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Medical Decisions > Exam 3 Notes > Flashcards

Exam 3 Notes Flashcards

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USMLE® Step 1 flashcards
1
Q

Studies have shown direct correlation between unprofessional behavior in med schools and subsequent….

A

….disciplinary actions by the state medical board

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2
Q

National practitioner databank (NPDB)

A

Web based database of reports to prevent practitioners from state to state without disclosure or discovery of previous damaging performance, includes items such as medical malpractice payments, federal and state licensure and certification actions, etc

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3
Q

Dr Christopher Duntsch

A

Dr Death, operated at multiple facilities on total of 38 patients with 31 having serious outcomes and 2 dying, facilities were hesitant to report for fear of lawsuit, emphasizes importance of utilizing the NPDB (National practitioner data bank)

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4
Q

What is considered unprofessional conduct?

A
  • Violation of any federal or state law that applies to healthcare tasks by the PA
  • claiming to be a physician or representing
  • performing tasks that are not delegated by supervising physician
  • habitual abuse of alcohol or substances
  • signing a blank, undated, or predated prescription form
  • gross or repeated malpractice
  • prescribing controlled substances or drugs for which the PA is not approved
  • Any conduct that is dangerous to the health of the public
  • Failing to use and affix the initials “PA” or “PA-C” after the PA’s name or signature on charts
  • failing or refusing to maintain adequate records on patients
  • false, fraudulent, or deceptive advertising
  • engaging in sexual contact with patient or former patient within 6 months of last medical consultation
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5
Q

How should a PA respond to a medical board complaint? (3)

A
  • Immediately notify supervising physician***, review chart immediately
  • if requested to meet with investigator, have legal council
  • stay factual
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6
Q

Whistleblowing in healthcare

A

A person with knowledge of fraud who brings a lawsuit exposing the fraud and recovering damages on the government’s behalf

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7
Q

Physician Health Program (PHP)

A

Most states have a PHP as part of a federal network thats goal is to help providers with addiction or psychiatric issues to get help they need to be able to continue to practice medicine, can be reported by other or self reported (tends to be looked on more favorably), does have relationship with medical board, can make disciplinary recommendations to the board, provider has to pay for services themselves

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8
Q

Any complaint may be filed with the medical board, and all complaints result in….

A

….an investigation being initiated

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9
Q

Principle of autonomy

A

Based on the principle of respect for persons, ideal that individual persons have right to make their own choices and have right to self governance/self rule/self determination, in medicine translates to principle of informed consent, legal premise linked to right to privacy and law on assault and battery (forbids unwanted touch), applies to medical diagnosis/treatment and research as well

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10
Q

Principle of respect for persons

A

The right to determine what life means by use of own judgement and decisions including right to self determination, therefore a competent adult has the right to make their own healthcare decisions

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11
Q

Institutional ethics committees

A

Utilized in cases where there is questionable legal grounds, courts may accept or reject their recommendations, must keep patients well being as primary focus and should not reflect values of medical professional over the patient, should operate at a level of transparency for patient or surrogate representation

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12
Q

5 components of informed consent

A

1) full disclosure (patient has right to know diagnosis, name/description of proposed treatment, benefits, risks including death, and alternatives)
2) competence (In order for a person to give consent they must have legal capacity to do so - such as being considered an adult or children legally emancipated, not under influence of any drugs or neurologically impaired OR can have surrogate on living will)
3) understanding (obligation to actually communicate and not use technical jargon, speak to level of education, repeat it back to you)
4) voluntary (free from undue influence or coercion)
5) completed consent form/signature (representative that all the above have occurred)

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13
Q

Prudent person rule (reasonable person standard)

A

Rule about disclosure of information where a provider tells the patient what a prudent, reasonable person would need to know to refuse or accept treatment including the diagnosis, nature and purpose, risks and consequences, expected benefits, alternative treatments including doing nothing, prognosis, and costs

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14
Q

2 subtypes of incompetence

A
  • temporary (unconscious or under influence)

- requiring a surrogate (not temporary, think dementia or neurologic deficit)

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15
Q

Strong paternalism

A

Attempt to overrule/override wishes of competent person, usurps right to make decisions, controversial if ever acceptable

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16
Q

Weak paternalism

A

Overriding of temporarily incompetent individuals wishes, attempts to restore patients competence so they can give informed consent

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17
Q

Therapeutic privelege

A

Medical paternalism, withholding info from patient when provider has reason to believe disclosure will have adverse effect on patients condition or health

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18
Q

exceptions to informed consent (2)

A
  • emergency situations
  • Implied consent (procedures of routine diagnostics or those that are non-invasive such as lab work or x rays respectively)
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19
Q

Battery and 4 examples

A

Intentional wrongful act or infringement of a right without an individuals consent

1) failure to obtain consent
2) performs different procedure than that for which consent is given
3) performing procedure on wrong part of body
4) different unconsented-to provider performs procedure

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20
Q

Tort of negligence

A

Failure to exercise care in doing what is otherwise permissible (medical malpractice, substandard care provided)

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21
Q

Religion vs spirituality

A

Religion is a set of beliefs, rituals and practices embodied within an institution or organization or community vs spirituality is how we feel personally about our beliefs and values regarding the afterlife and meaning of the universe

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22
Q

Patients who feel punished within their religion (manifested by their disease state) will have…

A

….worse outcomes on overall health than those who do not

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23
Q

Key values in medicine (7) and which ones overlap with religious key values

A
  • Nonmaleficence (overlaps)
  • beneficence (overlaps)
  • justice (overlaps)
  • autonomy
  • confidentiality
  • truthfulness (overlaps)
  • compassion, service, altruism (overlaps)
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24
Q

Healing vs curing

A

Healing is more holistic and has to do with outlook and relationship of patient to their health vs curing is removal of a disease state, not mutually exclusive as one can be healed or cured or neither and religion plays a role in both

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25
Q

Positives of religion (3)

A
  • encourages healthy moral behavior
  • opposes self indulgence and self destruction
  • provides social support and ethical value system
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26
Q

Negatives of religion (2)

A
  • misuse of religion to do evil

- faith healing use instead of more modern medical approach

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27
Q

Unless a child is emancipated, they do not have the right to make decisions on a….

A

….religious basis (unless the religious values will bring harm or neglect to a child)

28
Q

Roman Catholics beliefs

A
  • life begins at conception and abortion is wrong
  • exception made in case to save mothers life
  • do not believe in in vitro fertilization
  • do not belief in cloning
  • do not believe in euthanasia or any form of suicide
  • animals are allowed in research
29
Q

Church of England and Methodist church beliefs

A

-oppose abortion but may be acceptable in victims of sexual abuse, incest, or to save mother’s life etc

30
Q

Eugenics

A

Study and pracatice of selective breeding applied to humans with aim of improving the species, positive encourages reproduction among the “genetically advantaged” and negative lowers the fertility against “genetically disadvantaged”

31
Q

Human genome project

A

1990 project completed in 2003 to identify and map approximately 20,500 genes, since then other projects have shown Mendelian Inheritance in man (OMIM) for over 12,000 genes identifying all known Mendelian inherited disorders

32
Q

Does a person have to legally disclose to their family members if they test positive for an inherited disease state?

A

No, although some might consider it ethical to do so

33
Q

Preimplantation genetic diagnosis (PGD)

A

A single cell that is removed from an embryo that has been fertilized in vitro, and this cell is tested for genetic abnormalities, if passes test the rest of the embryo can be transferred to the mother’s uterus

34
Q

Chorionic villus sampling (CVS)

A

10-12 weeks of pregnancy, villus cells that have same genetic composition of cells in the fetus and can be used to test for genetic abnormalities

35
Q

Amniocentesis

A

Done between 12-24 weeks of pregnancy to sample amniotic fluid to screen for abnormalities in the fetus

36
Q

Newborn genetic screening

A

Blood sample collected from newborn infants within 24 hours of birth and tested for a panel of disorders up to 32+, can save an infants life if parents consent as early diagnosis and treatment can be imperative for a good outcome

37
Q

Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome

A

Inherited form of disease results in increased risk of colon cancer, ovarian cancer, gastric cancer, high lifetime chance of developing a cancer

38
Q

Familial adenomatous polyposis (FAP)

A

2nd type of hereditary colon cancer, involves mutation of gene that causes hundreds of polyps to grow which then becomes cancerous (often by teens) near 100% chance of developing cancer by 45 with only choice for treatment be removing colon

39
Q

Is Long QT syndrome inherited?

A

A form of it is inherited, many are caused by certain drugs or other conditions

40
Q

BRCA1 and 2

A

5-10% of breast cancers are geneetic and those with mutations on both have 85% greater lifetime chance of developing breast cancer than women with unaffected genes,

41
Q

Genetic Information Nondiscrimination Act of 2008 (GINA)

A

Prohibits discrimination of health coverage and employment based on genetic information, however insurers can charge higher rate for those who are at higher risk due to genetic testing, does not apply to employers with fewer than 15 employees, does not extend life insurance, disability insurance or long term care insurance, does not mandate coverage e for any particular test or treatment

42
Q

Stem cell differences with age

A

Embryologic stem cells have ability to differentiate into any type of cell and proliferate for a year or more in a lab without differentiating, unique from adult stem cells that cannot

43
Q

Henrietta Lacks

A

Patient diagnosed with cervical cancer and passed away but cells taken without her knowledge have been used for numerous research purposes as they continue to reproduce (HELA cells), despite this her family has not received any recognition or compensation, despite her cells being vital to the development of many modern medical techniques such as the polio vaccine

44
Q

LA genetic testing in forensics

A

In Los Angeles the police are able to assist in convictions by asking suspects if they have children or siblings, sampling their DNA, and seeing how close it is a match to crime scene DNA in order to better implicate an individual. It is legal but controversial

45
Q

3 forms of duty

A
  • civic duty (owed to country or society)
  • filial duty (owed to culture or family)
  • legal duty (according to law, not to be negligent)
46
Q

Fiduciary responsibility

A

Highest legal and moral standard of duty agreed to often by boards of directors or others that oversee organizations that state there will be no conflict of interest in acting in the best interest of another party

47
Q

A conflict of interest is not these 3 things, what is it?

A
  • a bias that influences a decision
  • a preconceived notion or belief that guides a decision
  • a decision made where the party it affects believes it harms them where there is no duty to act on the part of the party making a decision

-An individual has an interest in multiple organizations whereas an action or decision for one could corrupt the motivation to act for another

48
Q

In order to win a malpractice settlement, the party must prove they were damaged (economic or pain and suffering) as a result of…

A

….substandard care

49
Q

Standard of care

A

Level and type of care that an ordinary prudent professional with the same training and experience would practice under the same or similar circumstances and with the same or similar resources - not the average professional but the minimally competent one, a breach in this on the part of the provider is negligence

50
Q

Intentional torts

A

Purposeful damages in malpractice, most often result in punitive damages (put a person out of business beyond economic means to ensure no one else is harmed)

51
Q

Trial timeline (8)

A
  • Any provider can be sued
  • penalty exists for frivolous lawsuit
  • Plaintiff files complaint
  • defendant must answer within 2 years of discovery of the damage
  • certificate of merit signed off by provider to see where potential for negligence occurred
  • settlements can be made forgoing trial
  • real trial requires preponderance of evidence (civil) not beyond a reasonable doubt (criminal)
  • collect (supervising physician is held liable in some states)
52
Q

2 types of malpractice insurance

A 
Claims made (policy only provides coverage if the policy is in effect both when incident took place and when lawsuit is filed, requires tail coverage for 7 years, cheaper)
Occurrence (cover any claim for an event that took place during the period of coverage even if the claim itself is filed after the policy lapses, does not require tail coverage, but more expensive and less frequently offered)
53
Q

Recurring issues for allegations of malpractice for healthcare professionals (4)

A
  • insensitivity
  • inadequate, altered, or untimely documentation
  • absence of differential diagnosis
  • not listening to patients or families
54
Q

Recurring medical conditions for allegations of malpractice (4)

A
  • pulmonary emboli
  • imminent CVA
  • pulmonary fibrosis or CHF
  • not diagnosing malignancy
55
Q

Providing a testimony guidelines (4)

A
  • honesty is malleable, do not answer yes or no only
  • ask them to rephrase the question
  • do not expand an answer beyond the response to the question
  • consistency is key
56
Q

Culture vs society vs ethnic group

A

Shared way of life among a group of people transmitted across generations vs a group of people in a specific geographic area sharing culture vs group of people who identify with one another within the society and prevailing culture, sharing common ancestry, country of origin, culture, and language

57
Q

Acculturation definition

A

Process whereby attitudes and behaviors of people from one culture are modified as a result of contact with a different one dependent on length of time, age of individual, socioeconomic status, etc.

58
Q

Explanatory model

A

Idea that how patients think about illness stems from the patients belief system which contains their explanation of the illness based on spiritual, religious, or social circumstances and should drive questions “what do you think caused your problem?”

59
Q

Who can be used as an interpreter? (3)

A
  • a legal requirement trained interpreter
  • not a family member
  • never a child
60
Q

3 major supreme court cases regarding abortion

A
  • Roe v Wade (right of woman to control her body and have abortion)
  • Webster v Reproductive Health Services (restrictions imposed on use of state funds, facilities, and employees in performing, assisting, or counseling about abortions)
  • Planned Parenthood v Casey (can give birth control to minors and discuss options)
61
Q

Opaque definition in regards to abortion

A

Refers to the inability to tell with the technology we have right now when a fetus has a soul objectively

62
Q

Motives for abortion

A
  • Therapeutic (cure a pregnant woman, potentially save her life)
  • Eugenic (what is best traits for society)
  • Socially eugenic (if there is overpopulation or societal need)
  • Juridicial (Mental well being in cases of rape and incest)
  • Good of the family (social, economic factors)
  • Good of the mom
63
Q

Wedge principle

A

Idea that if you open the door for one reason to get an abortion, then its a slippery slope

64
Q

Almost___ of pregnancies were unintended

A

1/2

65
Q

PA’s role in abortion

A

-discuss risks, benefits, burdens, and alternatives

Medical Decisions (3 decks)

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