Final Exam Flashcards
What can patient regulation serve as?
risk management protection strategy and long term practice building strategy
What are some qualities of a “comparison shopper”?
- pocketbook more important than healthcare
- temptation to ignore needed tests
- waive copay or deductible
Does the patient have the right to decline tests or treatment? What do they not have the right to do?
yes they can deny test/tx, but they do not have to right to receive tx unless they are willing to submit to the doc’s dx protocol and recommendations
What are some qualities of a “previous doctor basher”?
- reporting dissatisfaction w/incompetent doc, hospitals etc.
- bad experience with 1 or 2 docs
What is a warning sign of a previous doctor basher?
long litany of unsuccessful tx efforts
What are some qualities of the “flatterer”?
- “heard so many good things about you”
- no one else could help
- claims doc can cure their illnesses
- standard that will be difficult to meet
What are some qualities of the “scholar”?
- researched their symptoms/condition
- medical jargon
- already with dx
- question every phase of care; take control
What are some qualities of the “trendy health fanatic”?
- bring articles from health magazines/websites
- insists doc incorporate into tx
- a lot of diet/exercise changes
- leaping from tx to tx
What are some qualities of the “responsibility shifter”?
- done all they can by going to your office
- refuses to lose extra weight, quit smoking etc.
- it’s docs job to keep them fit/healthy
What are “special patients”?
- friends, family, other docs, long time pts
- temptation to “cut corners”
What should you do if you have a difficult patient?
- allow for a reasonable opportunity to find another doc
- pre withdrawal letter if relationship can be salvaged
- document missed appts, failure to comply to recommendations etc.
Can doctors just refuse care to an est. pt?
No
- difficult to determine reasonableness
- few wks to months
- follow up with a certified letter
What are benefits for a doctor to control the creation of a doc-pt relationship?
- delay it form starting
- intake documentation may limit relationship
- assess for potential problem patients
What should be included in the initial documentation?
- state that the doc has the right to accept or reject potential patients until completing a hx and exam
- hx and exam are meant to determine if you can help pt
- don’t charge for initial consultation if you do not accept the pt
What are specific circumstances where the dr-pt relationship should be limited?
- limited purpose exams
- work phys, sport phys
- IMEs
- state this is a one time screening
Is there still a possibility for litigation in limited exams?
yes there’s a chance for failure to dx a condition
-or for a “negative” or unfavorable report to school or employer
What are IMEs?
- independent medical examinations
- make sure malpractic ins covers
- only provide clinical info
What will most insurances cover for IMEs?
- hands on exam
- possibly not for only a paper review
What could you lose if you up code, mis-code or code unbundling?
- participation in ins programs
- automatic payment status
- personal liberty
What can happen if a skillful lawyer mentions failure to obtain a thorough hx?
-can reflect adversely on the docs general competence even if it had little connection with specific malpractice allegation
What are examples of non-delegable tasks?
- obtaining informed consent
- making the dx
What are benefits of symptom logs?
- reduce inconsistencies between pt and dr’s recall of symptoms described
- describe progression of symptoms
What is the MC diagnostic aid DC’s use?
x-rays
How are diagnoses of metastatic bone dx usually acquired?
through radiological imaging and can not be determined by a physical examination or inspection
When was the first alleged malpractice lawsuit for failure to take an x-ray?
April 1896
If you take a film that comes out low quality, what should be done?
repeat the film before beginning tx
What are the five “Ds”?
dizziness drop attacks diplopia dysarthria dysphagia
What are the 3 “Ns”?
nausea
nystagmus
numbness
What are some liability complications with VAD symptoms after adjustment?
- failure to recognize, write off as “normal/typical” rxn
- failure to monitor and document progress of pt and your thought process
- failure to manage situation properly and in timely manner
- readjusting pt
- sending pt home
- acting casual “you might want to see another provider”
- failure to document
What are some table safety measures?
- unplug when office is closed and even locking tables
- install safety locks
- disclaimers have limited value
What is the issue with “puffing” in ads?
- comes close to guaranteeing a cure
- if a pt feels lied to or taken advantage of = more likely to sue
“give-a-ways” are subject to what types of claims?
- bait and switch
- misrepresentation
- fraud
What is breech of contract?
act of breaking the terms that was set out in a contract
What may be the single best tool available to the doctor for good risk management?
good record keeping
What should be done so that there is verification of the patient being in the office?
use daily sign in sheets but cover previous signatures
What are ways to document patient progress?
- patient progress forms
- SOAP notes
What is the purpose of the assessment in the SOAP note?
to reconcile subjective and objective components and note their deviation
What 3 options does the doctor have when a patient has checked multiple problems on a form?
- render tx appropriate to the facts and circumstances revealed
- determine if the condition indicated was in the past or has already been treated
- pursue the inquiry to determine if the patient is receiving tx or intends to consult an appropriate physician
What should be done if an amended entry is made that you feel may be significant to issues of patient and physician competence?
have two people initial entry
What should each page or card have in a patient’s record?
patient’s name and unique identifier
How long should you keep records?
since there are many variables in statutes of limitations and they change unexpectedly, you should never dispose of them
What are the 2 primary functions of records and forms?
- help provide quality patient care
- protect the doctor
What is a material risk?
one that is germane, pertinent and appropriate for disclosure as part of the decision making process
What are 2 types of material risk?
- patient standard
- physician or professional standard
What is physician standard?
provide info as a reasonable physician would do under same or similar circumstances
What is patient standard?
provide info as a reasonable patient under same or similar circumstances need to make an informed and prudent decision
Which material risk standard is described as “subjective”?
patient standard
Which material risk standard is described as “clinically objective and emotionally detached”?
physician standard
Which material risk standard is more “demanding” and which is more “forgiving”?
- patient = demanding
- physician = forgiving
How is material risk estimated?
by statistical analysis
What determines the requirement of disclosing certain risks?
seriousness of consequences
-less serious, less likely courts require disclosure
What is an Inherent Risk?
risks that are foreseeable or so frequently associated that they can be reasonable anticipated
What are some examples of inherent risks?
- soreness
- audibles
- rib fx
- may hurt worse
What should you do if a patient denies treatment?
have them sign a notation in the patient file acknowledging a decision not to accept tx as their own and is made contrary to professional advice
What if a patient refused to sign a notation denying tx?
send a certified letter with similar considerations
What is informed consent categorized as?
a process/procedure NOT a form
-a form can be used to document the event
What is included in informed consent?
- nature and character of tx
- anticipated results of tx
- recognized alternative tx
- recognized serious possible risks and anticipated benefits involved in tx and in alternative tx including no tx
Which lawsuit hold the traditional standard which required a medical referral?
Mostrom vs Pettibon
What are the 3 requirements a DC must comply when a patient is in need of medical attention?
- recognize a medical problem as contrasted with a chiropractic problem
- refrain from further chiro tx when a reasonable DC should be aware that the condition is not amendable with chiro tx
- refer the pt to a medical dr when a medical mode of tx is indicated
How is the Wisconsin referral requirements different that Washington’s?
Wisconsin says that the DC only had to recognize that the problem was beyond his expertise, but had no duty to make the referral
What should you do if you refer a patient to another doctor?
- monitor referral
- forward patient records and patient’s authorization
- referral follow up
- document referral in records
What is a demanding legal burden?
the responsibility for negligent acts of an employee
What is vicarious liability?
holds a person who is otherwise fault free, liable for the negligence of another
What is respondeat superior?
holds the employer responsible for torts committed by their employees within the scope of their employment
What are the 2 exceptions to respondeat superior?
- intentional tortious act by employee
- separate, independent duty of employee
Are both partners responsible if an act is committed by one partner?
yes, unless the partner acts outside of the partnership
How does vicarious liability differ in a professional corporation?
the corporation is responsible for all employees, however each employee is insulated from personal liability for negligent acts of others in corp.
What is a de facto partnership?
when doctors commit actions where a sufficient relationship can be made
such as act as partners, pool funds, share profits, cover for each other etc.
What is a general agent?
someone who is employed to do all the acts connected with a particular trad, business or employment
What should you do after an exposure event?
- express genuine concern without admitting guilt
- do not admit negligence or responsibility
- contact insurance company
What is irrebuttable presumption?
assumes the missing records contained incriminating inromation
What are the duties of the insured?
- report accurately the scope and natuer of the practice to be insured
- pay premiums
- cooperate with company
When is the patient’s expectation of confidentiality waived?
once a suit is filed
-dr can ethically release info to his attorney and insurer
What are 2 duties of coorperation the insurance company has with the insured?
(1) persons that may owe contribution or indemnity are those persons that might be involved in the injury or share responsibility to the injury (associates, assistants, manufactures, etc) may be brought into the suit (2) the insured shall not voluntarily make any payment, or incur any expense (any private
settlement)
What are the forms of the discovery process?
- interrogatories
- depositions
- request for production of documents
What are written interrogatories?
when the plaintiff and defendant can each submit questions to the other
-shortens depositions
What is a deposition?
a discovery process by which lawyers for each party ask questions of witnesses in person
What should be done before a deposition?
predeposition conference with defense counsel
