Chapter Summaries Flashcards
Ethics
- definition
- main purpose
- penalties
- standards/guide to conduct
- elevate standard of conduct
- penalty determined by peers as part of the ethics committee
Moral Values
- definition
- main purpose
- penalties
- personal beliefs created from family, culture, society
- serves as a guide for ethical conduct
- not a penalty, but as a consequence. If you do not have moral values you will have difficulty getting along with others
Bioethics
- definition
- main purpose
- penalties
-medical discipline relating to the ethics concerning biological research
Law
- definition
- main purpose
- penalties
- set of governing rules
- to protect consumers (public)
- upon conviction: fine/imprisonment/license revocation/other penalty determined by court
Explain why knowledge of law & ethics is important to heal care practitioners
To perform at the highest level of your profession and to avoid litigation
Distinguish among law, ethics, bioethics, etiquette, protocol
Law-rules for conduct (protects consumers)
Ethics-rules for governing behavior
Bioethics-study of ethical implications in biomedical research
Etiquette-good manners
Protocol-Expectations of behavior set forth by employer
Define moral values and explain how they relate to law, ethics, and etiquette
Moral values are the ideas and beliefs a person accrues over time from influences of family, religion, environment, etc. Without good moral values you will not have a good base of moral ethics or etiquette. Without those, you will be left vulnerable to legal entanglements.
Discuss the characteristics & skills most likely to lead to a successful career in one of the health care professions
Courtesy, Common Sense, Compassion, People Skills, Technical Skills, Critical Thinking Skills
Describe and compare need and value development theories
Maslow’s Hierarchy of Needs stands on the idea that human behavior is based on specific human needs that must often be med in a specific order
Piaget believed in 4 stages of development (Sensorimotor, Preoperational, Concrete Operational, Formal Operational)
Kohlberg expanded upon Piaget’s model. It may take longer for stages to fulfill. 6 levels in 3 stages (Preconventional, Conventional, Postconventional)
Identify the major principles of contemporary consequence-oriented, duty-oriented, and virtue ethics
Consequence-Oriented (Teleological) says that it is the outcome of the act that determine its moral rightness or wrongness. Utilitarianism is a form of consequence-oriented ethics in which the outcome of the decision made must benefit the majority of people
Duty-Oriented (Deontelogical) says that it is the intent of the action that determine its moral rightness or wrongness. The outcome of the action/decision is irrelevant
Virtue Ethics says that whatever decision the person chooses is the morally right decision because the person is virtuous. The outcome will be virtuous because the person making the decision makes moral choices since he/she is virtuous.
Define the basic principles of health care ethics
Veracity (truth telling)
Justice (give patient what he/she is due)
Role Fidelity (stay within limitations of your capabilities)
Autonomy (patient can decide for themselves)
Beneficence (promote well-being)
Nonmaleficence (do no harm)
Confidentiality (do not misuse or divulge private information)
How do licensure, certification, registration, accreditation differ?
Licensure is a mandatory credentialing process
Certification is a voluntary credentialing process
Registration means you are registered in an official record
Accreditation is the process in which schools, facilities,
health care plans are officially authorized
How are physicians licensed and regulated?
Medical Board enacted by the state Medical Practice Acts
What is the health care team?
Physicians and allied health workers who generally have completed a course of study leading to licensure, certification, or registration in one of the health care professions
What are the different types of medical practice management systems?
Sole Proprietorship- One doctor working as private practice
Associate Practice- Two or more doctors sharing staff and facilities but operating separately
Partnership- Two or more doctors who share all costs of business under contract)
Corporation- Multiple operation under single entity
Group Practice- Three or more doctors functioning together. Can be Partnership or Corporation. Can be same profession or a collective of specialites
What is the basis of law in the United States?
Federal Statutes
Stat Statutes
Municipal Ordinances
Constitutional Law (law derived from federal/state constitutions)
Case Law (established through common law and legal precedent)
Common Law (body of unwritten law developed in England; primarily from judicial decisions based on custom and tradition)
How are laws classified?
Substantive- Statutory (legislative) or written law that defines and regulates legal rights and regulations
-Criminal law involves crimes against the state
(misdemeanor/felony)
-Civil law involves wrongful act against persons
Procedural- law that defines the rules used to enforce substantive law
What are the torts and how do they affect health care practitioners?
A tort is a civil wrong committed against a person or property (excluding breach of contract)
Intentional tort involves intentional misconduct
Unintentional torts are not meant to cause harm but are committed unreasonably or with a disregard for the consequences. In legal terms, this constitutes negligence.
What is a contract, and what are its essential elements?
A contract is a voluntary agreement between two parties in which specific promises are made for a consideration.
The agreement- one party makes an offer, and another party accepts it
The consideration- something of value is bargained for as part of the agreement
Legal subject matter- contracts are not valid and enforceable in court if terms if the services or purposes of the contract are legal.
How do expressed contracts differ from implied contracts?
Expressed contracts are spoke/written in precise terms
Implied contracts aren’t spoken/written in precise terms, but are understood
What are the contractual rights and responsibilities of physicans?
Physician has the right to:
- setup practice w/in the boundaries of his/her license to practice medicine
- setup an office wherever he/she chooses and establish -office hours
- specialize
- decide which services he/she will provide and how those services will be provided
Physician has the obligation to:
- use due care, skill, judgment, and diligence in treating patients
- Stay informed about the best methods of diagnosis/treatment
- exercise his/her best judgment
- consider the established, customary treatment in similar cases
- no experimenting on patient w/o prior approval and consent
- provide proper instructions for post-care
- provide complete information about diagnosis, options, methods of treatment, and fees for services
- take every precaution to prevent the spread of contagious disease
- advise patients against needles or unwise operations
What are the contractual rights and responsibilities of patients?
Patients have the right to:
- receive considerate and respectful care
- receive complete information concerning his/her diagnoses, treatment, and prognosis
- receive information necessary to give informed consent prior to the star of any procedure and/or treatment
- refuse treatment to the extent permitted by law
- receive every consideration of his/her privacy
- be assured of confidentiality
- obtain information about his/her health care
- know whether treatment is experimental and be free to refuse to participate
- expect reasonable continuity of care
- examine his/her bill and have it explained
- know which hospital rules and regulations apply to patient conduct
- terminate the physician-patient contract
Patients are obligated to:
- follow instructions given and cooperate as much as possible
- give all relevant info to physician (if not, physician can’t be held liable)
- follow treatment orders (if not, patient does not have legal recourse)
- pay fees for services rendered
What is the law of agency and how does respondeat superior apply to health care contracts?
Law of agency: employee=agent employer=principal
(governs the relationship between agent and principal)
Respondeat superior: employer is liable for employee acts, if the acts are within the scope of the employee’s duties
What are the three areas of general liability for which physician/employer is responsible?
Employee safety
Grounds of facility
Automobiles used for job fulfillment
Differences between reasonable person standard, standard of care, and duty of care.
Reasonable person standard: individual can be charged with negligence if they acted in a manner that a reasonable person would not have acted or failed to act in a way which a reasonable person would have acted in a similar situation
Standard of care- level of performance expected of a health care practitioner in carrying out his/her professional duties
Duty of care- legal obligation of health care workers to patients and nonpatients
What are the responsibilities of health care practitioners concerning privacy, confidentiality, and privileged communication?
Health care practitioners have a legal and ethical obligation to safeguard a patient’s privacy and maintain confidentiality.
Patients may sue for breach of confidence if protected information is released and results in damage to the patient.
What are the four D’s of negligence?
Duty (responsibility to patient care)
Dereliction (breach of duty of care)
Direct Cause (breach of duty of care was the direct cause to injury)
Damages (legally recognizable injury)
What are the phases of a lawsuit?
Pleading Phase
Interrogatory/Pretrial Discovery Phase
Trial Phase
Appeal Phase
Difference between testimony by deposition and interrogatory testimony.
Testimony by deposition- recorded outside courtroom during pretrial phase
Interrogatory testimony- written set of questions requiring written set of answers under oath
What is alternative dispute resolution?
Settlement of civil disputes between parties using neutral mediators or arbitrators without going to court
What are the four Cs of medical malpractice prevention?
Caring
Communication
Competence
Charting
Why do patients sue?
- unrealistic expectations
- poor rapport and poor communication
- greed
- lawyers and our litigious society
- poor quality of care (either in fact or perception)
- poor outcome
- failure to understand patients’/families’ perspectives and devaluing their point of view
What general categories of information should be documented for legal purposes?
- what treatment was performed and when
- referrals
- missed appointments
- dismissals
- treatment refusals
- all other patient contact
What types of defense may be used in medical malpractice lawsuit?
Denial
Affirmative (contributory negligence, comparative negligence, assumption of risk, emergency)
Technical (release of tortfeasor/person responsible for original wrong, res judicata/double jeopardy, statute of limitations)
What are the common risk management methods?
Quality Assurance/Quality Improvement
Credentialing
What types of professional liability insurance are available to medical providers?
Claims made (only valid for claims made while policy is in force)
Tail coverage (with canceled policies, coverage provided for malpractice claims that occurred during time when policy was in effect)
Prior acts coverage (can only be purchased as new subscriber to insurance policy. Coverage granted for malpractice claims that have not yet occurred/been filed)
Occurence (coverage is granted for any malpractice claims that occur while the policy is in force, regardless of when the claim is made)
Self-Coverage (subscriber pays in to trust fund to pay for potential damage awards)
What purposes do medical records serve?
- they are required by licensing authorities and provide a format for tracking, documenting, and maintaining a patient’s communication data, both inside and outside a health care facility
- they provide documentation of a patient’s continuing health care, from birth to death
- they provide a foundation for managing a patient’s health care
- they serve as legal documents in lawsuits
- they provide clinical data for education, research, statistical tracking, and assessing the quality of health care
What information is entered into a patient’s medical record?
- contact and identifying information/drivers license/emergency contact
- insurance information
- person responsible for payment and billing
- patient’s health history
- dates and times of appointments
- description of patient’s symptoms and reasons for appointments
- examinations performed
- physician’s assessment, diagnosis, recommendations, treatment, progress notes, prescriptions, and instructions to patient
- all test results
- notations of telephone calls
- notations of copies made
- documentation of informed consent
- names of guardians/legal representatives if patient is unable to give informed consent
- all other documentation
- condition of patient at time of termination of treatment
What are the five Cs of entries in medical records?
Concise Complete Clear Correct Chronologically Ordered
What is the accepted manner for correcting errors in a medical record?
- Draw a line through the error
- Write correct information above or below original line
- Note why correction was made
- Enter the date, time, and initial the correction
- Ask a coworker to witness and initial the correction when it is made
Who owns a person’s medical record?
How long should medical records be kept?
The owners of the facility where the records were created
Until the applicable statute of limitations period has elapsed
For what purposes is medical information routinely released?
- insurance claims
- transfer of the patient to another physician
- use in a court of law
What information does the patient need in order to give informed consent?
- proposed methods of treatment
- why the treatment is necessary
- risks involved
- available alternatives
- risks of alternatives
- risks involved if treatment is refused
Who cannot give informed consent?
- minors
- persons who are mentally incompetent
- persons who speak limited or no English
When do Good Samaritan laws protect health care practitioners who stop to help in emergencies?
- when care is given in good faith
- when caregivers act within the scope of their training and knowledge
- when caregivers use due care and under the circumstances
- when caregivers do not bill for their services
What benefits does the federal government ascribe to the adoption of health information technology, including the conversion to electronic health records?
- improving health care quality
- preventing medical errors
- reducing health care costs
- increasing administrative efficiency
- decreasing paperwork
- expanding access to affordable care
What machines require special care in preventing technological threats to confidentiality?
- photocopiers
- fax machines
- computers
- printers
What considerations do federal and state privacy laws share?
- information collected and stored about individuals, and the access of that information, should be limited to what is necessary to carry out the functions of the business, including employees, or government agency collecting the information
- personal information cannot be released outside the organization collecting it unless authorization is obtained from the subject
- when information is collected about a person, that person should know that the information is being collected and should have the opportunity to check the information for accuracy
Which federal laws most extensively regulate health care, including privacy?
- Health Insurance Portability and Accountability Act (HIPAA) of 1996
- American Recovery and Reinvestment Act (ARRA) of 2009
- Patient Protection and Affordable Care Act (PPACA) of 2010
- Health Care and Education Reconciliation Act (HCERA) of 2010
Which HIPAA terms are health care practitioners most likely to routinely use?
- business associate
- covered entity
- covered transaction
- de-identify
- designated record set
- electronic data interchange (EDI)
- electronic transmission
- encryption
- limited data set
- minimum necessary
- Notice of Privacy Practices (NPP)
- patient identifiers
- permission
- protected health information (PHI)
What are the four HIPAA standards and rules?
- Transactions and Code Sets: A transaction refers to the transmission of information between two parties to carry out financial or administrative activities. A code set is any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes
- Privacy Rule: Policies and procedures health care providers and their business associates put in place to ensure confidentiality of electronic, written, and oral protected health information
- Security Rule: Security refers to those policies and procedures health care providers and their business associates use to protect electronically transmitted and stored PHI from unauthorized access
- National Identifier Standards: Provide unique identifiers (addresses) for electronic transmissions
What rules does HIPAA have for disclosing PHI?
- permission from patients required for releasing PHI
- special requirements for disclosing PHI
- civil/criminal penalties for unauthorized disclosure of PHI
- patient’s rights under HIPAA: (1) right to obtain personal medical records (with some exceptions), (2) right to request a change to one’s own medical records, (3) right to request a list of disclosure over the past 3 years, (4) right to request notifications at alternative locations, (5) right to restrict access, (6) right to file a complaint
What recent legislation significantly changed HIPAA privacy, security, and enforcement rules?
-American Recovery and Reinvestment Act (ARRA) of 2009
(Title XIII, called the Health Information Technology for Economic and Clinical Health (HITECH) Act)
What patient rights does HIPAA define?
- access to medical records and the right to copy them
- request for amendment to designated record set
- request for an accounting of disclosures of PHI
- request to be contacted at an alternate location
- requests for further restrictions on who has access to PHI
- right to file a complaint
