Midterm - models of care

Question 1

What is autonomy?

Answer 1

the principle that ensures that patients are afforded the chance to make informed, un-coerced decisions

Question 2

What is beneficence?

Answer 2

The principle that obligates doctors to do everything they can that would benefit or help the patient

Question 3

What is non-maleficence?

Answer 3

the principle of “primum non nocere” (first, do no harm) which obligates doctors to do as little harm as possible

Question 4

What is justice?

Answer 4

the principle of fairness. In health care Justice normally refers to distributive justice, which is fairness in distribution of resources

• Remember that fairness is NOT the same as “equality”. Insurance relies on the principle of justice to collect small amounts of money from many and pool it to pay for the expensive care of the few that get sick…

Question 5

What is the paternalistic model?

Answer 5

The guardian

Question 6

What is the informative model

Answer 6

Competent technical expert

Question 7

What is the interpretive model?

Answer 7

Counselor or advisor

Question 8

What is the deliberative model?

Answer 8

Coach or teacher

Question 9

What is the paternalistic model? Informative? Interpretive? Deliberative?

Answer 9

Paternalistic = guardian 
Informative = competent technical expert
Interpretive = counselor or advisor 
Deliberative = coach or teacher

Question 10

N emergency situation would favor the _____ model

Answer 10

Paternalistic (Guardian)

Question 11

A problem for which the management requires some intense and likely unpleasant therapy such as post-surgery rehabilitation otherwise a poor outcome can be expected would favor the ______ model

Answer 11

Informative (competent technical expert)

Question 12

A short term condition (back injury) for which the patient has a role in the cure (exercises and stretches) would favor the ___________ model

Answer 12

Interpretive (counselor/advisor)

Question 13

A long-term management problem such as diabetes would favor a ____________ model

Answer 13

Deliberative (coach or teacher)

Question 14

It is generally accepted that commencement of the doctor patient relationship is established when
______________ has been offered

Answer 14

Informed Consent - in other words when a bona fide intent to treat is established

• In some jurisdictions, the establishment of the doctor/patient duties occurs prior- at first examination effort on the part of the doctor.

Question 15

In casual, nonprofessional (social) situations, one can avoid the appearance of creating or promoting the engagement of a doctor patient relationship by:
(5)

Answer 15

• Avoiding in-depth inquiry to the nature of the patient’s problem
• Avoiding examination or any form of treatment (even as benign as a brief massage) outside an office or designated professional setting
• Avoiding recommending a specific therapy
• Avoiding promising anything to the patient
• Clarify in conversation that any ideas expressed are without the benefit of a complete evaluation, which is absolutely necessary before any sound advice could be offered

Question 16

Obligations of a physician in the doctor/patient relationship: (7)

Answer 16

• Abiding the legal requirements of practice
• Within-scope competent practice
• Billing and communication that is ethical, legal and accurate
• Truthful and patient-centered advocacy
• Ethical care of the patient (abiding the boundaries)
• Protecting from unauthorized disclosure all protected health information
• To honor the Dr./Pt relationship until it is formally terminated through release from care, and to ensure that legally appropriate behavior survives the relationship

Question 17

Recall that when conflicts in payment policies vs. best care approaches exist, the physician must behave thus (5)

Answer 17

• First duty is to patient
• Efficiency and best practices should prevail for the patient
• Advocate for the patient
• Do NOT violate the law or the contractual obligations of an insurance plan
• Do NOT falsify or “substitute” care or documentation to achieve both agendas

Question 18

Patients want their doctor to: (5)

Answer 18

• Care about them as people
• Be competent
• Be effective
• Be efficient
• Be an advocate in “the system”

Question 19

Elements of caring: (3)

Answer 19

• Empathy
• Arranging to meet healthcare needs
• Respect and non-judgment

Question 20

Recall the elements of effective communication: (6)

Answer 20

• Active and engaged listening- not controlling or interrupting them
• Giving information in appropriate doses (inform as needed)
• Choosing words carefully and check for meaning
• Being direct and straightforward but not abrupt
• Being consistent in your verbal and nonverbal behaviors
• Exhibiting a soft but confident tone, slow pace, and comfortable appearance

Question 21

Communication dynamics: What drives patient’s perceptions of your caring:

• Talking constitutes up to ___% of a Dr./Pt interaction but only ___% of the conveyance of humanistic qualities…
• ___% of humanistic quality is conveyed by “tone of voice”
• ___% is conveyed by visual perception of your body language

Answer 21

75%, 7%
22%
55%

Question 22

• Empathy is driven by recognition and understanding of _____________.
• Not adopting or internalizing the perspective of the individual who is in need
• Maintaining an __________ state of awareness
• Understanding of circumstances, emotions and behaviors without losing __________ ability to evaluate and contextualize the patient’s feelings
• Being able to interact in a way that honors the moment- by- moment experience of the patient (being sensitive) but not be compelled to act based on that awareness (remaining
  ___________)

Answer 22

Another’s viewpoint
Objective
Objective
Objective

Question 23

Empathy skills- the doctor should demonstrate: (4)

Answer 23

• Reflection/ give a name to the emotion
• Validation of the patient’s feelings and experience
• Respect the importance these feelings and expressions have to the patient
• Offer your partnership/ support to ensure they understand they can count on you

Question 24

Remember that several things mimic empathy, but are NOT empathy: (3)

Answer 24

• Sympathy- feeling the emotions of the patient and internalizing them- losing objectivity and vesting part of your feelings in their feelings
• Identification- losing objectivity because of a significant trait or characteristic in common with the patient- example- ethnicity, gender, socio-economic status, religion, etc.
• Pity- insincere empathy- expression of empathy that is condescending, patronizing or otherwise lacking genuineness and honesty