Knowledge

Question 1

What 2 questions are important to assess a persons’sDecision making capacity?

Answer 1

1. if person can understand information that is relevant to making a decision about treatment
2. Can person appreciate potential consequences of their decision

Question 2

How do you judge a person’s competence

Answer 2

And it’s all person is presumed be competent to make decisions about their care unless they’re reasonable grounds to suspect otherwise the onus is on others to prove incapacity in capacity

Question 3

Attributes of patient-based medicine

Answer 3

• identifies and respects patient feelings and values
• involves patient and significant others
• provides high-quality information
• addresses physical and emotional needs
• provides access to appropriate care
• ensures continuity of care

Question 4

Listening to patients

Answer 4

Requires openness, humility

Question 5

4 questions related to 4 principles

Answer 5

What are patients’ wishes and values?

What can be done for the patient? What are the harms and benefits of the options?

Is the patient being treated fairly? Given the competing claims of others, how can the needs of all be satisfied?

Question 6

How to know when to say no to patient when they are asking for treatment

Answer 6

If treatment is not going to benefit them

Question 7

How to say no to patient

Answer 7

Say no; don’t be vague.
Be kind, not dismissive, explain reasoning.
Offer alternatives (including follow up if no improvement)
Allow them to vent; be empathetic
Understand why they are making the request -> address the underlying reason

Question 8

WHO definition of a good health system

Answer 8

Delivers quality health services to all people, when and where they need them

Question 9

Autonomy

Answer 9

-prioritizing/ incorporating patients point of view into decision making = cornerstone of decision making in medicine

Patient’s: concerns, wishes, values

When patient is competent, wishes should guide decisions about their treatment

Physicians collaborate with the patient; they listen, but question the patient

Ask patient to tell you about themselves

Question 10

Beneficence

Answer 10

Doing good for the patient

Question 11

How to understand patient

Answer 11

Conversation
Listening
Asking focused questions (straight-forward; precise, but brief; able to elicit appropriate response)
Examination
Careful observation
Try to understand what life is like for the patient without making any assumptions

Question 12

Justice

Answer 12

Fairness
Is their reflective of their fair share of health resources
How will the treatment affect/burden others? The family? Other patients? Professional staff?

Question 13

Non-maleficence

Answer 13

Above all, do no harm

Recommend the intervention leading to least possibility of harm for the patient

Most interventions involve possibility of risk (even taking blood)

Can’t be the primary principle; or else therapeutic nihilism (view that any medical treatment is worse than disease)

Some skepticism is appropriate (ie overprescribing dangerous drugs)

Question 14

Best choice

Answer 14

Option where potential benefits outweigh the risks/harms (not objective; subjective to the patient)

Question 15

Non-intentional maleficience

Answer 15

Ignorance
Conflict of interest 
Dishonesty 
Incompetence 
Mental illness 
Lack of fortitude to ration 
Overaggressive Prescribing unproven or ineffective therapies

Question 16

Questions to ask to encourage empathic communication

Answer 16

Please help me understand what you’re experiencing…
What do you understand about your situation right now?
What are you hoping for?
How do you feel about all of this?

Question 17

Other than ethical factors, what else influences making a decision?

Answer 17

Legal
Familial
Aesthetic 
Cultural 
Religious 
Emotional

Question 18

Virtue

Answer 18

Morally upright tendencies; formed by habit

Guide one to pursue the right action

Aristotle: whether one habit or another is inculcated in us from an early age makes all the differences

What would a virtuous person do in this situation?

Question 19

Virtues of good clinician

Answer 19

Compassion: feeling of concern inclining one to empathize with and to desire to relieve the suffering of others

Prudence: taking care, showing due diligence in actions

Altruism: putting the interests of others before ones own

Trustworthiness: commitment to patients

Humility: able to admit one might be wrong, fallible

Self awareness

Openness to criticism

Question 20

Deontology

Answer 20

Right vs wrong = whether something is consistent with duty/ universal rule

Example: lying is wrong, goes against duty of truth telling; physician must always tell patient the truth, regardless of the consequences

Duty: respect for human dignity: Never treat someone I was merely a means to an end

Question 21

Consequentialism

Answer 21

Right vs wrong = based on consequences

Right: promotes happiness

Wrong: causes pain

Option that causes most pain = most wrong

Medicine example: weighing potential benefits vs risks

Criticism: if focus only on outcomes, how can you be sure you can measure what outcomes mean to other people?

Question 22

How do emotions contribute to ethics

Answer 22

Emotions guide us; strong emotions may signal something is more important than other options
Without emotions, ethical reasoning would be lifeless and calculating

Compassion!

Question 23

How to learn about patients story (narrative-based medicine)

Answer 23

Ask patient: what would you like me to know about you?
Listen; don’t interrupt
Elicit patients view of their condition
Ask patients about impact of the illness on their lives
Assess the distress and suffering
Examine your stereotypes and assumptions and patient and their culture
If non-compliant, need to understand why; it’s their hidden story

Question 24

Tests of moral reasoning (questions)

Answer 24

What are the consequences? Benefits/ risks? (Consequentialism)

What if everyone knew?

Is this how you would want to be treated/ how you would treat those close to you?

Can you sleep at night with your choice (conscience)?

What are the universal moral norms? (deontology)

Do your actions make sense once you know the details of the persons story?

Does your action follow from a set of similar cases?

Do your actions maximize the capabilities of others?

Question 25

What influences moral decisions

Answer 25

Institutional regulations
Local laws
Attitudes of your fellow healthcare professionals
Your emotions
Patient’s cultural background, significant others
Social determinants of health (poverty, homelessness, illiteracy)

Question 26

8 Activities of Daily Living

Answer 26

Use toilet
Eat
Dress
Bathe
Groom
Get out of bed 
Get out of a chair 
Walk

Question 27

Independent Activities of Daily Living (without, can’t live safely on own)

Answer 27

Shop for yourself 
Prepare food 
Maintain housekeeping 
Do laundry 
Manage medications 
Make phone calls
Travel 
Handle finances

Question 28

3 people you’d like to have a conversation with

Answer 28

William Osler (father of modern medical education; emphasis on compassionate care, listening to your patients: “the good physician treats the disease, the great physician treats the patient who has the disease”—also born in Ontario)

Question 29

Limits to autonomy

Answer 29

• requests for illegal or unprofessional care
• patient incapacity
• limited resources
• limited knowledge/expertise
• social welfare/ public health interests: violent persons, protection of the public, control of contagious diseases

Question 30

What’s another word for informed “consent”

Answer 30

Informed “choice”

Presenting the patient with information so they can make a choice about their treatment, including whether or not to undergo treatment at all

Question 31

What are the conditions for informed consent in Canada

Answer 31

Modified objective test

Modified = subjective part; “in the plaintiffs position”

Objective = what a reasonable person would want to know to make their decision

Question 32

Why are patients vulnerable when making informed choice

Answer 32

Inherent power and knowledge Imbalance in patient physician relationship

Gravity of the matters involved

Question 33

What principle encourages honest disclosure?

Answer 33

Autonomy and respect for persons

• encouraging valid choice
• promoting patient empowerment
• supporting authentic hope

Question 34

Why is it important to tell the patient the truth

Answer 34

They have a right to know the truth so they can make informed choices about their care

It’s based on your respect from their personhood and autonomy

It’s vital to the trust required for the patient-physician relationship

Question 35

3 elements of informed choice

Answer 35

1. Adequate, truthful disclosure of information
2. Capacity to understand and make decisions
3. Voluntariness of choices made

Question 36

Components of disclosure in consent

Answer 36

1. Nature of the treatment
2. Gravity
3. EXPLAINING (ensuring comprehension by patient):
   - Alternatives (including doing nothing)
   - their benefits, risks (including unlikely risks that are serious) + prognosis

*answer the patients’ questions

Question 37

Privacy

Answer 37

The right of an individual to control the information others have about them

Question 38

Confidentiality

Answer 38

The duty of the HCP to protect sensitive or personal information they have about others from being shared with unauthorized people

Question 39

Legislation for privacy in Canada

Answer 39

Personal information protection and electronic documents act (PIPEDA)—federal

Personal Health Information Protection Act (PHIPA)—Ontario (must meet or exceed expectations in pipeda)

Question 40

Questions for interviewer

Answer 40

What do you love most about McMaster?

If you don’t mind me asking, what is something you like most about McMaster, and what is one thing you would change if you could?

If you are a medical student or a physician, is there any piece of advice you’d like to share, or something you wish you would have known before entering medical school?

How did you choose your specialty?