PRINCIPLES OF PATIENT CARE Flashcards
foundation of patient care and is as much an ongoing educational endeavor as learning new procedures or technique
Professionalism
prohibits a physician from revealing information regarding the patient unless the patient waives that privilege
right to privacy
process whereby the physician educates the patient about the medical condition, explores her values, and informs her about the risks and benefits of treatment and reasonable medical alternatives.
Informed consent
does not allow a patient’s wishes to take precedence over good medical judgment
concept of autonomy
person’s right to self-rule, to establish personal norms of conduct, and to choose a course of action based on a set of personal values and principles derived from them
Autonomy
a person’s right to decide how and to whom personal medical information will be communicated is part of autonomy
Confidentiality
the obligation to promote the well-being of others or, in medicine, to benefit the patient through meeting a goal of medicine by the care offered
Beneficence
a binding agreement between two or more parties for the performance of some action
Covenant
a relationship founded on faith and trust and the obligation to act in a trustworthy manner
Fiduciary Relationship:
the patient’s acceptance of a medical intervention after adequate discussion and consideration of the nature of the procedure, its risks and benefits, and alternatives
Informed Consent
the right of individuals or groups to claim what is due to them based on certain personal properties or characteristics
Justice
the act of committing harm
Maleficence
obliges one to avoid doing harm
Non-maleficence
Health care providers fulfill a basic need -WHAT IT IS
need—to preserve and advance the health of human beings.
a giving of oneself to the greater good.
calling
It is a fundamental principle of excellence in patient care.
Professionalism
balance the differences of fiduciary and contractual relationships between physician and patient
Professionalism
what are the
expressions of that trust or covenantal relationship
- Honesty
- disclosure
- confidentiality and
- informed consent
In creating a trustworthy and safe environment, disclosure of ____ can add to the trust patients have in their health care team and ensure that all medical errors or near misses are used to improve then environment of care
unanticipated outcomes
are inevitable in the delivery of health care
To Err Is Human
creates an environment conducive to restructuring the systems or procedures that make it possible for errors to occur and is critical in development of a safety culture
climate of no-fault discussion of errors
Skills that seem common to disclosure are
- telling the medical facts,
- honesty and
- truthfulness (responsibility and answering questions),
- empathy (and apology),
- stating how future errors will be prevented, and
- using good communication skills
generated less litigation
- open disclosure
is essential to the trust relationship between doctor and patient.
- Privacy
must be maintained even when it does not seem intrinsically obvious.
privilege of privacy
a process that involves an exchange of information directed toward reaching mutual understanding and informed decision making.
INFORMED CONSENT
conversation between physician and patient that teaches the patient about the medical condition, explores her values, and informs her about the reasonable medical alternatives
Informed Consent
an interactive discussion in which one participant has greater knowledge about medical information and the other participant has greater knowledge about that individual’s value system and circumstances affected by the information
Informed Consent
- barriers facing physicians and patients regaring informed consent
- Fear that the information may frighten patients,
- fear of hearing the information by the patient,
- lack of ability to comprehend technical information, and
- inability to express that lack
Informed consent arises from the concept of
a. privacy
b. autonomy
c. confidentiality
d. disclosure
b. autonomy
one who, in his thoughts, work, and actions, is able to follow those norms he chooses as his own without external constraints or coercion by others.”
- autonomous person
surrogate decision making may be required If the ability to make choices is diminished by:
- extreme youth
- mental processing difficulties
- extreme medical illness, or
- loss of awareness
For adults
what is the sequence of surrogate decision makers?
- the first surrogate decision maker is a court-appointed guardian if one exists and
- second is a durable power of attorney,
- followed by relatives by degree of presumed familiarity (e.g., spouse, adult children, parents).
For children who is the surrogate decision maker
- parents are the surrogate decision makers, except in circumstances in which the decision is life threatening and might not be the choice a child would make later, when adult beliefs and values are formed
the basis of medical care of Hippocrates
The principles of beneficence and nonmaleficence
“to do good and no harm”
Of all the principles of good medical care, ____ is the one that continually must be reassessed
benefit
should be considered in all aspects of patient care
- The benefit or futility of the treatment,
- along with quality-of-life considerations
Some systematic approaches depend on a sequential gathering of all the pertinent information in four domains:
- medical indications (benefit and harm),
- patient preferences (autonomy),
- quality of life, and
- contextual issues (justice)
The essence of good medical care is
a. Physicians have no obligation to continue or initiate therapies of no benefit
b. to attempt to be as clear as possible about the outcomes of the proposed interventions
c. benefit is the one that continually must be reassessed
b. to attempt to be as clear as possible about the outcomes of the proposed interventions
effect of therapy on the patient’s experience of living based on her perspective
quality of life
often referred to as Stark I and II, affecting physicians’ ability to send patients to local laboratories and facilities in which they have a potential for financial gain
- Legislation
Another abuse of the physician–patient relationship caused by financial conflicts of interest is
fraudulent Medicare and Medicaid billings
individuals with high-risk (e.g., volatile, argumentative, aggressive) temperaments have been shown to have a high rate of premature death (particularly before ____ years of age)
55
directly related to decreases in psychological distress
- Adequate sleep,
- reasonable working hours,
- exercise, and
- nutritional balance
various methods of proposed distribution of burdens and benefits
- Equal shares (everyone has the same number of health care dollars per year)
- Need (only those people who need health care get the dollars)
- Queuing (the first in line for a transplant gets it)
- Merit (those with more serious illnesses receive special benefits)
- Contribution (those who have paid more into their health care fund get more healthcare)
everyone has the same number of health care dollars per year
Equal shares
only those people who need health care get the dollars
Need
the first in line for a transplant gets it
Queuing
those with more serious illnesses receive special benefits
Merit
those who have paid more into their health care fund get more healthcare
Contribution
