Other:Ethics Flashcards
What are underlying assumptions in rights?
- The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status
- These claims can be made against a duty bearer such as the state and are universal.
What rights are frequently engaged in healthcare?
• Art 2 – the right to life (limited)
• Art 3 – the right to be free from inhuman and degrading treatment (absolute)
• Art 8 – the right to respect for privacy and family life. (qualified)
• Article 12 – right to marry and found a family
(limited and qualified rights can be restricted if other circumstances occur)
What are absolute rights?
- right to protection from torture, inhuman and degrading treatment and punishment (Article 3),
- the prohibition on slavery and enforced labour (Article 4)
- protection from retrospective criminal penalties (Article 7)
What are limited/qualified rights?
- These rights are limited under explicit and finite circumstances,
- e.g., right to liberty (Article 5)
- Article 8(2) - state can restrict the right to respect for private and family life;
- To protect health or morals, or the protection of the rights and freedoms of others; social needs
What is the libertarian approach?
each is responsible for their own health, well-being and fulfilment of life plan.
eg. vaccinations compulsory? Blood donation?
Is there a right to medical treatment?
Article 2: there is a positive obligation upon the State; to take appropriate steps to safeguard life. But cannot impose an impossible or disproportionate burden on the authorities.
What is a judicial review?
opportunity for an individual to challenge the exercise of power by a public body.
What are exceptionality criteria?
It is proper for an authority to adopt a general policy for the exercise of such an administrative discretion, to allow for exceptions from it in ‘exceptional circumstances’ and to leave those circumstances undefined’
What is sustainability?
: meeting the needs of today without compromising being able to meet the needs to tomorrow.
What is Peyton’s 4-step procedure for skills training?
1) Trainer demonstrates without commentary
2) Trainer demonstrates with commentary
3) Learner talks through and trainer does
4) Learner talks through and learner does
What are the common pitfalls of Peyton’s 4-step procedure?
- Lack of clarity, thoroughness and accuracy of description – what to look at and for
- Accuracy and consistency of the demonstration
- Failing to make use of all senses
- Talking too much
- Insufficient time for the student to get the feel of a feature or practice the skill
- Failing to provide opportunities for repeated practice
- Failing to check student/trainee understanding of what they are doing and why
- Giving insufficient feedback
What are Pendleton’s rules for feedback?
1) Clarify any points of information/fact
2) Ask the learner what they did well
3) Discuss what went well, adding to your own observations
4) Ask the learner to say what went less well and what they would do differently next time
5) Discuss what went less well, adding your own observations and recommendations
What is questioning useful for?
- Learning needs analysis
- Raising awareness
- Developing clinical reasoning
- Formative assessment purposes
- Clinical debriefing
- Teaching
List some questioning strategies
Evidence Clarification Explanation Linking and extending Hypothetical Cause and Effect Summary and Synthesis
Why do you need to teach diversity education?
o Reduce health inequities
o Enhances all doctor-patient encounter
o Improves patient safety
o Develops professionalism
What is the cultural-expertise model?
where training focuses on providing information about different groups based on one characteristic
what are positives of culture-expertise model?
may give us information that will help in clinical care
What are negatives of culture-expertise model?
- Inter vs intra group heterogeneity
- Static
- Doesn’t allow for acculturation
- Risks oversimplification and stereotyping
- Too many categories to learn
Define epigenetic
the study of changes in organism caused by modification of gene expression rather than alteration of the genetic code itself?
What is culture?
socially transmitted patter on shared meanings by which people communicate, perpetuate and develop their knowledge and attitudes about life.
Describe the iceberg model of culture
Visible: gender, age, ethnicity, nationality
Below surface: socio-economic status, occupation, health, religion, education, social groupings, sexual orientation, political orientation, cultural beliefs.
Describe kahneman thinking
Thinking, fast and slow
System 1: fast, unconscious, automatic, everyday decisions, error-prone
System 2: slow, conscious, effortful, complex decisions, reliable
Define ethnocentrism
the tendency to evaluate other groups according to the values and standards of one’s own cultural group, especially with the conviction that one’s own cultural group is superior to the other groups.
e.g. colonialism, Nazi Germany, big fat Greek wedding
Define stereotype
Involves generalisations about the ‘typical’ characteristics of members of a group.
What are the goals of cross-cultural education?
1) The first goal of cross-cultural education is to understand how culture influences our thoughts, perceptions, biases and values.
2) The second goal is to understand the nature of the individual cultural identity as a multidimensional and dynamic construct.
What is prejudice?
Attitude towards another person based solely on their membership of a group.
o Cognitive: involves stereotypes
o Affective: involves negative or positive feelings towards someone
what is discrimination?
actual positive or negative actions towards the objects of prejudice
What is the cultural sensibility model?
We are a combination of different characteristics and that there is a complex interplay between internal and external factors to produce unique beings with their own sense of self, and having a very personal culture
What are some challenges of working across cultural distance?
Effortful – energising/exhausting Assumptions more likely to be wrong Humour/Rapport Language Different expectations of roles for Dr and patient Different explanatory model
What are the different forms of empathy?
o Cognitive empathy: perspective taking
o Emotional empathy: physical experience of sharing someone’s emotions
o Compassionate empathy: the drive to do something practical for people in difficulties
o Perspective taking: really important attribute for doctors, but cognitive empathy alone can be problematic (sociopaths, narcissists)
o Emotional empathy excess can lead to burnout.
What are kleinman’s 8 questions?
1) What do you call the problem?
2) What do you think has caused the problem?
3) Why do you think it started when it did?
4) What do you think the sickness does? How does it work?
5) How severe is the sickness? Will it have a long or a short course?
6) What kind of treatment do you think the patient should receive?
7) What are the chief problems the sickness has caused?
8) What do you fear the most about the sickness?
What are the 2 questions in helmen’s folk model of illness?
What has happened?
Why has it happened?
What is quality improvement?
The combination of a change with a method to attain a superior outcome.
What are the 5 P’s for assessment in quality improvement?
1) purpose
2) patients
3) professionals
4) processes
5) patterns
What is the structure of quality improvement?
1) investigate problem and make assessment (5Ps)
2) generate a diagnosis (change ideas)
3) apply and iterate treatments (plan, do, study, act cycle)
4) monitor and follow up (sustain)
What does PDSA stand for?
plan
do
study
act
What is the great man theory?
Suggests that leaders are born, not made, shaping history through their personal attributes, such as charisma, intelligence and wisdom.
What is the trait theory?
It states that people possess certain traits that cannot be learnt, certain traits are particularly suited to leadership, and those who possess these traits can lead in very different situations.
What is the behavioural theory?
This differs by focussing on what leaders actually do. Successful leadership behaviours can be differentiated from ineffective behaviours. Blake and Mouton’s Leadership Grid is a well-known model of behavioural theory,
What is the contingency theory?
This focuses on how leaders operate depending on the situation. Different contexts require different leadership styles. Effective leaders develop different ways of working with their followers depending on the situation and the needs and attributes of followers.
What is transactional leadership?
This occurs where the leader, possessing clear authority, motivates by reward or punishment. Transactional leadership is still practised widely in healthcare settings.
What is transformational leadership?
This states that people will follow a leader who inspires them through vision, passion and enthusiasm. In this respect transformational leaders can truly be seen as change agents, placing the concern and development of others above themselves.
What factors cause human error?
communication, judgement error, omissions, lapses, violations
What is neglect?
Falling below accepted standard Repeated minor mistakes Culture of not caring Necessary care is withheld Safeguarding Nutrition and personal care Medical care
What is poor performance?
A problem of attitude
Often rudeness, tardiness, scruffiness and laziness
Failure to learn from mistakes and listen to advice
Affects patient care
Usually evident from student days
What is misconduct?
Deliberate harm Lack of candour >Hiding own or other’s mistakes >Ignoring mistakes, hoping they’ll go away >Altering medical records >Failing to report concerns Fraud/theft >False expense claims >Time: sickness >Drug + alcohol problems Improper relationships >Patients >Relatives >Colleagues – students/juniors with supervisors
What are the 4 tests to demonstrate medical negligence?
1) Was there a duty of care?
2) Was there a breach in the duty of care?
3) Did the patient come to harm?
4) Did the breach cause the harm?
What is the Bolam test?
Would a group of reasonable doctors do the same?
What is the bolitho test?
Would it be reasonable for a doctor to do so?
What are Aristotle’s virtues?
- Moral virtues: courage + integrity
- Intellectual virtues: knowledge, skill and judgement
What is expected utility theory?
EU = likelihood x value
Works for risks and gains
What are the limitations of expected utility theory?
Poor at estimating likelihood and values
What is dual process theory?
1) Intuitive thinking with its irresistible combination of heuristics and biases
2) Analytic thinking, using evidence-based medicine
Not always ‘either/or’ often both
Describe intuitive decision?
Recognition primed and heuristic, irresistible, without conscious reasoning
Advantages and disadvantages of intuitive decision?
Advantages: fast + frugal (using heuristics)
Disadvantages: strong (cognitively predisposed to recognise; prone to biases)
What are biases in intuitive thinking?
i. Error of over-attachment: confirmation bias, premature closure, sunk costs
ii. Error due to failure to consider alternative: multiple alternatives bias, search satisfaction
iii. Error due to inheriting thinking: diagnosis momentum, framing effect
iv. Errors in prevalence perception or estimation: availability bias, base-rate neglect, gamblers fallacy
What is an advantage of analytical thinking?
Accurate and reliable
Disadvantages of analytical thinking?
Slow - keeps other patients waiting) Resource intensive (costs money) Cognitively demanding (exhausting)
What 3 ways can you reduce the risks of intuition?
1) decision environment + process
o Decision density + contingency (distractions)
o Physical environment (noise)
o Process environment
2) personal debasing techniques o Affective >Acknowledgment of bias >Personal accountability – anxiety, hunger, fatigue o Cognitive: executive override >Slowing + stopping techniques >Cognitive forcing strategies
3) Structural debiasing o Training in DPT o Structural forcing strategies o Checklists o Group decision strategies: MDTs, ward rounds
What are never events?
Events that cause harm or even death to patients
What are some examples of never events?
o Surgery e.g. wrong site or implant, retained foreign object
o Medicine e.g. wrong preparation, wrong route, overdose etc
o Mental health e.g. suicide
o General healthcare e.g. falls from windows, entrapment in bed rails, misplaced NGT, misidentification
o Maternity e.g. death due to PPH
What are some red flags of error chains?
- Ambiguities/anomalies/conflicting information/surprises.
- Broken communication or inconclusive discussions
- Confusion/loss of awareness/uncertainties
- Missing information/incomplete briefing
- Departures from standard procedures/normal practices
- Fixation/pre occupation
- Time distortion/event runaway
- Unease/fear; Denial/stress/action
- Alarm bells in your mind or warning from equipment
Describe the Swiss-Cheese model
- based on an understanding that every step in a process, or every layer of a system, has weakness that can lead to failure
- likened processes or systems to slices of swiss cheese laid side by side. The holes represent potential weakness at each particular stage or layer
- some of the holes are considered ‘active’ – an individual making an error, and others are ‘latent’ – these weaknesses are inherent to the system and may include poor organisational design or weak management systems.
Describe the three-bucket model
- Based on the understanding that frontline staff can help to stop errors and unsafe practice occurring they adopt a risk-aware and ‘error-wise’ mindset. This will enable them to recognise situations with a high risk of error occurring and improve their ability to correct errors early.
- The ‘buckets’ in the model represent ‘self’, ‘context’ and ‘task.’ The model’s contention is that the possibility of error or unsafe action in any given situation depends to a large extent on how much ‘bad stuff’ is in those 3 buckets at any particular time.
- The 3 buckets are constantly emptying and filing at any point in time in response to whatever is happening at that time: an empty bucket in the morning does not necessarily mean an empty bucket in the afternoon. The key is having an awareness of the state of the buckets and developing strategies to empty them when they look full.
what are the 3 domains in the 3 bucket model?
1) self
2) context
3) task
how can culture lead to never events?
• Top-heavy structure (e.g. power/control)
• Lack of clear identity
• No clarity on who was responsible
• Lack of inter-professional collaboration
e.g. Bristol heart scandal, north Staffordshire, baby P
what is the conformity problem?
The greater the benefits and lower the likely consequences, the more common it is for people to ‘migrate’ towards working in ways that they know to be wrong or that break the rules. Over time these ways become normalised and are integrated into the culture.
e.g. “this is how we do it here”
What are some examples of reasons why patient safety might become compromised?
1) loss of situational awareness
2) perception + cognition
3) teamwork
4) culture
Define error type: Sloth
Not bothering to check
results/information for accuracy.
Incomplete evaluation.
Inadequate documentation.
Poor conscientousness.
Define error: Fixation and loss of perspective
Early unshakeable focus on a
diagnosis. Inability to see the
bigger picture. Overlooking
warning signs.
Poor situational awareness and poor open mindedness
Define error:Communication
breakdown
Unclear instructions or plans. Not
listening to or considering others
opinions.
Ineffective communication
Define error: Poor teamworking
Team members working
independently. Poor direction.
Some individuals out of depth,
others underutilised.
Define error: Playing the odds
Choosing the common and
dismissing the rare event.
Define error: Bravado
Working beyond your competence or without adequate supervision. A show of confidence to hide underlying deficiencies (not taking on that which you should)
Define error: Ignorance
Lack of knowledge. Unconscious incompetence. Not knowing what you don’t know.
Poor self-awareess
Define error: Mis-triage
Over/underestimating the
seriousness of a situation.
Poor prioritisation
Define error: Lack of skill
Lack of approrpriate skills, teaching
or practice.
Define error: System error
Environmental, technology,
equipment or organisational
features. Inadequate built in
safeguards.
