may be less stressful for docs than revealing it
   - common to use euphemisms like “growth” or “swelling”
   - withholding info about bad news is not consistent w/ pt preference

Question 29

what are the consequences of physician deception

Answer 29

1. For patients:
   - if medical record inaccurate – harm may occur
   - pt trust in physician may erode (if seen lying to others)
   
   2. For docs:
      
      • threat to medical professionalism and respect for medicine as an honest job
        
        • response to deception may be increased oversight, further challenging physician autonomy
        • loss of licensure/fines
2. For society:
   - the deception of insurance companies undermines:
   - the actuarial foundation of the insurance industry
   - harms others who pay premiums
   - fails to fix system problems
   - loss of trust society has in physicians