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Y2B3 - Early Clinical Experience 📘 > Forensic ⚠️ > Flashcards

Forensic ⚠️ Flashcards

1
Q

what a person should have to make the appropriate and best decision regarding his health?

A

To make any appropriate and best decision, the person should have mental capacity

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2
Q

what is Mental Capacity?

A

Ability to use & understand information to:

1) Make decision

2) Communicate any decision

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3
Q

Who is considered capacious or competent?

A

A person with normal healthy mind and brain function who can generally understand what decision he/she needs to make and its comnsequnces is consisted capacious or competent

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4
Q

Who should assess a doubtful capacity?

A

A psychiatrist or psychologist examine:

  • Does the person have an impairment of the mind or brain? (It doesn’t matter whether this impairment is temporary or permanent at the time of decision)

__________

  • Does the person have a general understanding of:
    a) What decision they need to make and why they need to make it?
    b) Consequences of making, or not making, this decision?

____________
- Is the person able to understand, retain, use and weigh up information relevant to this decision?

____________
- Can the person communicate their decision (by talking, using sign language or any other means)?

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5
Q

what is the definition of Incapacious Person (A person lacks capacity)?

A

A person whose mind is impaired & unable to give a decision

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6
Q

what are examples of Incapacious Person?

A
  1. Mental health conditions e.g. schizophrenia & bipolar disorder & dementia
  2. Severe learning disabilities
  3. Brain damage from a stroke or other brain injury
  4. Physical or mental conditions that cause confusion, drowsiness & consciousness loss
  5. Intoxication caused by drugs or alcohol misuse
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7
Q

what are the charachters of Incapacious Person?

A

Someone with such impairment is unable to make a decision if he/she cannot:

  • Understand information about the decision
  • Remember that information
  • Use that information to make a decision
  • Communicate their decision by talking, using sign language or any other means
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8
Q

Who can give or refuse consent in case of lack of capacity?

A

In case of lack of capacity, adult partner, legal custodian or adult family member who is responsible for the incompetent patient can give or refuse consent

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9
Q

what is the definition of Consent?

A

It is voluntary agreement, compliance or permission

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10
Q

autonomy of consent

A

Is the patient’s right to decide whether to agree (consent) or to refuse (refusal) of certain clinical examination or treatment

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11
Q

Importance of consent

A
  • To examine, treat or operate upon a patient without consent is assault (battery) in law, even if it is beneficial and done in good faith
  • If a doctor fails to give the required information to the patient before taking consent to a particular operation/treatment, he may be charged for negligence
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12
Q

Elements of Consent

A

1) Competence (Capacity)
2) Voluntariness
3) Disclosure (Informed)

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13
Q

what is the consenting age? and how gives consent for those who are under this age?

A
  • more than or equal to 21 years (age of full civil rights in Egyptian law)
  • For a child, or patient of unsound mind, guardian or local authority designated to care for the child can give consent
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14
Q

what are the types of consent?

A

Implied & Expressed

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15
Q

Implied consent

A
  • When patient presents himself at doctor’s clinic, this implies agreement to be examined
  • This does not imply to procedures more complex than inspection, palpation, percussion and auscultation
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16
Q

what do further examinations like rectal, vaginal examinations require?

A

Further examinations:
a) Rectal
b) Vaginal
c) Withdrawal of blood

  • Need expressed permission
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17
Q

Expressed consent

A

It is specifically stated by the patient in distinct and explicit language

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18
Q

what are the types of expressed consent?

A

Oral/verbal consent:
- For minor examinations or therapeutic procedures, in presence of disinterested party (a nursee.g. blood collection & ECG

Written consent
- For:
a) All major diagnostic procedures:endoscopy, bone marrow aspiration
b) General anesthesia
c) Operations

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19
Q

what are the charachters of Informed valid Consent?

A
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20
Q

Charachters of informed refusal

A
  • The patient should be informed that he has right to refuse examination and that the result may go against him. If he refuses, he cannot be examined
  • The doctor must inform the patient about the risks of refusing a particular operation, test, medication, or other medical intervention
  • To be legally valid, such informed refusal must be reduced to writing with signatures of patient, doctor and witness
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21
Q

what makes a consent invalid?

A
  • Not an informed consent
  • Given for committing a crime or an illegal act, such as criminal abortion
  • Obtained by misrepresentation or fraud
  • Given by one who had no legal capacity to give it:
    a) A minor
    b) Insane person or under the influence of drugs or intoxication
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22
Q

Therapeutic Privilege

A
  • The doctor withhold (Hide) from patient the information (as to risk), if the disclosure would cause serious psychological threat to the patient (malignancy or unavoidable total results)
  • However, he should disclose full information to a competent relative
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23
Q

Blanket (open) Consent

A
  • The consent practiced in most hospitals that cover almost everything a doctor might do to a patient
  • Without mentioning anything specific
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24
Q

what are Exceptions to Informed Consent?

A
  • Emergencies (e.g. danger to life or limb)
  • Medico-legal postmortem examination
  • Examination of an arrested accused
  • Treatment of patient suffering from notifiable diseases
  • Psychiatric examination or treatment by court order
  • Prisoners (new entrants)
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25
Q

what is assent?

A

A child’s agreement to medical interventions and research

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26
Q

Assent in children

A
  • Children under 18 & adolescent below 21 can agree to treatment if they’re intelligent, competent
  • Doctors should listen to opinions and wishes of children who aren’t able to give full consent and should try to obtain their assent
  • Children should receive information in easy way to give their assent or dissent
  • Assent must protect the dignity, privacy and confidentiality of the child and his or her family
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27
Q

How should doctors act when treatment is necessary to save life or prevent serious harm?

A
  • The doctor has the duty to act in the best interest of the child
  • If parents refuse to consent, national laws and legal mechanisms may be used
  • The courts can make a decision if treatment is thought to be in the best interests of the child
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28
Q

How should doctors act when n an emergency, where treatment is vital and waiting for parental consent would place the child at risk?

A
  • In an emergency, where treatment is vital and waiting for parental consent would place the child at risk, treatment can proceed without consent
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29
Q

what should a consent be?

A

Consent should be free, voluntary, clear, intelligent, informed, direct and personal

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30
Q

what a consent shouldn’t be?

A

There should be no undue influence, fraud, misrepresentation of facts, compulsion, coercion or other consequences

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31
Q

In what type of language should a consent be?

A
  • The knowledge regarding the intervention should be in understandable language and format so that decision can be made by the patient
  • A doctor should present reasonable information considering best practices
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32
Q

What form should the consent be?

A
  • Should be in a proper form and suitably drafted for the circumstances
  • The more specific the consent, the less likely it will be construed against the doctor or hospital in court
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33
Q

what is considered one of the most important terms of written consent?

A
  • The written consent should be witnessed by another person, present at the signing
  • To prevent any allegation that the consent was obtained under pressure
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34
Q

Recieving consent in case of no nearest relative

A

When there is no nearest relative a physician may provide necessary treatment if:

a) He believes that the proposed treatment is essential

b) another treatment provider agrees in writing that the proposed treatment is essential

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35
Q

Consent in criminal cases

A
  • The victim cannot be examined without consent
  • The court cannot force a person to be medically examined
  • Accused person can be examined by a doctor using reasonable force, if requested by a police officer, if examination may provide evidence
  • Arrested person may be examined by a doctor at his request to detect evidence in his favor
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36
Q

Consent in female examination

A
  • Better made by or under supervision of a female medical practitioner
  • Such an examination by a male doctor must be carried out in the presence of a female nurse
  • In rape cases, the victim should not be examined without her written consent
  • In medico-legal cases of pregnancy, delivery and abortion, the woman should not be examined without her consent
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37
Q

Consent for Sterilization and artificial insemination

A

consent of both husband & wife should be obtained

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38
Q

Consent for Mass immunization

A

law provides the consent

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39
Q

Consent in prenatal diagnostic procedures

A

informed written consent of pregnant woman is obtained and a copy of the consent is given to the woman

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40
Q

Postmortem consent

A
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41
Q

General Guidelines of Consent

A
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42
Q

what is the definition of professionalism?

A

1. A set of values, behaviors, and relationships that underpins the trust the public has in doctors.

2. A set of values, attitudes, behaviors that sets client’s self-interest before ➔ self-interest of the professional.

3.It is a habitual & judicious use of .(CK SFERV)….
- communication
- knowledge
- technical skills
- clinical reasoning
- emotions
- values
- reflection
in daily practice for the benefit of the individual & community.

4. Professionalism is also the moral understanding among medical practitioners that gives reality to what is commonly referred to as the social convention between medicine and society.

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43
Q

what is a mark of excellence for dctors?

A

Professionalism

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44
Q

what happens when a doctor becomes aware of the fact that the people have certain expectations & certain standards for judging the competence of doctors?

A
  • the sense of responsibility increases and improves the patient care
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45
Q

what does professionalism has to do with?

A

❶ effective communication skills
❷ achieving excellence in skills plus ethics.

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46
Q

Professional competence

A
  • Professional competence that should be practiced spontaneously regarding

❶ upgrading your knowledge

❷ improving your skills

❸ better communication

❹ showing your commitments and sympathy

❺ giving good explanation to your judgment armed with values in all aspects that at the end of the day ensure safe patient with full satisfaction for all parties looking after the patient.

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47
Q

Who defined medical profrssionalism?

A

Medical professionalism was defined by many organizations such as

  • the American college of physicians
  • the European federation of internal medicine
  • American College of surgeons
  • American Medical Association
  • Association of American Medical Colleges
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48
Q

Definition of medical professionalism

A
  • an impressive catalogue of virtues in an era when physician autonomy and self- regulation are increasingly challenged by third-party payers, patients and their families, and external critics.
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49
Q

Fair SERI

what are physicians expected to do?

A

Physicians are expected, among other things, to

❶ subordinate their own Interests to the interests of patient (and to assume risk when doing so)

❷ Strive for excellence, knowledge, and competence

❸ work for Fair allocation of health care resources

❹ treat patients, physician colleagues, and other health care professionals with Respect

❺ avoid conflicts of Interest

❻ demonstrate Sensitivity to other cultures.

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50
Q

what are the principles of professionalism?

A

Principles are built upon the establishment of
❶ clinical competence
❷ communication skills
❸ ethical and legal understanding.

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51
Q

what must happen to show professionalism?

A

To show professionalism you must be:
❶ Competent in your field
❷ Good communication skills
❸ Ethical oriented

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52
Q

Definition of professionalism according to ABIM

A
  • The American Board of Internal Medicine (ABIM), who is leader and has explicitly, addressed the definition of professionalism in the 1990s
  • Their widely adopted definition was broad and inclusive and is composed of:
    ❶ 3 commitments
    ❷ 6 elements
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53
Q

Commitments of professionalism according to ABIM

A

❶ To maintain the highest standards of excellence in the practice of medicine

❷ To sustain the interests & welfare of patients

❸ To be responsive to the health needs of society.

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54
Q

Elements of professionalism according to ABIM

A
  • Alturism
  • Accountability
  • Excellence
  • Honors
  • Integrity
  • Respect for others

Profession —> Commitment to professional ethics —-> Make evidence based decisions —-> Life long learner

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55
Q

Professionalism pyramid

A
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56
Q

what is Culture competence?

A

Having a defined set of values & principles that allow to demonstrate others’ behaviors & attitudes that enable them to work effectively cross culturally.

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57
Q

what is Culture sensitivity?

A
  • Awareness that cultural differences & similarities exist, without assigning values (better/ worse, right/ wrong) to those cultural differences
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58
Q

what is Culture knowledge?

A
  • Familiarization with the selected cultural characteristics, history, value, belief systems, & behaviors of members of another ethnic group.
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59
Q

what is language barrier?

A

حاجز في التواصل يظهر بين مجموعة لا تستطيع ان نتحدث نفس اللغة

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60
Q

what are the Pillars of professionalism?

A
  • Probity
  • Alturism
  • Honesty & Integrity
  • Respect
  • Responsibility & accountability
  • Standards
  • Expertise
  • Commitment to excellence
  • Care & compassion
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61
Q

what does Probity mean?

A

The word “probity” is taken from the Latin for good, honest and upright.

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62
Q

According to Probity, A professional person should be ….

A

A professional person should be all these things, as well as Fair & law-abiding and of general good character.

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63
Q

what is Probity considered?

A

Probity is central to the public trust, so medical workers should, through their actions, uphold this reputation.

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64
Q

Give examples for Altrusim

A
  • Pursue to serve patients and their families with perfect clinical care, with their needs first
  • Assists colleagues/ learners to address personal issues and enhance knowledge and skills required in a clinical or educational setting
  • Actively support the educational mission
  • Recognizes that the time and energy specified to performing these functions should not interfere with time for caring for self and family.
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65
Q

what is this? “Pursue to serve patients and their families with perfect clinical care, with their needs first

A

Alturism

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66
Q

Examples of Honesty & Integrity

A
  • One must uphold the highest standards of behavior and refrain from words and actions that would violate one’s personal or professional codes.
  • In learning and study, demonstrating honesty and trustworthiness by referencing sources for intellectual material.
  • Openly identifies personal conflicts that interfere with patient’s care.
  • Make sure the patient can easily understand the provided information and respects patients’ confidentiality
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67
Q

which pillar of professionalism is this?

“In learning and study, demonstrating honesty and trustworthiness by referencing sources for intellectual material”

A

Honesty & Integrity

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68
Q

Respect in medicine

A
  • There are expectations that a professional will work and behave in a manner that is appropriate to the nature of their particular profession.
  • In medicine, these expectations are unique
    ❶ good standards of personal appearance and dress
    ❷ appropriate standards of speech and personal conduct
  • such attributes (1,2) will confirm to a patient an acceptable standard of respectability
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69
Q

Respect Is good-natured in daily interactions with classmates, teacher’s health care professionals, patients, and families

A

…

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70
Q

what does it mean to respect others?and who does this apply to?

A
  • hold and acknowledge in high regard feelings, opinions, and values of the members of the larger medical community whether at school, or in clinical environments.

This should apply to:
❶ individual patients and their families
❷ other health care professionals
❸ colleagues, co-workers
❹ others with whom they come in contact.

  • One must respect the dignity and autonomy of individual patients, take their beliefs and values into consideration, and maintain their confidentiality at all times.
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71
Q

what does responsinility focus on?

A

focuses on what one can do and should do

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72
Q

what is the definition of responsibility?

A

it defines the duty and moral obligation and responsibilities to:
❖ to individual patients
❖ to health care professionals
❖ to society
❖ to the profession.

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73
Q

what does accountability mean?

A
  • is often used interchangeably with responsibility, yet the terms are different.
  • Accountability measures one’s behavior against established rules or norms.
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74
Q

what does placing emphasis on accountability risk?

A
  • Placing emphasis on accountability risks that too much attention may be focused on the rules, with both agent and overseer losing sight of what is ultimately important.
  • By contrast, responsibility implies duty and moral obligation.
  • Hence, the responsibility relationship is one of trust.
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75
Q

what are the doctor responsibilities?

Mnemonic: Fair Chef QR IK

A

❶ Maintain professional competence and be committed to evaluating and upgrading scientific knowledge

❷ Seeks clarity on roles and responsibilities and managing conflicts of interest from colleagues, teachers, staff and preceptors.

❸ Attends to own personal health through nutrition and physical activity and seeks help when physically or mentally ill

❹ Commits to excellence in health care, improving access to care, and optimizing the health of the community

❺ Seeks and gives feedback to colleagues, teachers, staff and preceptors.

❻ Be honest with patients

❼ Respect patient confidentiality

❽ Avoid inappropriate relations with patients

❾ Advance scientific knowledge

❿ Improve quality and access of care

⓫ Promote the just distribution of resources

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76
Q

Standards of a professional

A

A professional person is expected to have the ability and dedication to achieve a set of standards in their duties that their peers find acceptable

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77
Q

Expertise of a professional

A
  • A professional person is expected to have a particular set of skills in their chosen field, at a level that can be considered expert.
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78
Q

A professional person is expected to have a particular set of skills in their chosen field, at a level that can be considered expert, This will have been acquired through:

A

❶ Learning
❷ Knowledge
❸ training and practice of the relevant skills

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79
Q

How is the level of expertise demonestrated?

A

by qualifications or accreditation of some kind.

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80
Q

How is the validity of expertise maintained?

A

by ongoing training throughout the
course of a medical career.

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81
Q

Commitment to Excellence

A

Excellence is a conscientious effort to exceed ordinary expectations

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82
Q

what does Commitment to Excellence imply?

A
  • It implies first a commitment to lifelong learning.
  • Besides, to continually upgrade yourself with new knowledge that requires a commitment to continued learning:

❶ new studies are published that have a direct impact on patient care

❷ practice guidelines are revised and updated

❸ new drugs emerge, and the efficacy and safety of existing drugs are regularly challenged

❹ advances in technology change the way health care is delivered

❺ new legislation and policies have implications on the practice.

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83
Q

Care & compassion

A

To care and to be compassionate are at the very center of the fiducial relationship with the patient.

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84
Q

what is caring in the most basic terms?

A

means to attend to the needs of others and to have personal concern for the well-being of another

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85
Q

What is caring in the professional context?

A

has been defined as expressing attitudes and actions of concern for patients to support their well-being, alleviate Excessive discomfort, and meet obvious or anticipated needs

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86
Q

what does it mean to be compassionate?

A

is to recognize and understand the needs of others but, more important, to act on this compassion and desire to help them.

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87
Q

DRS

Professional Vs. Unprofessional

A

A professional person will

❶ Take pride in doing a job well and pay attention to Detail.

❷ Take personal Responsibility for their actions and the consequences.

❸ Seek to Develop and improve their skills.

❹ Not be Satisfied with a substandard result and will seek to put things right.

❺ Be prepared to Acknowledge mistakes, learn from them and take appropriate steps to prevent recurrence.

❻ Show Respect for those who consult them in a professional capacity.

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88
Q

What does the caring nature of the profession mean?

A
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89
Q

what are examples of Social responsibity?

A

❶ Compassion for those suffering pain and hardship

❷ A proper and responsible role in society

❸ A responsible attitude to the environment

❹ Good employment practices

❺ An awareness of social issues where the medical profession is in a position to play an important or central role

❻ Humanity in both professional and personal matters

❼ Adherence to the law

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90
Q

FB RF CM RML

Role of the students

A

❶ Seek and accept feedback and constructive instruction from teachers, peers, residents and faculty in order to continually improve educational experience, knowledge, and clinical skills.

❷ Commit to the highest standards of competence.

❸ Be mindful of demeanor, language, and appearance in the classroom, in the presence of patients, & in all health care settings.

❹ Admit to and assume responsibility for mistakes in a mature and honest manner and develop productive strategies for correcting them.

❺ Refrain
- from using illicit substances.
- from using alcohol, non-prescription or prescription drugs in a manner that may compromise judgment or ability to contribute to safe and effective
learning.

❻ Be considerate and respectful of others’ (teachers, peers, residents and faculty) time, rights, values, religious, ethnic and socioeconomic backgrounds, lifestyles, opinions, and choices

❼ Meet the expectations for participation and timeliness that are communicated to me by those who teach me.

❽ Recognize limitations and seek help when one’s expertise, knowledge, or level of experience is inadequate to handle a situation in the classroom, hospital, or research setting.

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91
Q

what is the definition of professional secrecy?

A

It means duty of doctor, pharmacist & other medical personnel to keep secrets they know about patient away from divulge, except in certain conditions.

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92
Q

characteristics of Professional secrecy

A

Medical journals: Not allowed to publish names or photographs of patient.

Hospitals: Must keep information & investigations concerning any patient away from non-responsible persons.

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93
Q

what is the doctor obligated to do (concerning professional secrecy)?

A
  • He is obliged to maintain secrets that he comes to know concerning patient in course of a professional relationship except when:
  1. He is required by law to divulge secrets or
  2. Patient has consented for its disclosure.
  • It is mandatory that whatever a doctor sees or hears in life of his patient must be treated as totally confidential.
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94
Q

what does the patient have the right to (concerning professional secrecy)?

A
  • Can sue doctor for damages or face disciplinary action, If disclosure is voluntary & resulted in harm to patient and is not in the interest of public.
  • Disclosure would be failure of trust and confidence.
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95
Q

privacy and confidentiality

A

These terms have been used together in much of teaching we have received; thus, many may think they are synonymous, but they are not

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96
Q

what is the definition of privacy and what is it concerned with?

A
  • Is that right or expectation not to be interfered with, or more generally, a moral right to be left alone
  • Concerned with setting within which patient’s medical information is taken. (i.e., patient’s body)
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97
Q

what is the definition of confidentiality and what is it considered with?

A
  • The Right of an individual to have personal, Identifiable medical information kept out of reach of others
  • Concerned with information collected from / about patient. (i.e. patient’s information) which Includes:
  • Written.
  • Computerized.
  • visual or audio.
  • recorded
  • simply held in memory of health professionals, this information is subject to duty of confidentiality.
98
Q

Should a physician answer any inquiries by third parties?

A
  • Physician should not answer any query by 3rd parties, even when enquired by close relatives, either with regard to nature of illness or any subsequent effect of such illness on patient, without his/her consent.

It includes:

  • The individual’s past, present, or future physical or mental health or condition.
  • Any clinical information about an individual’s diagnosis or treatment.
  • Pictures, photographs, videos, audiotapes, or other materials of the patient.
  • Who the patient’s doctor is and what clinics patients attend and when.
  • Anything else that may be used to identify patients directly or indirectly
  • The past, present, or future payment for the provision of health care to individual.
99
Q

تلك البيس

what are the measures to protect patient’s privacy?

A
100
Q

what are Patients information that Shouldn’t be exposed?

(measures for confidentiality)

A
  • Email & fax
  • Electronic records
  • Manual records
  • All records
  • General measures
101
Q

Email & fax

A
  • Whenever possible, clinical details should be separated from demographic data.
  • All data transmitted by email should be encrypted
102
Q

تلبس

Electronic records

A

Always
- Logout of any computer system or application when work is finished.
- Clear screen of a previous patient’s information before seeing another.

Do not:
- Leave a terminal un-attended & logged in.
- Share Smartcards or passwords with others.

Change:
- passwords at regular intervals to prevent others using them.

103
Q

استر

Manual records

A
  • Hold in secure storage.
  • Tracked if transferred, with note of their current location within filing system.
  • Return to the filing system as soon as possible after use.
  • Stored closed when not in use so that contents are not seen by others.
  • Kept on site unless removal is essential.
104
Q

All records

A
  • Never inappropriately access records.
  • Shut / lock doors, offices & filing cabinets.
  • Query status of visitors / strangers.
  • Advise senior personnel if anything suspicious or worrying is noted.
105
Q

General measures

A

Limit
- Accessibility to medical records.
- Sharing of information with other staff, unless in cases of consultations & second opinion.

Do not
- Discuss patient’s medical information with unauthorized family members.

  • Disclose patient’s information without his/her consent, or in established exceptions (below).
  • Collect information not related to the provision of care.

Set policies

  • that regulate access to medical information & address how any breach to confidentiality is managed.
106
Q

how to achieve privacy and confidentiality?

A
107
Q

Ethical implications of doctor

A
  • There are issues related to the duty of doctors not to harm their patients and to strive to do good for them.

———

  • Breaching people’s privacy and disclosing their medical information irresponsibly is considered to be professional misconduct which might cause psychological, social, and sometimes physical harm to the patient.

———–

  • This harm may extend to their families and colleagues.
108
Q

what is Breaching people’s privacy and disclosing their medical information irresponsibly considered as?

A
  • Considered to be professional misconduct which might cause psychological, social, and sometimes physical harm to the patient.
  • This harm may extend to their families and colleagues.
109
Q

legal implications of doctor

A
  • You are required to keep your patient’s body and medical information private and confidential.

———-

  • Sharing them with the press, or with friends may make you legally liable for your actions.

———

  • You may face unnecessary legal troubles if the patient and/or his or her family decide to sue you or your hospital and claim damages.
110
Q

what could Sharing the patients information with the press, or with friends may make you?

A
  • May make you legally liable for your actions.
  • You may face unnecessary legal troubles if the patient and/or his or her family decide to sue you or your hospital and claim damages.
111
Q

Disclosure of facts about illness to relatives in case of:

  • Major
  • Minor or insane
A

if patient is major (>18 years):
- Physician should not disclose any facts about illness without his consent to parents or relatives even though they may be paying doctor’s fees.

In case of minor or insane person:
- guardians or parents should be informed of nature of illness.

112
Q

Disclosure of facts about illness to community

A
  • A doctor should not disclose illness of his patient without his consent, Even when requested by a public or statutory body, except in case of notifiable diseases.
  • If patient is minor or insane, consent of guardian should be taken.
113
Q

Disclosure of medical information in case of husband and wife

A

Facts relating to nature of illness of one must not be disclosed to other, without consent of concerned person.

114
Q

disclosure of medical information in cases of divorce and nullity

A

No information should be given without consent of concerned person.

115
Q

disclosure of medical information when domestic servant is examined at request of Master

A

physician should not disclose any facts about illness without consent of servant, even though master is paying fees.

116
Q

disclosure medical information of a person in police custody as under trial prisoner

A
  • Has right not to permit doctor who has examined him, to disclose nature of his illness to any person.
  • If convicted: he has no such right & physician can disclose findings to authorities.
117
Q

disclosure of medical information of dead person

A

Any information regarding a dead person may be given only after obtaining consent from a relative.

.

118
Q

what is the definition of Privileged communication?

A
  • Conditions of permissible disclosure of professional secrets.
  • A statment made by a doctor to concerned authority, due to his duty to protect the interests of the community or of the state.
  • Exchange of information between 2 individuals in a confidential relationship —> An exception to professional secrecy.
119
Q

what is a must that should be taken in concern when you do privileged communication?

A

it must be made to person who has a duty towards it.

120
Q

what happens when privileged communication is directed to more than one person or to a person who is not of interest?

A

plea of privilege fails.

121
Q

what are conditions of permissible disclosure of a professional secret?

A
  • request of patient himself
  • For sake of patient
  • For sake of public
  • For sake of medical men
  • In cases of expert witness
122
Q

permissible disclosure of a professional secret under the request of the patient himself

A
  • If patient asks or permits for this disclosure.
  • As a rule, his relatives & parents are not allowed to know his own secrets even after death.
123
Q

permissible disclosure of a professional secret for the sake of patient

A

If patient is mentally diseased, his relatives should be notified for proper care & treatment.

124
Q

permissible disclosure of a professional secret for the sake of public

A

In cases of infectious diseases e.g. typhoid & AIDS:
- To prevent propagation of disease everywhere.
- Proper authorities should be notified.

In cases of diseases that is contraindicated to his job:
- Uncontrolled Hypertension in drivers.
- Gonorrhea among bathers in the swimming pools.

125
Q

permissible disclosure of a professional secret for the sake of medical men

A

If he is accused by malpractice, he is allowed to divulge secrets about diagnosis and treatment followed.

126
Q

permissible disclosure of a professional secret in cases of expert witness

A
  • When a medicolegal expert is asked to give a certain report in a certain problem.
  • Medical persons working for insurance company can refuse to give a report about one of his own patients.
127
Q

can a doctor disclose and discuss medical facts with the other healthcare workers?

A

A doctor can disclose & discuss medical facts of a case with other doctors & paramedical staff, such as nurses, radiologist & physiotherapist to provide better service to te patient.

128
Q

Take home messages concerning professional secrecy

A
129
Q

what is the definition of medical malpractice?

A

Covers all failures in the conduct of doctors, which influence their professional skills, ability and relationships.

130
Q

aspects of medical malpractice

A

civil and criminal aspects

131
Q

define civil aspect of medical malpractice

A
  • damage can be compensated by paying money
132
Q

define criminal aspect of medical malpractice

A
  • Is more serious than civil negligence.
133
Q

Give examples of civil aspect of medical malpractice

A
  • When a patient brings suit (claim) in a civil court for compensation from his doctor, if he has suffered injury due to negligence.
  • When doctor brings a civil suit for the realization of his fees from patient or his relatives, who refuse to pay, alleging professional negligence.
134
Q

give examples of criminal aspect of medical malpractice

A
  • Practically limited to cases in which the patient has died.

Doctor shows
❶ gross incompetency
❷ inattention in the selection application of remedies
❸ Undue interference by him or criminal indifference to the patient’s safety.

135
Q

can the physician be liable to both civil and criminal negligence by a single act?

If yes, Give example

A

Yes, A physician may be liable to both civil and criminal negligence by a single act.

Example:

  • If he performs an unauthorized operation on a patient (illegal abortion)
  • Amputate a wrong limb

He may be sued in civil court for damages and prosecuted in criminal court for assault.

136
Q

what are the types of medical malpractice?

A
  • Professional misconduct (behavior)
  • Incompetence (skills)
  • Medical negligence (care)
137
Q

Definition of professional miscoduct

A

Where the personal, professional behaviour falls below that which is expected of a doctor.

138
Q

Who punishes a medical practitioner if he commits any type of act interfering with the standard conduct (considered as misconduct)?

A
  • The medical council is responsible for his punishment.
  • Any conduct of the doctor who might reasonably be regarded as disgraceful or dishonourable as judged by professional men of good repute and competence.
139
Q

when could registeration be restored?

A

Registration can be resorted within 2-5 years

العقوبات: اللوم والانذار –غرامة مالية تدفع في صندوق النقابة - او الشطب او سحب الترخيص

140
Q

What are aspects of professional misconduct?
(commission or omission)

A
  • Related to certificates & absence from work
  • Related to pregnancy & labor
  • Related to personal ethics
  • Related to ethics towards his work and collegues
141
Q

professional misconduct related to certificates & absence from work

A
142
Q

professional misconduct related to Related to pregnancy & labor

A
143
Q

professional misconduct related to personal ethics

A
144
Q

professional misconduct related to Related to ethics towards his work and collegues

A
145
Q

what are examples of commiting adultery is considered as professional misconduct?

A

Sexual act with mentally ill, unconscious, or anaesthetized patient.

146
Q

Examples of violations to the provisions of Drugs and Cosmetics Act.

A
  • Sell poisons to the public, or prescribe steroids/ psychotropic drugs/narcotics when there is no medical indication.
  • Supply or sell addiction forming drugs to a patient other than medical grounds.
147
Q

what are important offences to professional misconduct?

A

❶ Association with unqualified persons.
❷ Adultery.
❸ Advertising.
❹ Addiction.
❺ Abortion (criminal).
❻ Alcohol.

148
Q

definition of Incompetence

A

Lack of reasonable medical skills (failure to follow the basic medical principles which are not a subject of any discussion).

149
Q

Effects of Incompetence

A

Incompetence leads to minor or fatal mistakes about which the practitioner is responsible about.

150
Q

Prevention of Incompetence

A

Specialists are obligated to update their information and skills for the best practice

151
Q

Definition of Medical negligence

A
  • Lack of reasonable care in diagnosis, treatment & follow up which may result in serious bodily injury (harm/loss)

OR

  • Death of the patient (omission or commission)
152
Q

what are cases that show Medical negligence?

A
  • Where the standard of medical care given to a patient is considered to be inadequate.
  • A physician who very competently delivered the wrong care, however, would also be likely to be found to have been negligent, if their patient had harm or injured.
153
Q

Examples of Medical negligence

A

❶ Leaving towels and instruments after operations.

❷ Prescription overdose of a known toxic substance.

154
Q

who is responsible for Medical negligence?

A

❶ A hospital is liable at law for the negligence of its employed nurses and radiographers.

❷ Doctors are legally responsible about the act of their assistants in his private practice.

155
Q

what are examples of medical malpractice (professional liability)?

A
  • Delay in diagnosis
  • Diagnostic error
  • Therapeutic misadventures (drugs and physicians liability)
  • Inadequate care and follow up by medical and hospital personnel
  • Delayed recognition & improper treatment of medical & surgical complications
156
Q

Delay in diagnosis

A
157
Q

Diagnostic error

A
158
Q

Therapeutic misadventures (drugs and physicians liability)

A
159
Q

what are Examples for universal drug reactions?

A

Anaphylactic shock: acute life threatening reaction including shock, cardiac arrhythmias, cardiac arrest, laryngeal oedema with shocking and respiratory failure.

Drug interaction: between multiple prescribed drugs.

Teratogenic effect: mainly in the 1st trimester leading to fetal malformation.

160
Q

Inadequate care and follow up by medical and hospital personnel

A
161
Q

Delayed recognition & improper treatment of medical & surgical complications

A
  • anaphylactic shock, haemorrhage, cardiac and respiratory failure.
162
Q

Surgical operations responsibility

A
  • The surgeon is responsible about the act of assistants and nurses as long as they act under his direct supervision

EXAMPLE: forgetting of towels & instruments inside the patient.

163
Q

Responsibility in anaesthesia (pre-operative)

A

❶ Proper examination for medical fitness (mainly heart & lungs).

❷ Proper investigations for blood & urine to exclude diseases.

❸ Removal of dentures before operations.

164
Q

Responsibility in anaesthesia (Operative)

A

❶ Adequate observation of vital signs & conscious level.

❷ Proper preparation of the theatre, working apparatus & proper circuits.

165
Q

Responsibility in anaesthesia (Post-operative)

A

❶ Proper care and follow up during recovery from anaesthesia.

166
Q

what are other types of medical negligance?

A
  • Contributory negligence
  • Composite negligence
  • Corporate negligence
167
Q

Definition of Contributory negligence

A
  • Any unreasonable conduct, or absence of ordinary care on part of the patient or his attendant, which combined with the doctor’s negligence contributed to the injury complained of, as a direct cause and without which the injury would not have occurred.
168
Q

Could Contributory negligence be used as defence?and what must a doctor do to use it?

A
  • Yes, in civil cases But not in criminal cases
  • The doctor has to prove patient’s negligence, But, the physician is expected to foresee that the patient may harm himself and to warn according
169
Q

what are examples of Contributory negligence?

A

❶ Patient did not give proper history

❷ failure to follow doctor’s instructions regarding drugs, tests& diet

❸ Leaving the hospital against doctor’s advice.

170
Q

Damages in cases of Contributory negligence

A

Damages awarded by the court may be reduced.

171
Q

Definition of Composite negligence

A
  • Injury is caused to the person without any negligence on his part, a result of the combined effect of the negligence of some other persons (two or more).
172
Q

Who is liabily to harm in cases of Composite negligence?

A

each wrong person is jointly and severally liable to the injured for payment of the entire damages,

173
Q

Who could the injured person sue in cases of Composite negligence?

A

the injured person has the choice of proceeding against all or any of them.

174
Q

Definition of Corporate negligence

A
  • It is the failure of those in hospital administration/ management who are responsible for providing the treatment, accommodation and facilities necessary to carry out the purpose of the institution, to follow the established standard of conduct.
175
Q

Examples of Corporate negligence

A

❶ Provides defective equipment or drugs.

❷ Selects or retains incompetent employees including doctors.

❸ Fails in some other manner to meet the accepted standard of care, and such failure results in injury to a patient to whom the hospital owes a duty.

176
Q

when is a Medical personnel are responsible for malpractice?

A

❶ There was negligence or incompetence from him.

❷ Patient suffered from a harm or damage.

❸ This damage is proved to be resulted from this negligence or incompetence.

177
Q

Definition of Medical maloccurrence

A

It is a legal term which defines a less than ideal outcome that is unrelated to the quality of medical care delivered by the health care team.

178
Q

Examples of Medical maloccurrence

A

❶ Medical & surgical complications that can be anticipated and represent unavoidable risks of appropriate medical care

❷ Complications that arise unpredictably and are unavoidable.

❸ Complications that arise as a result of decisions made by patient and doctor with fully informed consent but appear, in retrospect, to have been a less appropriate choice.

179
Q
  • Maloccurrence is often unrelated to the reasonable risks of quality of care that was provided.
  • In some cases, in spite of good medical attention and care, an individual fails to respond properly.
A

..

180
Q

What are examples of Medical maloccurrence?

A
181
Q

Doctor action in cases of defence against negligance

A
  • The doctor in charge must request an efficient attorney in case of alleged malpractice & should ask for help in the medical syndicate.
182
Q

In case of alleged negligence, the following may be helpful for defence…

A
183
Q

Examples of Error of judgment

A
  • One of the expected risks follows an operation takes place or some known complications occur which lessens the benefit that was hoped .for, he makes an error of judgment
  • Moreover, the doctor is not responsible if the patient does not respond to the treatment.
184
Q

What is the definition of Medical mistake?

A
  • is a situation where a person not intending to do unlawful act, does so because of wrong conclusion or understanding of fact.
185
Q

“No fee was charged for the treatment”

  • Could this be used as defense in negligance cases?
A

No

186
Q

Guidelines for appropriate social media use

A
187
Q

which social media account should be used during interacting with patients?

A

Don’t use personal social networking or social media sites such as Facebook to interact with patients.

188
Q

Context of interaction with patients on social media

A

Any interactions should occur in the context of a physician– patient relationship.

189
Q

Interacting with patients

A
190
Q

Discussion of medicine online

A
191
Q

Privacy / confidentiality in social media

A
192
Q

Disclosure (Social media)

A
193
Q

Posting content

A
194
Q

what should providers be warned about? (Concerning social media)

A

Providers are warned of:

  • The risks of postings being disseminated beyond the intended audience
  • Remarks being taken out of context or misconstrued
  • Content being permanently accessible.
195
Q

Professionalism (Social media)

A
196
Q

what are Fundamentals of professional online behavior?

A
197
Q

what is the definition of Telemedecine?

A
  • Telemedicine is the practice of medicine over a distance, in which Interventions, Diagnoses therapeutic decisions, subsequent treatment recommendations are based on patient data, documents and other information transmitted through telecommunication systems or video-conferencing tools.
198
Q

compare between telemedicine & telehealth

A
199
Q

Types of telemedicine

A

❶ Store and forward
❷ Remote monitoring
❸ Real-time interactive services

200
Q

Definition of Store & forward

A

-It surpasses the need for the medical practitioner to meet in person with a patient.

  • Instead, data such as medical images or biosignals can be sent to the specialist as needed when it has been acquired from the patient.
201
Q

Examples of Store & forward

A

This practice is common in the medical fields of:
- Dermatology
- Radiology
- pathology.

202
Q

Definition of Remote monitoring

A
  • Also known as self-monitoring or self-testing.
  • It uses a range of technological devices to monitor health and clinical signs of a patient remotely.
203
Q

Examples of Remote monitoring

A

This is extensively used in the management of chronic diseases such as:
- cardiovascular
- disease diabetes
- mellitus asthma

204
Q

Definition of Real-time interactive services

A

Interactive services can provide immediate advice to patients who require medical attention.

205
Q

Examples of Real-time interactive services

A

Tele neuropsychology

206
Q

Characters of Real-time interactive services

A
  • There are several different mediums utilized for this purpose, including:
  1. Phone
  2. Online
  3. Home visits.
  • A medical history and consultation about presenting symptoms can be undertaken, followed by assessment similar to those usually conducted in face-to-face appointments.
207
Q

What is a Condition that should be achieved to ensure the good use of telemedicine?

A
  • It has the potential to improve health care but
    must be consistent with in-person services and ethical rules which respect:
  • Patient-physician relationship
  • Autonomy
  • Privacy/Confidentiality
  • Quality of care are mandatory.
208
Q

Ethical guidelines when practicing telemedicine

A
209
Q

Types of physician-patient relationship

A
  • Therapeutic relationship
  • Formal relationship
210
Q

Therapeutic relationship

A
  • A doctor is free to accept or refuse to treat a patient except in emergencies.
211
Q

what is the case in which A doctor is not free to accept or refuse to treat a patient?

A

emergencies

212
Q

what are the circumsatnces in which a doctor has the right to refuse to treat a patient?

A

❶ Beyond his practicing hours.

❷ Not belonging to his specialty or beyond the competence and qualification.

❸ Doctor or any other family member is ill.

❹ Doctor having important social function in family.

❺ Doctor having alcohol.

❻ Patient is malingering

❼ Patient has been defaulting in payment.

❽ Patient or his relatives are abusive/uncooperative.

❾ Patient refuses to give consent.

❿ An unaccompanied minor or female patient.

⓫ When doctor remains engaged with an emergency or more serious case.

213
Q

Formal relationship

A
  • A third party has referred the patient for medical examination; e.g:

❶ Pre-employment.
❷ Insurance policy.
❸ Yearly medical checkups.
❹ Cases of rape or victims of crimes or Medico-legal cases.
❺ In certain psychiatric illnesses referred by court/ police.

214
Q

Doctor duties towards formal relationship

A
  • Doctor has to comply with the directive of the party demanding such examination.
215
Q

Rights & privileges of of Registered medical Practitioners

A
  • Right to choose his patient, but not in emergency
  • Right to use title and description of the qualification to his name
  • Right to practice medicine
  • Right to dispense medicine to his patient
  • Right to possess and supply dangerous drugs to his patients
  • Right to issue medical certificates and medico-legal reports
  • Right to recovery of fees, if the patient does not pay the justified fees, help of court can be taken
  • Right for appointment in public & local hospitals
216
Q

Rights & privileges of patients

A

❶ Access to health care facilities and emergency services

❷ Choice: To choose his own doctor freely.

❸ Continuity: To receive continuous care.

❹ Comfort: To be treated in comfort during illness and follow-up.

❺ Complaint: Right to complain and redressal of grievances

❻ Confidentiality: All information about his illness should be kept confidential

❼ Dignity: To be treated with care, compassion, respect without any discrimination.

❽ Privacy: to be treated in privacy

❾ Refusal: Can refuse any specific or all measures.

❿ Records: Can have access to his records and demand summary or other details

217
Q

Duties of Patient

A

❶ He should furnish the doctor with complete information about the facts & circumstances of his illness

❷ He should strictly follow the instructions of the doctor as regards diet. medicine & lifestyle

❸ He should pay a reasonable fee to the doctor

218
Q

Duties of a doctor

A
  • General duties
  • Duties of Physician towards State (Compulsory duties)
  • Duties of a Physician towards Patients
  • Duties of a Physician in Consultation
  • Responsibility of Physicians towards Each Other
219
Q

General duties of a doctor

A
  • Character of physician
  • Maintaining good medical practice
  • Maintenance of medical records
  • Display of registration numbers
  • Use of generic names of drugs
  • Highest quality assurance in patient care
  • Payment
  • Evasion of legal restrictions
220
Q

Character of physician (General duties)

A
  • A physician should uphold the dignity & honor of his profession and render service to humanity
  • reward or financial gain is a subordinate consideration.
221
Q

Maintaining good medical practice (General duties)

A
  • Improve medical knowledge and skills (up to date)
222
Q

Maintenance of medical records (General duties)

A
  • Physician should maintain the medical records for 3 years from the date of treatment.
  • On request for medical records, they should be issued within the period of 72 h.
  • He should maintain a register of medical certificates issued.
223
Q

Payment (General duties)

A
  • Physician should clearly display his fees in his chamber and/or hospitals he is visiting.
224
Q

Evasion of legal restrictions (General duties)

A
  • Physician should observe the laws of the country in regulating the practice of medicine
225
Q

Duties of Physician towards State (Compulsory duties)

A
  • Poisoning cases
  • Notification
  • Responding to emergency military service as & when required
226
Q

Poisoning cases
Duties of Physician towards State (Compulsory duties)

A
  • Assist police to know whether poisoning is accidental, suicidal or homicidal.
  • Death certificate should mention poisoning & recommend PM examination.
227
Q

Notification

Duties of Physician towards State (Compulsory duties)

A
  • Doctor is bound to give information of communicable diseases, births, deaths & outbreak of an epidemic to public health authorities.
228
Q

Duties of a Physician towards Patients

A
  • Exercise reasonable degree of skills & knowledge (competent) & should not guarantees cure or an assured improvement.
  • Attendance & examination
  • Prescribe proper and suitable medicines
  • Instructions
  • Prognosis
  • Control and warn
  • Third parties
  • Consent
  • Investigations
  • Emergency cases
  • Professional secrecy/ confidentiality
229
Q

Attendance & examination

(Duties of a Physician towards Patients)

A
  • When a doctor agrees to attend a patient, he is under an obligation to attend to the case, as long it requires attention.
  • If the doctor is called by police to attend a case of road side accident, he may give first aid and advice, but no doctor-patient relationship is established.
230
Q

what should a doctor do when he is called by police to attend a case of road side accident?

A
  • he may give first aid and advice, but no doctor-patient relationship is established.
231
Q

Instructions

(Duties of a Physician towards Patients)

A
  • Doctor should give full instructions to his patients or their attendants regarding use of medicines (quantities and timings) and diet.
232
Q

Prognosis

(Duties of a Physician towards Patients)

A
  • The patient or his relatives should have such knowledge of the patient’s condition as will serve the best interests of the patient and the family.
233
Q

Control and warn

(Duties of a Physician towards Patients)

A
  • Doctor should warn patients of the side-effects of prescribed drug
234
Q

Third parties

(Duties of a Physician towards Patients)

A
  • If a patient suffers from an infectious disease, the doctor should warn not only the patient, but also third parties who are close to the patient.
235
Q

Consent

(Duties of a Physician towards Patients)

A
  • A mentally sound adult (> 21 years in Egypt) must be told of all the relevant facts in non-medical terms and in a language the patient understands and then obtain consent.
236
Q

Investigations

(Duties of a Physician towards Patients)

A
  • For proper diagnosis & to know the progress, the doctor should advise investigations, like biopsy, X-rays, etc.
237
Q

Emergency cases

(Duties of a Physician towards Patients)

A
  • He has moral, ethical and humanitarian duty to help the patient in saving his life.
238
Q

Professional secrecy/confidentiality

(Duties of a Physician towards Patients)

A
  • The doctor is obliged to maintain the secrets
  • Disclosure would be failure of trust and confidence.
239
Q

Duties of a Physician in Consultation

A
  • Consultation for patient’s benefit is of foremost importance
  • Unnecessary consultations should be avoided.
  • Consultation is advised with a specialist in some cases
240
Q

Cases in which consultation is advised

A

❶ In case of emergency.

❷ If the patient requests consultation.

❸ In cases where diagnosis remains obscure.

❹ In connection with organ transplantation.

❺ When treatment or operation involves risk of life.

❻ When an operation involves mutilation or destruction of an unborn child.

❼ To take decision about termination of pregnancy case, after 12 weeks and upto 20 weeks of pregnancy.

241
Q

Responsibility of Physicians towards Each Other

A
  • No insincerity, rivalry or envy
    All respect should be observed towards the physician in-charge of the case
  • Consultant not to take charge.
  • Appointment of substitute:
    A physician should accept to attend another physician’s patients during his temporary absence from his practice
242
Q

Display of registration numbers

(General duties)

A
  • Physician should display the registration number accorded to him by the SMC in his clinic & in all his prescriptions, certificates, money receipts given to his patients.
  • Physicians should display as suffix to their names only recognized medical degrees or such certificates / diplomas & memberships / honors which confer professional knowledge

Y2B3 - Early Clinical Experience 📘 (5 decks)

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