Ethics/Legal/Professional Flashcards
Smoking cessation
pts who are either unaware of or appear to be minimizing the harms of smoking can benefit from a nonjudgmental, collaborative approach; this involves asking the pts perspective, knowledge and concerns about smoking; providing relevant information and then eliciting the pts understanding of the information
patient confidentially
prohibits physicians from disclosing a pts protected health information to anyone not directly involved in the pts medical care, including physician colleagues; physicians should not identify their pts when it is not medically necessary because doing so is a breach of pt privacy
informed consent
pts have the right to withdraw consent for a procedure at any time; when pts change their minds and refuse tx, it is the physicians responsibility to engage them in a NEW discussion of informed consent or informed refusal
decision making capacity
when a pt is unable to give consent for care and does not have a designated surrogate, a decision-making capacity falls to the next of kin; in an emergency, the physician can tx an incapacitated pt w/o containing consent
assessment of intimate partner violence (IPV)
routine screening for intimate partner violence includes the use of direct questioning (ex: have you even been hit by your partner?) to encourage disclosure; however pts with suspected active IPV may be less forthcoming and require indirect questioning (ex: How are things going at home?)
protecting patient confidentiality
physicians must be cautious about discussing protected pt health information in public spaces, including public settings within the hospital, even with other medical personnel; conversations regarding pts should be deferred to a later time when a more private setting can be arranged
motivational interviewing
pt-centered approach to help change maladaptive behaviors; acknowledge the pts resistance and develop the pts own motivation to change
veracity: confronting the facts
physicians should disclose medication errors and provide an apology in a timely fashion regardless of whether harm has occurred
root cause analysis
a quality improvement measure that identifies what, how and why a preventable adverse outcome occurred; the first step involves collecting data mainly through interviewing multiple individuals involved in the steps leading to the outcome
obtaining informed consent for tx
informed consent should be obtained by a qualified physician performing the recommended procedure; if informed consent is delegated to another provider on the care team, then the team member must thoroughly understand the procedure to adequately explain it and answer the pts questions
pt autonomy
when family members and pts have different opinions on tx, the pt should be provided the opportunity to talk confidentially w the physician; this respects the pts autonomy and facilities obtaining valid informed consent
pregnant pts affected by intimate partner violence (IPV)
pregnant pts affected by IPV require immediate safety planning (ex: information about domestic violence program) and resources for long-term planning
Closed-loop communication
a form of effective communication used in health care setting and other high risk fields; team members repeat back the information received to ensure that the correct information has been conveyed; this is a highly effective form of communication and reduces the risk of medical errors
Exceptions to informed consent by parent/guardian in minors
minors do not require parental consent for medical tx of conditions that may be sensitive or stigmatizing such as STIs, pregnancy and substance abuse
disclosure of a diagnosis
autonomy, which supports a pts right to know his pr her diagnosis is a fundamental ethical principle; however, limiting disclosure of a diagnosis may be appropriate under certain circumstances (ex: pt preference, imminent safety concerns); an understanding, open approach is necessary to uncover these circumstances
gender identity
gender-diverse pt require culturally competent medical care, which includes a tactful inquiry about preferred identities (ex: name, pronouns) followed by accurate and consistent documentation in the EMR
types of health insurance plans
a health maintenance organization (HMO) is an insurance plan w low monthly premiums, low copayments and deductibles and low total cost for the pt; HMOs reduce utilization by confining pts to a limited panel of providers, requiring referral from primary care provider prior to specialist consults and denying payment for services that do not meet established guidelines
new pt: review of medications (antihistamines)
review of medication to determine if any unnecessary or causing adverse effects is essential in providing high -quality pt care; the cumulative anticholinergic burden of multiple meds is especially problematic for the elderly
unexpected loss
responding to bereaved individuals following a suicide requires a compassionate and open-ended approach; clinicians should acknowledge the bereaved individuals emotional distress and offer to answer any questions pertaining to clinical course and rx that may help to make sense of what happened
directive counseling
directive counseling is ethically appropriate when ONLY ONE option is medically reasonable and has clearly superior evidence-based support
low health literacy
a common and under recognized barrier to healthcare; it is important to assess pts understanding of provided information w/o shaming or causing embarrassment
sensitive information
when discussing sensitive information (ex: HIV testing) w a pt for the first time, the discussion should be private so that the pt can decide if and when to disclose information to friends and family; initial conversations should take place w/o family present
refusal of vaccinations
trust is central to the provider-pt therapeutic alliance and is associated w improved outcomes; distrust by minority pt may result from numerous factors (ex: historical legacy of discrimination); providers can build trust through open-ended discussion and focused reassurance using culturally relevant materials
advanced directives
a healthcare proxy is a person legally designated to make medical decisions if the pt loses decision-making capacity; the healthcare proxy has more authority than all other surrogate decision makers and is expected to act in accordance to the best estimate of what the pt would have chosen
patient-centered medical interviewing
should focus on the pt perspective of the illness; interviews are best initiated w an open-ended question that elicits the pt major concerns in the pt own words; the best approach is to redirect the conversation back to the pt to elicit their perspective
discharge checklist
a discharge checklist detailing medication changes and follow-up appointments can significant facilitate a pts transition from the hospital and improve adherence to outpatient tx; individuals who experience smooth transitions from inpatient to outpatient settings are at lower risk for rehospitalization
advanced directives
during hospital admissions, ALL PATIENTS admitted must be asked about resuscitation preferences and whether advance directives are in place because serious clinical deterioration can happen unexpectedly
preventable adverse event
preventable medical errors involve harm to the pt by act of commission to omission rather than from the underlying disease as the result of failure to follow evidence-based best practice guidelines; this preventable medical error resulted in delayed diagnosis
parent tx refusal
parents often have misconceptions regarding medical conditions and the potential risks and benefits of tx; the initial step in counseling pts regarding tx refusal is to calmly probe their understanding of the disease process
aggression
in agitated pts, especially those admitted for self-limited injuries or recent violence the potential for further violence should be addressed directly; pts should be asked if they are having any thoughts or impulses to hurt themselves or others
counseling pts in treatment failure
failure of oral medications is common in long-standing DM2 due to progressive loss of pancreatic beta cell function; pts should be counseled that because of the natural history of the condition, the need for supplemental insulin is common and does not represent a personal failure
physician fatigue
sleep deprivation in physicians often causes cognitive impairment, resulting in medical errors; although mandated resident work-hour limitations are in place, it is the responsibility of all physicians to self-regulate their workloads to promote pt safety
planned home birth
desiring a planned home birth may reflect low satisfaction or negative experiences w a prior in-hospital delivery; providers should assess what, if any, aspects of the prior in-hospital delivery were concerning to the pt
certification of disability
physicians are frequently asked to evaluate whether a pt is entitled to disability benefits; when interacting w demanding pts; it is best to explain that the physician has a responsibility to perform a thorough assessment prior to making this determination
unexpected concerns
when a pt raises an unexpected concern during an office appointment and adequate time has not been allotted to evaluate it, the physician should generally ask the pt to schedule an appointment at a later date to address that concern; extending appointments w/o having time would make subsequent pt visits late and lead to rushed and incomplete assessments
when pts and families request that “everything” to be done
when approaching goals of care, the specific meaning of a pt or family’s request that “everything be done” should be explored and revisited regularly, including whenever there is a major change in clinical status
acceptance of expensive gifts
it is ethically problematic for physicians to accept expensive gifts as they may influence or appear to influence professional judgement; these gifts should be declined after expressing appreciation for the gesture
respecting pt autonomy
sexual history
takin a sexual history is a key part of comprehensive care and requires an inclusive and nonjudgemental approach; physicians should avoid making assumptions about a pts sexual history and use an open-ended inquiry about all sexual partners
communicating w pt who have limited English proficiency
physicians must ensure the appropriate use of medical interpreters to promote adequate pt understanding and participation in the decision-making process; this is particularly important when obtaining informed consent for tx
bias against uninsured pts
trust is central to the physician-patient relationship and distrust may arise from prior negative experiences; physicians can build trust by identifying shared goals, seeking pt perspectives and prioritizing patient-centered care
Medicare
medicare is a federal socialized medical insurance program that covers elderly and younger individuals w disabilities; the pregnant women, her boyfriend and child (when born) can be covered by Medicaid only, not Medicare
suspected child abuse
physicians are obligated to report suspected child abuse or neglect to child protective services for further investigation; reporting is MANDATORY and reasonable suspicion is sufficient to make a report
sexual assault
physicians are often 1st line of support for survivors of sexual assault; disclosure of sexual assault should be met w supportive, nonjudgemental and patient-centered statements; pts are encouraged to set the pacing of the evaluation
absence of an advanced directive
direction for medical care can be obtained from an advance directive, either living will or previously designates health care proxy; in the absence of one, decision-making defaults to a surrogate who is responsible for making decisions based on what the pt would have chosen
personal questions
physicians should not feel pressured to respond to questions the they find overly personal or intrusive; exploring why pts are asking is a helpful strategy that can assist the physician in gaining a deeper understanding of their specific concerns
alternate therapies
when discussing complementary and alternative medical interventions, the physician should be honest, helpful and nonjudgemental, developing a trusting physician-patient relationship conducive to sharing evidence-based information; physicians should obtain more information on unfamiliar products and follow up w the pt or direct the pt to reliable information sources
Hospice model
patients w advanced metastatic cancers or terminal illnesses and a life expectancy of <6 months should babe evaluated for hospice care
initial encounters
initial encounter w new pts often set the tone for the physician-patient relationship; when in doubt about how to address pts, the physician should ask them their preferred form of address
conscientious refusal of abortions
conscientious refusal of tx occurs when a provider refuses to provide care due to a moral conflict; providers who cannot provide tx that a pt requests are obligated to refer them to a provider that can in a timely manner; this respects the pts autonomy
hearing loss
hearing loss can impair communication, resulting in adverse health outcomes, strategies to improve communication include minimizing background noise, facing the pt and speaking clearly at a normal pace
elder abuse
physicians should be alert for signs of elder mistreatment, including evidence of neglect, deterioration in medical conditions and malnutrition, atypical injuries and behavioral changes; it is mandatory to report suspected elder mistreatment to Adult Protective Services
independent verification
risk of wrong-site surgery can be reduced by requiring “dual identifiers” (usually nurse and physician) to independently confirm that they have the correct pt, site and procedure; checks must be truly independent to ensure pt safety
women who decline pelvic examinations by male health providers
when no female health provider is available. they be offered a female chaperon
capitation
capitation is an arrangement in which a payor pays a fixed, predetermined fee to provide all the services required by a pt; payors may negotiate a capitated contract w an insurance company that then pays the providers or a large medical group may negotiate directly w the payor
