Midterm #1

Question 1

Ethical Principles it involves

Answer 1

– Autonomy
– Beneficence
– Non-maleficence
– Justice

Question 2

Models describing the Pt/Dr relationship

Answer 2

• Paternalistic model
• Informative model
• Interpretive model
• Deliberative model

Question 3

Paternalistic model

–The guardian

Answer 3

–Principle = Dr = make (nearly) all decisions for a patient

–Assumptions = People = not always rational/mature. Experts know better about the needs of patients.

–Problems = Qualified doctors have good will.
Are the needs of patients objective? How can we be sure that doctors have good will?

–Concerns = Threats autonomy// Assumes Pt does not understand or like the plan

Question 4

Informative model

– Competent technical expert

Answer 4

Principle = The doctor should provide all the relevant information for the patient to make a decision, and provide the selected intervention on this basis.

Assumptions = A fact/value division of labor yields the best medical result.
What is good for a patient depends on what his/her personal values.

Concerns = What if the patient is unconscious or incompetent?
What if the patient is making choices unacceptable by our ethical standards? Third party payers’ role

Question 5

Interpretive model

–counselor or advisor

Answer 5

–Principle = The doctor should help the patient articulate his/her values through interpretation, and provide intervention which is truly desired.

–Assumptions = Patients have subconscious and inconsistent desires.
Their conscious decisions may not reflect their deepest values.
see his/her own desires/values more clearly, but not to criticize them.

–Concerns = What if the patient is unconscious or incompetent, incompetent, and making choices totally unacceptable by our ethical standards? Third party payers’ role
All that a doctor can do is to help the patient
Interpretive model

Question 6

deliberative model

–friend or teacher

Answer 6

Principle = The doctor should help the patient to deliberate well through dialogue and discussion, and so develop values which are objective and truly worthy.

Assumptions = The objectivity of values.
The patient’s good life consists not in the satisfaction of desires, but maturity and rationality.

Problems = The difference between dialogue and persuasion The boundary between doctor and patient can blur

Question 7

communication dynamics

Answer 7

words = 7%
tone of voice = 22%
body language = 55%

talking = 75% of the Dr/Pt relationship

Question 8

empathy skills =

Answer 8

reflect
validate
respect
support

Question 9

things that are NOT empathy =

Answer 9

1) sympathy = internalizing the pt emotions = lose obj.
2) identification = lose obj bcuz something in common
3) pity = insincere empathy = condescending, patronizing

Question 10

duties under duress =

Answer 10

activities performes w/ pain or difficulty

Question 11

under no apparent distress =

Answer 11

instances where reported limitations are not validated

Question 12

patient specific functional scale (PSFS)

Answer 12

= ID 3 important activities and rate each on scale 0-10

Question 13

What is caring?

Answer 13

• -Communicate effectively
• -Empathetic
• -Arrange to meet healthcare needs
• -Respectfulandnonjudgmental

Question 14

empathetic skills =

Answer 14

• -Reflection/ give a name to the emotion
• -Validation
• -Respect
• -Support

Question 15

bad message

Answer 15

• Sighing
• Crossed Arms/ Legs
• Head Tilt ***
• Eye Contact ***
• Leaning Away
• Tensing of Muscles
• Facial Expression
• Breathing Changes
• Squirming and Shifting

Question 16

good message

Answer 16

• Eye contact consistent
• Forward lean
• Avoid fidgeting
• Avoid distracted looks
• Hands…where are they & what are they doing?
• Facial expressions of concern, understanding ***
• Nodding of head

Question 17

Three key elements of patient compliance:

Answer 17

– expectancy that results can be achieved
– belief that actions will lead to desired outcome
– having attractive or valuable goals

Question 18

most frequent patient dissatisfaction =

Answer 18

failure o adequate an explanation

Question 19

Report of Findings

Answer 19

1) offer a creditable explanation
2) Explain how you’d like to approach treatment for their problem(s)
3) Outline specifics of the treatment plan
4) Prognosis (know the course of the disease)

Question 20

enhancing patients compliance with treatment plan

Answer 20

• -tie symptoms and limitations to cause of problem
• -stress pt role in recovery
• -ID barriers to compliance
• -involve pt in addressing barriers

Question 21

PARQ conference is required by Oregon law &…

Answer 21

CMS requirement (for Medicare and Medicaid patients)

Question 22

when is risk so remote as to be not worth discussing…

Answer 22

If it is minor and rare, forget about it

• If it is minor and common‐ discuss it
• If it is major and common‐ discuss it
• If it is major and uncommon‐ discuss it

• If it is major and very rare‐ depends on what it is…
– CVA‐ yep. Very rare and yet discussed
– Death from lumbar manipulation? Nope.

Question 23

when do you need a PARQ?

Answer 23

ant time there needs to be an informed consent decision about therapeutic/diagnosis procedure

Question 24

PARQ Vs. ROF

Answer 24

• ROF > comprehensive > PARQ
• PARQ = what can go wrong > not what we’re going to do
• PARQ can be within a ROF or not
• PARQ is the minimum requirement before tx.
• PARQ must include opportunity for questions**