Final Exam Review (Ch. 1-10) Flashcards
1
Q
Ethics
A
- Branch of philosophy related to morals, moral principles, and moral judgement
- Morality is being virtuous: practicing right conduct
- Uses reason and logic to analyze problems and find solutions
- Concerned with actions and practices that improve welfare of people in a moral way
2
Q
Utilitarianism
A
- Utiliarianism is the greatest good for the greatest number
- Impact of actions on welfare of society as a whole, rather than merely the individual
- EX: Medicare
- Weakness
- The rights of some people, such as the poor or ill, may be ignored
- Can be result in biased allocations
- The vulnerable may be ignored
3
Q
Utilitarianism Weakness
A
- The rights of some people, such as the poor or ill, may be ignored
- Can be result in biased allocations
- The vulnerable may be ignored
4
Q
Rights-based Ethics
A
- Emphasis on individuals’ rights
- Rights belong to all people
- Weakness
- May result in individualist, selfish behavior—even anarchy
5
Q
Rights-based Ethics Weakness
A
May result in individualist, selfish behavior—even anarchy
6
Q
Justice-based Ethics
A
- Based on a “veil of ignorance” to allow decision-makers to be impartial in their decisions
- Weaknesses
- Unfair for the healthy to subsidize the unhealthy
7
Q
Justice-based Ethics Weakness
A
Unfair for the healthy to subsidize the unhealthy
8
Q
Duty-based Ethics
A
- Focuses on performing duty
- Explores depending on professional role
- Weakness
- Difficult to know who determines one’s duty
9
Q
Duty-based Ethics Weakness
A
- Difficult to know who determines one’s duty
10
Q
Virtue-based Ethics
A
- Emphasis on people, not decisions or principles involved
- Based on character traits such as integrity
- Virtues are good habits
- EX: fairness, honesty, courage, and justice
- Weakness
- A person may become too trusting and complacent
11
Q
Virtue-based Ethics Weakness
A
A person may become too trusting and complacent
12
Q
Medical Ethics
A
- Concerns issues related to practice of medicine
- Explores and promotes principles guiding conduct of healthcare professionals
- Involves the welfare and consideration of others in deciding how to act
13
Q
Why Study Law, Ethics, and Bioethics?
A
- Illegal is almost always unethical
- EX: Although marches during the Civil Rights were illegal, they were certainly not unethical- Basic understanding of law as it applies to medical practice is essential
- It helps to protect patients from poor medical care
- Helps protect employee and employer from lawsuits
- Assists medical professional in making decisions based on reason and logic rather than on just emotion
- We live in a litigious society
- unreasonably prone to go to law to settle disputes
14
Q
Medical Law
A
- Addresses legal rights and obligations that affect patients and protect individual rights, including rights of health care employees
- Provides yardstick to measure of judge actions
- Punishes unlawful actions
- Laws are rules or actions prescribed by a government authority that have a binding legal force
15
Q
Quality Assurance
A
- Gather and evaluate information about services
- Examine results
- Compare information against a standard
16
Q
Felony
A
- Serious crime such as practicing medicine without a license
17
Q
Misdemeanor
A
- Less serious crime such as a traffic violation
18
Q
Medical Practice Acts
A
- Establish state medical boards
- Provide baseline for practice of medicine
- Determine prerequisites for licensure
- Forbid practice of medicine without a licensure
- Specify conditions for renewal, suspension, and revocation of licenses
- Vary from state to state
19
Q
Managed Care Organization (MCO)
A
- Gatekeeper— Primary physician
20
Q
Health Maintenance Organization (HMO)
A
- Offers a wide range of services to members for a predetermined fee by a limited group of providers
- Capitation rate
21
Q
Preferred Provider Organization (PPO)
A
- Patient must use a medical provider who is under contract with the insurer for an agreed-upon fee
- Copayment
22
Q
Exclusive Provider Organization (EPO)
A
- Combines the concepts of HMO and PPO
- Fee for service (FFS)
23
Q
Types of Medical Practice
A
- Solo Practice
- Sole Partnership- Partnership
- Share responsibility for financial and legal matters
- Associate practice
- Share facility, but not accounting or legal responsibility
- Group practice
- Three or more physicians
- Share same facility
- Practice medicine together
- Can be designated as HMO or IPA
- Professional corporations
- Managed by board of directors
- Shareholders
- Protection of individual assets and liability
- Partnership
24
Q
Solo Practice
A
- Sole Partnership
25
Q
Partnership
A
- Share responsibility for financial and legal matters
26
Q
Associate practice
A
- Share facility, but not accounting or legal responsibility
27
Q
Group practice
A
- Three or more physicians
- Share same facility
- Practice medicine together
- Can be designated as HMO or IPA
28
Q
Professional corporations
A
- Managed by board of directors
- Shareholders
- Protection of individual assets and liability
29
Q
Fee splitting
A
- One physician offers to pay another for referral (unethical and illegal)
30
Q
Franchise
A
- Business run by individual to whom franchisor grants exclusive right to market product or service in certain market area (ethical)
31
Q
Franchisees
A
- Persons or companies that hold a franchise
32
Q
Physician’s Rights
A
- Right to select patients
- Right to refuse service to patients
- Right to determine type of services provided
- Right to be paid for services rendered
- Right to withdraw from relationship
- Right to vacation and time off
33
Q
Physician’s Responsibilities
A
- Be professionally competent
- Treat all patients equally
- Not to take “kickbacks” of money or other benefits in exchange for referrals
- Follow AMA code of ethics
34
Q
Physicians’ Duties
A
- Patient welfare above financial interests
- Professional courtesy
- Report any unethical conduct by other physicians
- Recommend second opinions when necessary
- Do not engage in sexual conduct with a patient during the physician-patient relationship
- Do not treat family members except in emergencies
35
Q
Duty to Treat Patients with AIDS
A
- Unethical to refuse to treat, work with, or provide housing for person who is HIV positive or has AIDS
- Physician, by law, must make full report to state about any patient who is HIV positive or has AIDS
- Ethical dilemma
- Report required regardless of consequence
- Ethical considerations
- Persuade patient to inform his or her partner
- Notify authorities if concerned that patient will not inform others
- As last resort, notify patients partner
36
Q
Minor
A
- Person under the age of maturity (18 is most states)
37
Q
In loco parentis
A
- Person assigned by court to stand in place of parents
38
Q
Parents patriae
A
- State takes over care for minor
39
Q
Mature minor
A
- Person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent
40
Q
Emancipated minor
A
- Person in mid to late teens who legally lives outside parents’ or guardian’s control
- Proof should be included in medical record
41
Q
Duty to Treat Indigent Patients
A
- “Dumping crisis”
- EMTALA
- Require patient stabilization in an emergency- Physician has right to select which patients to treat
- Physician does not have right to drop or abandon patients once treatment is agreed upon
42
Q
Professional Negligence and Medical Malpractice
A
- Professional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss, or damage to the patient
- Negligence
- Unintentional action that occurs when a person performs or fails to perform an action that a reasonable person would or would not have committed in a similar situation
- Negligence
43
Q
Feasance:
A
Performing an act or duty
44
Q
Malfeasance
A
- Performing a wrong or illegal act
45
Q
Misfeasance
A
- Improperly performing on otherwise proper or lawful act
46
Q
Nonfeasance
A
- Failure to perform a necessary action
47
Q
Four D’s of Negligence
A
- Duty
- Responsibility established by physician-patient relationship- Dereliction
- Neglect of duty
- Direct to proximate cause
- Continuous sequence of events, unbroken by an intervening cause, that produced injury and without which injury would not have occurred
- Damages
- Injuries caused by the defendant
- Dereliction
48
Q
Duty
A
- Responsibility established by physician-patient relationship
49
Q
Dereliction
A
- Neglect of duty
50
Q
Direct to proximate cause
A
- Continuous sequence of events, unbroken by an intervening cause, that produced injury and without which injury would not have occurred
51
Q
Damages
A
- Injuries caused by the defendant
52
Q
Affirmative defense
A
- Denial, assumption of risk, contributory negligence, comparative negligence, borrowed servant, statute of limitations, and res judicata
- Allows defendant to present evidence that patient’s condition was the result of factors other than negligence
53
Q
Denial defense
A
- Plaintiff must prove defendant did wrongful or negligent act
- Most common defense
- Jury must determine if defendant caused injury
- May bring in expert witness
54
Q
Assumption of risk
A
- Prevents plaintiff from recovering damages if plaintiff voluntarily accepts a risk associated with the activity
- Plaintiff must know and understand risk involved, and choice to accept risk must be voluntary
- Should have signature to document that patient authorizes procedure, understands the risks, and consents to treatment
55
Q
Public Health Records and Vital Statistics
A
- Important events in person’s life
- Used by government to determine population trends and needs
- Mortality rate: Death rate ratio of the number of deaths to population in a given location
- Morbidity rate- The number of sick people or cases of ds. in relationship to a specific population
- Public duty of physicians to report vital events
56
Q
Birth
A
- Physicians must sign certificate of live birth
- Certificate is filed at county clerk’s office in state birth took place
57
Q
Death
A
- Date and time of death
- Cause of death
- How long deceased was treated before dying
- Presence of absence of pregnancy
- Whether autopsy took place
- Death certificate
- Usually must be signed within 24 to 72 hours of death
- Proof that a death has occurred
- Often required to confirm information
- Settling an estate
58
Q
Coroner
A
- Public health officer holds inquest if death from unknown or violent cause
59
Q
Medical examiner
A
- Physician (Pathologist) who investigates unexplained deaths and can perform autopsy
60
Q
Autopsy
A
- Examination after death to determine cause of death by examining the organs and tissue
61
Q
Certain deaths require a coroner’s signature:
A
- No physician present at time of death
- Violent in nature
- Homicide, suicide, accident
- Death as result of criminal action
- An unlawful death
- Assisted suicide
- Result of undetermined causes
- Caused by electrical, radiation, or chemical injury
- Caused by criminal abortion
- Includes self-induced
- Occurring less than 24 hours after hospital admission
- Of a person who had no physician in attendance within 36 hours of death
- Occuring outside a hospital or licensed health care facility
- Suspicious death
- Fall
- Of a person whose body is not claimed by friend or relative
- Of a person of unknown identity
- Of a child underage of two if death is from unknown cause
- Of a person in jail or prison
- Violent in nature
62
Q
Duty to Report AIDS, HIV, and ARC Cases
A
- All states require reports of these cases to local or state department of health
- Who shall report the case varies from state to state (attending physician, laboratory, etc.)
- Many states have confidentiality statutes
63
Q
Disclosure to Patients of Health Workers’ HIV Status
A
- Health care workers consider disclosure an invasion of privacy
- All blood and tissue donors tested
- Patients have desire to know if they are at risk of HIV infection
64
Q
Child Abuse
A
- Child Abuse Prevention and Treatment Act: Requires reporting of all child abuse cases
- All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers
- Probable cause: A reasonable belief that something improper has happened
- Physicians have been held liable for not reporting cases
- Persons reporting is protected by law from being sued by parents and others
- Battered child syndrome— Describes a series of injuries, fractures, bruises, and burns. Signs of neglect, malnutrition, poor growth, poor hygiene
- Parental neglect
- States generally refrain from involvement
- State may have to intervene when a child is not receiving proper medical care
- All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers
65
Q
Elder Abuse
A
- Older American Act (1987)
- Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older
- Protects residents of nursing home facilities
- Protects against financial abuse or exploitation
66
Q
Spousal Abuse
A
- Laws governing the reporting vary by state
- Local police may have to become involved when spousal abuse is suspected
- Court may issue restraining or protective order prohibiting abuser from contact with victim
67
Q
Signs of Abuse
A
- Repeated injuries
- Bruises and unexplained swelling
- Signs of inadequate nutrition
- Unexplained fractures
- Bite marks
- Unusual marks
- Bruising or swelling in genital area
- Venereal disease and genital abrasions
- Makeup to hide bruises
- Sunglasses worn inside to hide blackened eyes
68
Q
Substance Abuse
A
- Abuse of prescription drugs is reportable immediately according to law
- Violation of controlled substances laws is a criminal offense
69
Q
Food and Drug Administration (FDA):
A
An agency within the Department of Health and Human Services that ultimately oversees and enforces laws regarding drug sales and distribution
70
Q
Controlled Substances Act of 1970:
A
A federal statute that regulates the manufacture and distribution of drugs that are capable of causing dependency
71
Q
Medical examiner:
A
A physician, usually a pathologist, who can investigate an unexplained death and perform autopsies
72
Q
Cultural Considerations
A
- Background and experience heavily influence personal beliefs
- Stereotyping: Negative generalities concerning specific characteristics about a group are applied to an entire population
- Bias: Unfair dislike or preference against someone, can prevent a health care professional from making an impartial judgement
- Do not judge a person
- Different cultures have their own practices for personal hygiene
- Ethnocentric people: Tend to believe that their way of viewing and experiencing the world is superior to other’s views
- Communication can be a challenge for many people who do not understand English
- Non-English-speaking patients need brochures and handouts in their own language
- Cultural restrictions can pose difficult situations
73
Q
Religious Considerations
A
- Patient autonomy
- Conditions can result in confusion for the medical professional
- Guardianship may have to be established
- It is never appropriate to judge another person’s customs or beliefs
- Employer has a legal obligation to accommodate religious practices
74
Q
Equal Employment Opportunity and Employment Discrimination
A
- Laws that affect recruitment, placement, pay plans, benefits, penalties, and termination
- People must be judged primarily by job performance
75
Q
Employment-At-Will Concept
A
- Employment-at-will: The employment takes place at either the will of the employer or the employee
- Employment takes place at will of either employer or employee
- Employment may be terminated at will at any time for no reason
- Employee may quit at any time
- Exception for a specific employment contract in which employment cannot be terminated during contract period
76
Q
Equal Credit Opportunity Act:
A
Prohibits businesses (including hospitals) from denying or granting credit based on race and gender, referred to as discrimination
77
Q
Equal Employment Opportunity Act (EEOA):
A
Authorizes the EEOC to sue employers in federal court on behalf of people whose rights have been violated under Title VII
78
Q
Title VII of the Civil Rights Act of 1964
A
- Prohibits discrimination, or unfair treatment based on race, color, religion, gender, or national origin
- Forbids discrimination in all aspects of patient care in institutions that receive federal financial assistance
- Makes sexual harassment a form of unlawful sex discrimination
- Equal Employment Opportunity Commission (EEOC)
- Equal Employment Opportunity Commision (EEOC): The group that monitors Title VII of the Civil Rights Act
- Sexual harassment is a form of unlawful sex discrimination
- Quid pro quo: Something for something (Ex: Sexual favor in exchange for job advancement)
- Affirmative action programs: To remedy discrimination practices in hiring minority group members. Also covered under Title VII
79
Q
Age Discrimination in Employment Act (ADEA):
A
- Protects persons forty years or older against employment discrimination because of age
- Protects persons 40 and older against discrimination
- Applies to employers with 20 or more employees
- Mandatory retirement prohibited except for certain exempt executives
80
Q
Americans with Disabilities Act (ADA):
A
- Prohibits employers who have more than fifteen employees from discriminating against disabled individuals
- Americans with Disabilities Act of 2008 (ADAAA): Broadened and clarified the definition of “disability”
- Americans with Disabilities Act (ADA) of 1990, Amended in 2008
- Prohibits employers who have more than 15 employees from discriminating against individual with disability
- Employer must make reasonable accommodations
- Exception if undue hardship for employer to make accommodations
- AIDS patients protected under this statute
81
Q
National Labor Relations Act (NLRA):
A
- Prohibits employer actions, such as attempting to force employees to stay out of unions, and labels these actions as “unfair labor practices.”
- National Labor Relations Act (NLRA) of 1935, Amended in 1947
- Gives employees right to form and join unions, to bargain collectively, and to strike for better benefits and working conditions
- Purpose of law is to protect employees
- National Labor Relations Act (NLRA) of 1935
- Establishes rights for both employees and employers, and defines some prohibitive acts by employers, called unfair labor practices
- Also called the Wagner Act
82
Q
Occupational Safety and Health Act (OSHA):
A
- Requires an employer to provide a safe and healthy work environment; the employer must protect the worker against hazards
- Occupational Safety and Health Act (OSHA) of 1970
- Employer required by law to provide safe and healthy work environment
- Must protect worker against hazards
- Occupational Exposure to Bloodborne Pathogens Standards
- Standards refer to urine, stool, sputum, nasal secretions, vomitus, and sweat if there is visible evidence of blood
83
Q
Health Maintenance Organization (HMO) Act of 1973, Amended in 1996
A
- Requires company with 25 or more employees to provide HMO alternative to regular group insurance if HMO is available in area
- Under HMO, patient has limited choice of doctors
- Patient may have to get a second opinion and permission from HMO for major procedures
84
Q
Consolidated Omnibus Budget Reconciliation Act (COBRA):
A
- Offers government financing for health insurance coverage continuation after an employee has been laid off their job
- Company with 25 or more employees must provide extended health care insurance to terminated employees for as long as 18 months
- Usually at employee’s expense
85
Q
Equal Pay Act:
A
- Makes it illegal for an employer to discriminate on the basis of gender in payment to men and woman who are performing the same job
- Equal Pay Act of 1963
- Amendment to Fair Labor Standards Act (FLSA)
- Illegal for employer to discriminate on basis of gender if performing same job
86
Q
Worker’s Compensation Act
A
- Protects workers and families from financial problems resulting from employment-related injury, disease, or death
- Employers pay into a fund to help cover costs when employee has work-related injury or disease
- Goal to get employee back to work as soon as possible
87
Q
Medical record:
A
- All the written and computer generated documentation relating to a patient
- Also called the health record
- All written documentation relating to patient, including:
- Past history
- Current diagnosis and treatment
- Correspondence relating to patient
- A legal document
- May be subpoenaed
88
Q
Purpose of the Medical Record
A
- Record of patient from birth to death
- Document for continual management of patient’s health
care - Provides data and statistics
- Tracks ongoing patterns of patient’s health
- Document for continual management of patient’s health
89
Q
Contents of the Medical Record
A
- Personal information about patient
- Clinical data or information
- Records of medical examinations
- X-rays
- Lab reports
- Consent forms
- Referrals: PT/OT
- Prescriptions and refills
- Admitting diagnosis
- Evidence of a physician examination
- Not more than seven days before admission or 48
hours after admission to a hospital
- Not more than seven days before admission or 48
- Documentation of any complications
- Signed consent forms
- Consultation reports
- Physicians’ and health care professionals’ notes
- Discharge summary, with follow-up care
- Should never contain irrelevant material
- Clinical data or information
90
Q
Corrections and Alterations
A
- Errors require correction
- Nothing should be deleted
- Note in the margin of the record why the change was
made - Use black or blue ink
- Draw one line through error
- Write correction above error
- Date and initial change
- Do not erase or use correction fluid
- Note in the margin of the record why the change was
- Electronic health record (EHR) corrections
- Falsification of medical records is grounds for criminal indictment
- Nothing should be deleted
91
Q
Timeliness of Documentation
A
- Medical records must be accurate and timely
- All entries must be made as care occurs or as soon as
possible afterward - Should be completed by physician within 30 days following patient’s discharge from hospital
- All entries must be made as care occurs or as soon as
92
Q
Completeness of Entries
A
- Medical records document type and amount of patient care that was given
- In eyes of court, “if it’s not documented, it wasn’t done”
93
Q
Reporting and Disclosure
A
- State laws require disclosure of some confidential medical record information without patient’s consent
- Reporting and disclosure are duties of the physician
94
Q
Improper Disclosure
A
- Health care providers and institutions may face civil and criminal liability for releasing medical records without proper patient authorization
95
Q
Subpoena Duces Tecum
A
- Written order requiring person to appear in court, give testimony, and bring information described in subpoena
96
Q
Electronic medical record (EMR):
A
Fully computerized method of record-keeping
97
Q
Corrections and Alterations
A
- Errors require correction
- Nothing should be deleted
- Note in the margin of the record why the change was
made - Use black or blue ink
- Draw one line through error
- Write correction above error
- Date and initial change
- Do not erase or use correction fluid
- Note in the margin of the record why the change was
- Electronic health record (EHR) corrections
- Falsification of medical records is grounds for criminal indictment
- Nothing should be deleted
98
Q
HIPAA’s Five Titles
A
- Title I: Protects health insurance coverage for workers and their families when they change or lose their jobs
- Title II: Known as the Administrative Simplification provisions
- Requires national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
- Title III: Sets guidelines for pre-tax medical spending accounts
- Title IV: Sets guidelines for group health plans
- Title V: Governs company-owned life insurance policies
- Title II: Known as the Administrative Simplification provisions
99
Q
Who is affected by HIPPA
A
- Public health authorities
- Health care clearinghouses
- Self-insured employers
- Private insurers
- Information systems vendors
- Various service organizations
- Universities
- Health care plans
- Treatment, payment, and health care operations (TPO)
100
Q
Protected health information (PHI):
A
Any individually identifiable information that relates to the physical or mental condition or the provision of healthcare to an individual
101
Q
Can Protected Health Information (PHI) Be Deidentified?
A
- To “deidentify” patient information, remove:
- Patient’s name
- Address, including e-mail
- Telephone and fax numbers
- All dates, including birth (except year), admission, discharge, and death
- Social security number
- Medical records numbers
- Health care insurance numbers
- License numbers
- Facial photos
- Other identifying numbers or characteristics
- E-mail and website address
- Motor vehicle registration numbers
- Facial photographs, such as found on driver’s license
102
Q
Title I:
A
Protects health insurance coverage for workers and their families when they change or lose their jobs
103
Q
Title II:
A
Known as the Administrative Simplification provisions
- Requires national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
104
Q
Title III:
A
Sets guidelines for pre-tax medical spending accounts
105
Q
Title IV:
A
Sets guidelines for group health plans
106
Q
Title V:
A
Governs company-owned life insurance policy
