ethics

Question 1

duty to act in patient’s best interest (advise to take meds)

Answer 1

beneficence

Question 2

have the right to choose what is done to their bodies (what treatment and if they will be treated)
may trump physician’s beneficence

Answer 2

patient autonomy

Question 3

do no harm

Answer 3

nonmaleficence

Question 4

physicians must treat people fairly (not based on patient having better insurance, more money, etc)

Answer 4

justice

Question 5

physicians have right to choose what treatments they will and won’t provide
must refer if won’t do

Answer 5

physician autonomy

Question 6

1) child abuse: need to protect victim and notify state
2) disease reporting (STD, TB, hepatitis, food poisioning) - monitor diseases and protect population at large
3) schools - record of illness/vaccines, can be shared among schools if transferring
4) employers - employee may have to provide record of illness, ask about conditions that would affect ability to work, can’t discriminate upon health factors that don’t impact employees ability to work

Answer 6

exceptions to patient confidentiality

Question 7

patient can give permission to family members to know about their health, can resend at any time

Answer 7

confidentiality

Question 8

understanding of procedure
risk involved
expected benefits
alternatives

Answer 8

informed consent

Question 9

exceptions to informed consent

Answer 9

1) lacks decision-making capacity: delerius, demented

Question 10

components of decision-making capacity

Answer 10

1) make and communicate a decision
2) discussed risk, benefits, alternatives - repeat back to ensure understand
3) consistent with values and goals (no coercion)
4) stable decision over time
5) not based on delusions or hallucinations

Question 11

if patient lacks decision-making capacity to give informed consent: need surrogate decision maker

Answer 11

if no advanced directive use substituted judgment: substitute someone else’s consent in place of patient’s consent
decision based on what patient would want

Question 12

if patient lacks decision-making capacity to give informed consent: need surrogate decision maker

Answer 12

advanced directive: instructions patient gives in advance about what they would or would not consent to

Question 13

types of advanced directives

Answer 13

oral AD
written AD (living will): directs physician to grant patient wishes

Question 14

ways to assign a surrogate decision maker

Answer 14

durable power of attorney for healthcare:

more flexible than living will

Question 15

if no surrogate (POA) was ever assigned

Answer 15

spouse > adult children > parents > adult siblings > other relatives

Question 16

informed consent from minors

Answer 16

get informed consent from minor’s parents or legal guardians

Question 17

exceptions where don’t need informed consent to treat a minor (

Answer 17

1) emancipated minors: if at least 16 yo and living on own and managing own finances
2) minor serving a sentence of confinement
3) Sex (contraception, STDs, pregnancy (other than abortion), child of minor - minor can give consent for child)
4) Drugs (addiction)
5) Rock and roll (emergency/trauma)

Question 18

testing strategy for ethics

Answer 18

eliminate wrong choices

quickly choose what you seem to be most reasonable then flag and go back

Question 19

basic principles for ethics questions

Answer 19

1) maintain good physician-patient relationship
2) respect patient rights to privacy + autonomy (CAN ALWAYS REFUSE CARE)
3) never CONSULT ETHICS (never refer!)
4) golden rule: how would I want to be treated?

Question 20

parents want doctor to force pregnant teenager into getting abortion

Answer 20

children of minor (pregnant teenager) is governed by minor parent: the patient has the right to determine what will happen to her child

Question 21

prenatal care (includes miscarriage or ectopic pregnancy) for a minor does not require parental consent but

Answer 21

most states require parental notification or consent in order for minors to have an abortion

Question 22

mom refuses immunizations for infant

Answer 22

patient’s parent has right to refuse vaccinations (patient autonomy = parent)
but public schools/state have right to require vaccinations and refuse to educate children unless they are immunized (waiver does exist)

Question 23

suicidal patient

Answer 23

1) ask if patient voluntarily wants to be hospitalized for treatment
2) if refuse, judge can issue mental health warrant (involuntary hospitalization)

Question 24

unethical for a physician to receive any kind of “kickback” for referring a patient to a specific facility (xray company, surgical center, equipment)

Answer 24

also can’t refer to facility that physician has ownership in

Question 25

quality improvement

Answer 25

DMAIC
Define the problem
Measure: establish an objective baseline
Analyze: identify cause of problem
Improve: identify and implement interventions (re-measure, re-analyze, re-intervene as needed)
Control: maintain the improvement

Question 26

too many patients disharged without flu shot

Answer 26

measure: retrospectively document % that didn’t get flu shot
improve: pop-up on EMR, re-measure in month too see if improved flu shot rates

Question 27

4 elements of malpractice

Answer 27

1) duty to provide medical care
2) breach of duty
3) patient suffered harm due to breach of duty
4) damage due to injury (physical, emotional, financial - loss of income)

Question 28

biggest risk for medical malpractice

Answer 28

lack of good patient-physician relationship

Question 29

if attracted to your own patient

Answer 29

do not pursue
continue to serve as physician as long as you can maintain professionalism
get chaperone if needed

Question 30

patient refuses to take medicine due to side effects

Answer 30

give informed consent
document conversation
work with patient - determine a plan that will work best for patient (don’t abandon patient)

Question 31

reporting inappropriate behavior of colleague

Answer 31

report to physician’s superior

Question 32

giving bad news

Answer 32

physician decides if bad news will be told or not (not family)
ask patient if they want to know. or what would you do if the test result is negative?
if they say they would kill themself - then telling would have negative effect on patient so don’t say anything

Question 33

exceptions to informed consent

Answer 33

1) patient lacks decision making ability or legally incompetent (activate POA)
2) implied consent in emergency
3) therapeutic privilege: withhold info when disclosure would harm patient
4) patient waves right to informed consent (even though healthy and conscious)