Exam 2 Flashcards
A long litany of unsuccessful treatment efforts should serve as a __________
Red flag
T/F As a matter of public policy, any regulated professional will have a very difficult time convincing a court that they can avoid consumer protection by simply having a patient sign a form
True
Independent medical examinations will usually be covered by most malpractice insurances as long as it is a “________ exam”
Hands on exam
T/F D.C.’s can utilize seat belt waivers for their patients as long as there is a medical necessity.
FALSE
Which of the following is NOT a protection strategy for the doctor?
A) Avoid using terminology such as spinal correction
B) Guarantee a cure
C) Avoid fetal X-ray exposure
D) Avoid seat belt waivers
B) Guarantee a cure
Problems may arise when the patient receives the _____ from their insurance company explaining what services were billed for by the doctor
Explanation of Benefits (EOB)
What is the correct code for taking a cervical series (72040) at your office, but not writing a radiology report?
A) 72040-TC
B) 72040-26
C) 72040-25
D) 72040-77
A) 72040-TC
B = X-rays taken elsewhere and the rad report was written by you or DACBR
C = Films were taken and you wrote the report at your facility
D = Outside referral consultation
T/F It is a good protection strategy to record a thorough history
True
A _____________ emphasizing a doctors failure to elicit what appears to be crucial information of the patients past will make this omission reflect adversely on the doctors general competence even if the omission had little connection with the specific malpractice allegation
Skillful lawyer
What is the diagnostic aid DC’s most commonly employ?
X-ray
What is often criticized of chiropractic films?
Poor Quality
T/F The D.C. does not need to take diagnostic quality films if he only uses them for chiropractic analysis
FALSE
-All X-ray films taken by the D.C. must be diagnostic quality
Practicing defensively requires conformity with the current state of the art in arriving at a ____________
Differential Diagnosis
Practitioners debate the efficacy of the cranio-cervical provocative vascular tests (Georges) as a _________
Screening tool
T/F There are no reliable or safe tests that will rule out a VAD in progess. There are no tests that will identify a patient at risk for VAD
True
Warning signs of a VAD
Severe neck/head pain different/worse from any pain the patient previously had
5 D’s and 3 N’s for VAD
- Dizziness
- Drop attacks
- Diplopia
- Dysarthria
- Dysphagia
- Ataxia
- Nausea
- Numbness
- Nystagmus
T/F Never “re-adjust” the patient if they start to develop a VAD
True
T/F All disclaimers have limited value
True
Why is puffing allowed in retail business, but not in the health care field?
Because it comes close to guaranteeing a cure
“Give-a-ways” are always subject to claims of bait and switch, misrepresentation, and _____
Fraud
Use of a technique the patient perceives as forceful can result in a suit for _______
Breach of contract
____________ quickly erodes the relationship which is often the doctors best protection against malpractice claims
Depersonalization between the Dr. and patient
What should all forms, records, and paperwork be?
- Accurate
- Complete
- Timely
- Legible
- Honest
- Professional
In a malpractice context, _______ keeping may be the single best tool available to the doctor for good risk management.
Good record
T/F Seldom are chiropractic reccord badly neglected
FALSE.
-Most chiropractic records are often badly neglected
T/F Never alter patient records
True
-Loss, destruction, alteration or fabrication is morally wrong, certain of detection, and strategically suicide
Doctors should incorporate into the patients records a ____________ to be filled in, dated, and signed by the patient.
Patient progress form
An additional protection strategy closely related to the patient progress notes is the use of _____
SOAP notes
What does SOAP stand for?
-PART?
S- Subjective comments and analysis from the patient
O-Objective observations and findings
A-Assissment
P-Plan
P-Pain, A- Alignment, R-Range of motion, T- Tissue changes
Doctors will always have _________ defending against patient fabrications, but record keeping mesures can help
Difficulty
What 3 options must the doctor do if a patient circles asthma on their ROS from their pre-printed intake forms?
1) Render treatment appropriate to the facts and circumstances revealed
2) Determine if the condition was in the past or has already been treated
3) Pursue the inquiry to determine if the patient is receiving treament or intends to consult an appropriate physician.
(Mandatory the Dr. shows in the record that one of these was done)
T/F It is never safe to ignore patient complaints that have been recorded in the chart
True
T/F It is okay to erase something in the record, provided it has no direct outcome on the patient.
FALSE
- NEVER ERASE
- It has great potential to damage the Dr. credbility
When can a revision or addition to a record be made once litigation or a subpeona occurs?
NEVER
-Once the subpoena or litigation occurs, no record can be revised or altered
T/F Dr. should maintain record in ink
True
Each successive page or card in the patient record should record the ________
Patients name
DNKA
Did not keep appointmnt
-Document missed appointments to show patient is not complying with doctors instructions and treatments.
T/F All states say you can dispose of old records after 5 years
FALSE
-There are many variables in statues from state to state, so the only safe rule is to NEVER dispose of records
Informed consent is a _________ for treatment
Prerequisite
Largely a creature of case law and codified in some jurisdictions
Informed consent
What must the Dr. disclose to the patient in order to secure adequate informed consent?
1) The nature of the procedure employed
2) The material risks inherent in such treatment
3) The probability of those risks occuring
4) The availability and nature of other treatment options, if any
5) The material risks inherent in such options and the probability of such risks occuring
6) The risks and dangers of remaining untreated
The key words to be emphasized in a discussion of risks are _________ and _______
Inherent
Material
Risk that is germane, pertinent, and appropriate for disclosure as part of the decision making process.
Material Risk
What are the 2 standards associated with material risks?
Patient standard = what a reasonable patient would think under the circumstances.
OR….
Physician standard = what a reasonable physician would do in offering advise under the circumstances
T/F The physician standard is considered more objective while the patient standard is considered more subjective
True
T/F An example of a material risk is that one stroke per one million adjustments may occur
True
Risks foreseeable or so frequently associated with certain procedures that they can be reasonably anticipated
Inherent risks
T/F A doctor must supply information to the patient about the risks from remaining untreated
True
T/F Informed consent can easily be utilized by having the patient signing a form.
FALSE
-Informed consent is a process or a procedure and NOT a form
T/F The doctor needs to offer an opportunity for the patient to ask questions or seek clarification during informed consent.
True
T/F Informed consent has a very high standard or care
True
When in doubt about the prognosis of the patient, what should the doctor due to avoid a high standard of care?
Refer out to a specialist
-When in doubt, refer out
What is the traditional standard which requires a medical referral?
Mostrum vs. Pettibon
What 3 requirements must a DC must comply when the patient is in need of medical attention?
1) Recognize a medical problem as contrasted with a chiropractic problem
2) Refrain from further chiropractic treatment when a reasonable DC should be aware that the patient’s condition is not amenable to chiropractic care and continuation of such treatment may aggravate the condition
3) To refer the patient to a medical doctor when a medical mode of treatment is indicated
T/F The D.C. must document the referral in his records
True
Malpractice actions seeking to invoke vicarious liability are generally based on the legal theory of _____________, agency or negligence in the selection of the third person. DC assistants must conduct their activity with reasonable _________
Respondeat superior
Care and skill
Part of vicarious liability. Makes an emplyer accountable for the negligent acts of his employees
Respondeat superior
If an employee commits an act not within the ___________, the doctor may not be held liable in vicarious liability
Scope of employment
-Broad meaning
What are the 2 exceptions that may relieve a D.C. or respondeat superior and not make him liable vicariously?
1) Intentional tortious act by employee
2) Separate, independent duty of employee
T/F All members of a partnership are liable for patient injuries caused by any partner’s negligence while conducting partnership business
True
When doctors go further and act as partners, pool funds, share profits, covering for each other, a sufficient relationship exists between then to warrant each liable for the acts of the other
De facto partnership
T/F Common advertising could be an example of a de facto partnership
True
T/F One way to circumvent vicarious liability is to label associate doctors in your practice as “independent contractors”
FALSE
-If the “employer doctor” has any control over the actions of the “independent contractor” then they are NOT independent and the employer doctor is liable for their actions
What is the first thing the doctor should do after an exposure event?
Contact the insurance company
T/F The doctor should never admit negligence or responsibility
True
If during a CMT, we hear an unusual crack and suspect we cracked the patients rib. What should we do?
Don’t say sorry (tell them we talked about this during the informed consent)
- Take an X-ray to confirm the fracture
- Do NOT charge the patient for the X-ray (emergent care)
