Ethical dilemmas

Question 1

physician is caught under the influence. who do you report to?

Answer 1

must report suspected physician impairment to appropriate state regulatory board - like a physician health program or state medical board

Question 2

decision making capacity depends on:

Answer 2

communication of a choice, understands information provided appreciates consequences rational given for decision

Question 3

communicates a choice is

Answer 3

pt can clearly indicate a preferred treatment option

Question 4

understands information provided

Answer 4

pt understands having a condition and treatment options.

Question 5

appreciates consequences

Answer 5

pt acknowledges having condition and likely consequences of treatment options including no treatment

Question 6

rational given for decision

Answer 6

pt able to weigh risks and benefits and offer reasons for decisions

Question 7

if patient is able to articulate reasons for decision and shows no signs of delirium psychosis and severe depression that could understand information then

Answer 7

he has right to refuse treatment and decision should be respected

Question 8

what if pts has mild cognitive impairment (MOCA 24/30)

Answer 8

irrelevant to making decisions for oneself as long as no evidence of ability to understand consequences is affected

Question 9

Risk factors for elderly abuse

Answer 9

advanced age>80 yrs depression, female hx of stroke or hip fracture dementia poor socioeconomic status suspicious care taker behavior indication of financial exploitation

Question 10

physical signs of elderly abuse

Answer 10

skin tears, abrasions, and bruises lacking adequate explanation on trunk or other unusual locations fractures in sites not typical of osteoporotic fractures (long bones of arms or legs) dehydration or malnutrition pressure ulcers signs of sexual abuse (bruised breasts or anogenital trauma)

Question 11

what to do for suspected elderly abuse?

Answer 11

call adult protective services

Question 12

if physician friend wants a medication do you do it?

Answer 12

no, best to get a referral to independent physician who can perform a comprehensive clinical assessment in the pts best interest.

Question 13

what to do in “near miss” events:

Answer 13

since pt was not harmed you don’t need to report to htem but rather you need to report to the hospital administration to identify weaknesses in the system of care that jeopardize pt safety. This is meant to help form corrective measures. Near misses are more common but root causes should be evaluated.

Question 14

when an error is corrected before harming a patient a doctor should

Answer 14

use professional judgement when considering to inform the pts. IT can distress or confuse them unnecessarily. If the pt is aware of the near miss, then disclosure is recommended as not talking about it may increase anxiety and talking about it will improve trust and confidence.

Question 15

Medical errors that impact patient care or causes harm to patient

Answer 15

should be disclosed promptly.

Question 16

conflict of interest

Answer 16

must be appearance or even the conflict of interest of there’s a potential for financial incentives to influence medical judgement of physician (consciously or unconsciously) need to disclose it

Question 17

SPIKES mneumonic for family meetings

Answer 17

Question 18

if pt is an organ donar and it’s appropriate, who approaches the family and pt about organ donation?

Answer 18

Need to contact the organ donor network.

never appropriate for physician or any member of the medical team taking care of patient to approach family for consent for organ donation.

action can be misinterpreted as malicious and harmful to patient if family thinks that care is being withdrawn to harvest organs.

Question 19

“res ipsa loquitur” situation in which someone gets sued

Answer 19

the thing speaks for itself

situation where persons suffer injury caused by an action of another party that would not have otherwise occurred.

it does not require expert witness testimony as it is a clear violation of standard practice even to a layperson.

Ex: tool left in someone after surgery. Wire left in person after CVC.

Question 20

abandonment is

Answer 20

violation of principle that if a provider is unwilling to treat a patient provider must provide care until new provider is located.

can be cause for legal action.

seen in religious doctors who are dealing with someone who wants an abortion.

Question 21

vicarious liability

Answer 21

this is you are held liable for the negligent actions of another person

(ie doctor held liable for actions of the RN or attending with a negligent resident)

Question 22

“volenti non fit injuria” refers to

Answer 22

person who knowingly places himself at risk for danager cannot sue for any resulting injuries.

Question 23

if someone is goding and there is a needle stick injury that happens, what to do next

Answer 23

employee should leave the code and go the ED for care.

HIV antiretroviral therapy can significantly reduce the risk for seroconversion if taken following an exposure.

Question 24

how to effectively manage termination of a physician patient relationship?

Answer 24

if a doctor-patient relationship is irreparably compromised because of lack of trust, lack of mutual goals, failure to maintain an effective working relationship despite efforts to resolve differences then relationship can be terminated.

send pt a formal written warning informing him that patient physician relationship is to be terminated unless he is able to meaningfuly participate in plan of care.

Terminate relationship when pt is medically stable and alternative care is present.

Question 25

if patient threatens a physician or staff member then

Answer 25

termination of doctor-patient relationship can be immediate.