Clinician-pt relationship

Question 1

Describe a Fiduciary Relationship

Answer 1

• clinician has a responsibility to always act in the pt’s best interest
• requires clinician to stay UTD w/ medical knowledge, and advancements in order to provide sound clinical judgement
• requires refraining from divulging confidential PHI

Question 2

What is an implied contract

Answer 2

when a pt and clinician enter into a therapeutic relationship

Question 3

Describe the 5 Laws/Contracts that make up Clinician/Pt Contractual Rights/ Responsibilities

Answer 3

• implied contracts
• 1960 civil law
• Americans w/ Disabilities Act
• Emergency Medical Tx and Active Labor Act (EMTALA)
• Insurance contracts (ie employer contracts or HMOs)

Question 4

What was the focus of 1960 civil law

Answer 4

-made it so practitioners/institutions couldn’t refuse tx based on race, religion, or ethnicity

Question 5

What was the focus of EMTALA

Answer 5

-required EDs to medically screen every patient who sought emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay

Question 6

What was focus of Americans w/ Disabilities Act

Answer 6

prohibited discrimination against individuals with disabilities in all areas of public life

Question 7

What are the 5 events that would allow for Appropriately Terminating Clinician-Pt Relationship

Answer 7

1. tx noncompliance
2. follow up non compliance
3. office policy noncompliance
4. verbal abuse
5. nonpayment

Question 8

What are the 4 events that would Restrict a Clinician from Appropriately Terminating Clinician-Pt Relationship

Answer 8

1. in acute phase of tx
2. only source of medical care
3. only source of specialized medical care
4. member of a prepaid health plan

Question 9

What are the 3 steps a Clinician Should Take to Terminate Their Relationship w/ a Pt

Answer 9

1. provide pt w/ adequate notice
2. offer transfer of records
3. arrange for continuity of care if pt has chronic medical conditions

Question 10

What Elements Should be Included in a Written Termination Letter

Answer 10

• reason for termination
• effective date
• offer interim care
• provide suggestions for continued care
• offer copy of medical records to be sent to new provider
• express pt’s responsibility to f/u and continue medical care w/ new provider
• inform med refills end on effective date

Question 11

Describe the Role of Disclosure of Clinician’s Personal Info

Answer 11

• controversial whether it is appropriate
• pt care should remain primary focus of clinician-pt relationship
• pt’s tend to feel more comfortable/connected when they know certain info about their providers
• in the end, up to the clinician to decide on boundaries based on what is comfortable, professional, and of best interest of the pt

Question 12

Describe When it is Appropriate for a Clinician to Override/Strongly Encourage Specific Actions that are Different than a Pt’s Preferences

Answer 12

• when there is a high likelihood of harm and tx carries little risk
• court orders may be invoked if necessary though rare

Question 13

What are Some Issues That May Arise When Caring for Several Members of the Same Family

Answer 13

• difficult to maintain confidentiality of each family member
• difficult to maintain impartiality

Question 14

Describe Informed Consent

Answer 14

-provide adequate info that is comprehensible to a competent pt or pt surrogate

Question 15

Describe Clinician’s Duty to Disclose

Answer 15

-clinician is required to disclose all relevant info regarding medical tx in order to allow the pt to make a decision about tx

Question 16

Describe Conscientious Objection/Refusal of Information by Providers

Answer 16

• when provider beliefs disallow specific tx to be delivered
• still obligated to give informed consent
• if clinician can’t provide tx preferred to belief can refer

Question 17

Describe Competence

Answer 17

• mental ability to understand problems/ make decisions about accepting/rejecting proposed medical tx
• presumed unless obvious via clinical observation/judicial ruling

Question 18

Describe Decisional Capacity

Answer 18

• ability to communicate/understand info given
• ability to make logical decisions based on info given
• ability to understand current medical status
• ability to understand options for medical care

Question 19

When should Decisional Capacity Assessment be performed

Answer 19

• abrupt changes in mental status noted
• refused recommended tx w/o adequate reasoning
• accept risky tx w/o adequate processing
• known risk of impaired decision making

Question 20

How can Clinician’s Evaluate Decisional Capacity

Answer 20

• ask:
• does pt understand condition/tx
• can pt apply info to their condition
• reasoning consistent w/ facts/values
• can pt communicate their choices clearly

Question 21

What is difference b/w Competence and Decisional Capacity

Answer 21

• decisional capacity is situation-specific

- incompetence is a legal determination

Question 22

When Interacting w/ Pt’s w/ Differing Beliefs/Cultures, how can a clinician determine pt’s belief’s/customs

Answer 22

• ask:
• what do you call your problem
• what do you believe is the cause of your problem
• what course do you expect your problem to take/how serious is it
• what do you think this problem does inside your body/mind
• what do you most fear about this problem
• what do you most fear about tx

Question 23

Describe Implied Medical Consent

Answer 23

• “presumed” consent

- only to be used in emergencies when pt is unconscious/incompetent and no surrogate decision maker is available

Question 24

Describe Refusal of Care

Answer 24

-pt’s right to refuse care must be respected if they are a competent adult

Question 25

When can a Clinician Bypass a Pt’s Refusal of Care

Answer 25

• pt is incompetent

- refusal of tx is a threat to others