Prof & Ethics Flashcards
Benjamin Rush MD vs Samuel Hahnemann vs William Hammond MD vs Wooster Beach vs Pierre Louis
Father of “heroic” medicine; thought that fever alone causes tension in blood vessels, and that any dz = 1 dz d/t overstimulation of nerves and blood –> purging, bleeding, vomiting and blistering would restore body’s balance vs father of homeopathy; came up w/ “allopathy” d/t the tx’s at the time (purging, bleeding, calomel, etc); 1824: most effective drugs were those that induced sxs similar to those of dz but diluted –> popular alternative tx to purging, etc vs Army Surgeon General who also condemned heroic txs. 1864: court martialed for Order #6 - removing calomel from formulary vs used botanical remedies; eclecticism - using NONINVASIVE PRACTICE and botanical/natural therapies that were in harmony w/ body’s natural curative properties vs father of “numerical method”; introduced statistics into medicine –> empirical medicine and evidence-based medicine
Osteopathic tenets. When was osteopathy found? Still’s philosophy was influenced by?
The body is a unit; the person is a unit of body, mind, and spirit. The body is capable of self regulation, self healing and health maintenance. structure and function are reciprocally interrelated. Rational tx = based upon the understanding of the basic principles of each of the above. Still flung the banner of osteopathy in 1874, but didn’t get a charter for the school (ATSU KCOM) until 1892. methodist perfection - God created man to heal from w/in, Herbert Spencer’s mechanical views of interrelatedness of structure and function, Darwinian evolution (adaptation results from resistance and recovery from dz)
John Cline MD vs What happened in the CA merger? And after?
1952: President of AMA that called for acceptance of DOs and remove stigma –> chaired committee that had eval that quality of training b/w MD and DO = same vs 1962: CA Osteopathic Association and Medical Association combined –> DOs can by MD degree for $65; ex-DOs = segregated in 41st medical society; primary care DOs = better off than specialty DOs. 1966: Secretary of Defense ordered armed services to accept qualified DOs –> DOs served in VN war
How did Still contribute to Civil War? what txs = used in Civil War?
Kansas-Nebraska Act of 1854: settlers in those two states decide to be slave or Union state
1856: learned anatomy via cadavers who died from cholera and victims from Kansas battles (while under father apprenticeship)
1857: Still = elected to represent Douglas and Johnson counties in state legislature
1858: free-state constitution passed
1861: KS = Union State; Still enlisted in 9th Kansas Cavalry and served as hospital steward & scout surgeon
5 YRS IN KS LEGISLATURE
calomel, bloodletting/purging/vomiting, excisions/amputations, colchicine, opium, digitalis
Define professionalism. How can unprofessionalism impact your future career?
conduct, aims, or qualities that characterize or make a profession or a professional person. the value of your degree, next clinical site, the public’ regard to your training, reputation of those who train after you
4 behavioral themes of unprofessional behavior
disrespectful behavior (poor communication, discrimination/harassment, inappropriate clothing), dishonest behavior (lying/cheating, falsifying data), failure to engage (absent/tardy, poor teamwork), poor self-awareness (avoid feedback, resists change)
Classifications of Honor Code violations
Class I = minor offense –> 25hr college service. Class II = significant offense (cheating, plagiarism, unprof behavior) –> education on offense, 50hr college service, possible zero on assignment. Class III = major offense (unethical, illegal, unprof conduct; rpt Class I or II offenses) –> education on offense, zero in course and rpt, PESB may intervene for suspension or expulsion
beneficence vs nonmaleficence vs autonomy vs justice vs fidelity vs utility
trying to do good and benefit others; maintain pt’s well-being vs do no harm (“primum non nocere”) vs personal self-governance vs no prejudice, EGALITARIANISM - EQUAL DISTRIBUTION OF RESOURCES vs “faithfulness” - one does not exploit/abandon pts and no interest from 3rd parties vs act in a way that gives the best pos consequences and least neg consequences
VIRTUES ADDED TO CORE ETHICAL PRINCIPLES: veracity vs honesty vs integrity vs duty
devotion to the truth vs quality of communicating and acting truthful and w/ fairness vs concept of consistency, actions, methods, values; highest regard of honesty or accuracy of one’s actions vs moral commitment to someone or something; theoretically a fulfillment to promise w/o self interest
General concepts of professionalism in clinical setting
communicate truthfully w/ pts, respect pt privacy, deal fairly and honestly w/ colleagues, respect the law, work cooperatively w/ others, engage in continuing study
lying vs deception vs misrepresentation vs nondisclosure
stating something that one realizes or thinks it’s untrue vs stating something that is narrow or literal but intended to mislead or deflect the truth (intentional) vs stating something un/intentionally that’s correct in manner or context but irrelevant to situation (unintentional) vs not providing relevant info for situation
ethics vs morality
moral principles and behavior that governs person’s actions/decisions w/ other ppl and in society; critical reflection about morality vs what ppl believe to be good or bad
When was SAS approved? Changes under SAS vs Non-changes under SAS
2014, launched 2015, and completed in 2020. GME, Osteopathic Recognition (now include MDs; 253 programs in 2021), ONMM residency (open to MD and DO; 3 yrs), MD/DOs can compete for same NRMP match (since AOA and AACOM joined ACGME 2015-2020) vs boards agencies and licensing (AOA Certifying Board Services vs American Board of Medical Specialties), predoctoral education (COCA - accrediting agency for DO schools) vs LCME - accrediting agency for MD schools), COMLEX vs USMLE
what are the ethic/professional issues w/ social media?
confidentiality (respect pt privacy), boundaries (personal vs prof account), posting unprofessionally; discussing pt in halls, open rooms, w/ fam, or online
social media guidelines
do no harm; be transparent, know your role; don’t post VCOM img, logo, name w/o consent; don’t promote or condone unprofessional/high risk behavior; maintain confidentiality, no online interactions w/ pts
potential consequences of social media
disciplinary action –> affects residency, state medical boards authority, terminated by employer/tarnished prof reputation
steps of honor code process
report of SUSPECTED violation –> investigation –> HCC Committee Panel or PESB Panel –> recommendation to the dean of violation or not –> guilty. Charges can be dropped at any stage
Honor Code Council Intervention Sub-Committee vs Honor Code Council Committee. Purpose of Honor Code Council
not on permanent record, educate and prevent repeated behaviors (ex: dress code, parking violations) vs on permanent record, investigations, interview, recommendation to dean (ex: breach of honor code, cheating, repeated infractions post intervention subcommittee). maintain trust, interpret VCOM Honor Code thru peer review and investigate suspected violations, protect their right to participate in an academic environment free from injustice
Attributes of physicians vs VCOM Values
honesty, integrity, courage, fidelity, altruism, compassion, excellence vs professionalism, integrity, compassion, knowledge, critical thinking, altruism, duty
When do you see PESB? Choices for PESB review?
if suspected violation warrants direct referral to PESB, rpt class II/III violation. full panel, 3 person panel, campus dean
disruptive behavior vs unacceptable use of technology
inappropriate etiquette or disturbance repeated enough to produce a disrespectful trend vs anything that violates VCOM’s IT guidelines
ethical responsibilities of an OMS
gain clinical skills necessary to practice safe medicine, assure pt safety/privacy during visit and exam, be truthful in interactions, be honest in collecting and interpreting data
examples of legal issues in prof and ethics
drugs, alcohol, sexual harassment
What’s impairment and their sxs? High risk conditions?
when physician/med student can’t practice medicine safely and effectively d/t physical/mental illness or substance abuse. disruption in class, poor performance, threatening student safety, irresponsibility. fam hx, access, domestic issues, unusual stress at work, self-dx/rx, poor self-care
What are the assessments vs txs/interventions for impairment? How does VCOM handle impairment?
medical eval, psych eval, neuro eval, substance abuse eval, collateral info, fam therapy eval vs detoxification, individual/group/fam therapy, caduceus groups. contact Whitney or Dr. Mag, self report, call counseling services
What situations can not getting help lead to legal/ethical hearings?
harming pts/staff, losing license, domestic issues
4 theories of ethics: virtue theory vs utilitarianism vs consequentialism vs deontology
habits formed by someone d/t societal training and personality in a societal role or profession vs whatever action you do, it has to have the best probability to get the best outcome (like utility) vs figuring out the consequences of that action determines moral judgment; aka teleology; if consequences = unclear, then choose action that give best outcome vs focuses on the rights/wrongs of the action instead of rights/wrongs of the consequences
who decides what’s ethical?
physicians, pts, caregivers, ethics committee, judicial system
consequentialist framework vs duty framework vs virtue framework
you need to act that gives the most good/best consequences vs you need to perform the right/best actions vs act like the most virtuous person would
what is ethical dilemma and examples?
where the available choices won’t solve the situation ethically. ex: telemed, accepting gifts, organ buying, placebo, revealing mistakes, giving bad news, disagreements w/ pt’s fam
what is ethic leadership and ways to promote it?
activities bioethics leaders undergo to guide medicine to follow ethical principles. support ethics programs, ethics = priority in healthcare, practice ethical decision making, communicate clear expectations
which types of drugs can physicians w/ a DEA number prescribe?
controlled schedule II-V substances, non controlled substances, legend drugs aka prescription drugs
Schedule I vs II vs III vs IV vs V controlled substances
high potential for abuse, no current accepted medical use (ex: mj, LSD, heroin, peyote, ecstasy, methaqualone) vs high potential for abuse that could lead to physical/physiological dependence (ex: narcotics - morphine, Oxycontin, Dilaudid, opium, hydrocodone, Vicodin; stimulants - Adderall, Dexedrine, methylphenidate like Ritalin, cocaine, barbiturates) vs potential for abuse less than I and II that could lead to moderate/low physical dependence or high physiological dependence (ex: buprenorphine like Suboxone/Subutex; Didrex, anabolic steroids, ketamine) vs low potential abuse less than III (ex: Darvon/Darvocet-N; benzodiazepines like Valium, Xanax, Ativan, Versed, Klonopin) vs low potential for abuse; more for antidiarrheal, antitussive, analgesic; Epidiolex - 2018: FDA approved cannabidiol in schedule V
examples of medical professional misconduct
improper prescribing, disruptive behavior, medical fraud and abuse, substandard care, boundary violations, impairment, false advertisement, aiding unlicensed practice, harming the public
Founders of VCOM. Founding Dean and Campus Dean for VA vs Carolinas vs Auburn vs Louisiana
John and Sue Rocovich w/ Edward Via, Dixie Rawlins and President James Wolfe. 2001 Dixie Rawlins; 2010 Wilcox vs Dixie Rawlins; 2009 Kowalski –> Cannon 2019 vs 2015 Elizabeth Palmorozzi DO; Heath Parker 2021 vs 2018 Ray Morrison DO; Dr. Mark Sanders 2022 (interim Dean 2021)
how is ethical principle of justice incorporate into VCOM?
VCOM believes in equal tx and equal access to healthcare –> that’s why they really care about rural/underserved populations
oath says to “stay loyal in profession” vs “preserve health & life of pts” vs “perform faithfully in my professional duties” vs “aid general welfare in community” vs “respect the law” vs “not engage… bring shame/discredit on myself or profession” vs “strive for best interest for students after me”
osteopathic med profession has obligation to self-regulate vs not abandoning pts; physicians/hospitals must tx pts’ emergencies regardless of citizenship, legal status, or payments => EMTALA vs autonomy vs responsibility to volunteer or give service to community, protect and promote public health vs osteopathic med profession has obligation to self-regulate vs no false ads or bribes vs you’re setting an example for students after you; don’t let public judge you for your wrongs
bioethics vs ethical norms vs ethicist vs ethical behaviors
ethics concerns in medicine vs standards that define behavior of an ethicist in a given situation vs someone who studies and practices ethics vs set of standards that define the way ppl = expected to act in a given situation
Medical Practice Act vs Civil False Claims Act aka Lincoln Law vs Federal Anti-Kickback Statute vs Physician Self-Referral Statute
Defines medicine, sets standards for legal state med board, sets standards for licensing physicians, defines unprofessional conduct and sets standards that fall in line w/ unprofessional conduct vs anyone who make false claims for payment to fed gov’t = liable –> max $10000 civil penalty and 3x dmgs on gov’t vs anyone who receives/pays to influence Federal programs = charged w/ felony –> max 5yrs prison, max $25000 fine, and max $50000 civil penalty vs prohibits physicians from referring pts to practices they own or have financial interests –> max $15000 per improper claim
Dent vs West Virginia
1889: Dent (physician) sued WV for restricting his practice –> Supreme Court unanimously voted for WV that states can impose restriction as long as they’re reasonable –> physicians need license to practice medicine –> upheld power of state medical boards; balance b/w 10th and 14th amendments: right for WV to regulate occupation for public health and right for Dent to stay employed in lawful occupation against arbitrary decisions
pre 1889 vs post 1889/Pre-Flexner Report
anyone can choose and practice a profession, you choose your own style of practice, personal assessment on own competency, de facto contract where ppl pay based on outcome vs standardized requirement to obtain license, state/governing body determines power, external orgs test your competency and standard of practice, ppl pay based on service regardless of outcome
Explain the 3 main functions of the medical board. Regulation vs guideline?
Licensing: graduate from approved med school (COCA/AOA, LCME, ECFMG), pass boards (COMLEX, USMLE), complete post grad training (ACGME). demonstrate competencies (each state has its own - CME). discipline: perform investigations/hearing that lead to reprimands, suspensions, fines, revocations. regulation: clarify expectations and guidance on best practices for wide range of activities
minimum standard that must be followed (laws) vs optional and should be followed
Flexner Report. How did it affect minorities and women?
book-length study on medical ed; 160 MD & 8 DO schools in 1910 (pre), 66 MD & 7 DO schools in 1935 (post); close proprietary schools, increase admission standards, schools should be associated with a university, change how medical education is financed; harder for minorities/women to attend & it’s expensive
significance of 1918 swine flu epidemic
DOs = recognized nationally for success; allopathic tx (calomel) had higher mortality (5-15%) than osteopathic tx (manipulation promoting pulm function, hygiene, fluids) (0.2%)
Which president wrote in favor of DOs b/c of his fam’s tx by a DO?
Former president Theodore Roosevelt
When was pharmacology allowed in osteopathic curriculum?
1929: from debate AOA HOD —> pharmacological tx = standardized b/w 2 professions
Top 4 cases of burnout. Which specialties has most burnout vs least burnout?
Too many bureaucratic tasks, spending too many hours at work, feeling like a cog in a wheel, increased computerization of practice. EM, IM, FM, OBGYN vs path, ophthal, psych, endo
What were some improvements made by the AOA after their accreditation survey of osteopathic medical schools? (Pre-Flexner)
Because of a standardized three year curriculum, the AOA was able to lobby states to allow for the licensing of DOs
What is the connection of the mission to the expansion of the four campuses?
part of our mission to meet the needs of rural and medically underserved populations, it was important that each campus would be founded in areas that had medically underserved populations. VA: Southern VA. SC: The top part of the state is medically underserved. AL: 60/67 counties are considered medically underserved. LA: Similar to AL, there are several portions of Louisiana that is medically underserved. LA also demonstrated a significant disparity ranking in among the worse five states for healthcare outcomes.
Nat’l DO percentages
43% females, 56% PCP, 67% under 45, 74% female DOs under 45
Which 2 documents help guide ethical and professional behaviors?
AMA Declaration of Professional Responsibility, AOA Code of Ethics
What percentage of US medical schools reported incidents of students posting unprofessional content online? Approximately what percentage of medical students experience suicidal ideation during medical school? Approximately what percentage of medical students met diagnostic criteria for alcohol abuse/dependence?
60%. 10%. 30%
What are the risks for relapse of substance abuse among physicians?
Major opioid use, Family history of substance use disorder, Co-occurring mental disorder. Remember that having all 3 of these risk factors drives the risk ratio up to 13.25
Benchmarks used by clinical faculty to measure clinical competence
prof & ethics, PE, communication, clinical reasoning, documentation, oral case presentation
conduct vs competence
observance and exer of appropriate ethical an moral principles - demonstrating morals v attainment and exer of requisite knowledge and kills - demonstrating kill/knowledge
1st med board vs template for modern med board vs 1st state to license DOs. How many states have separate med boards to license MD/DO respectively? How may medical boards are authorized to regulate medicine in the United States?
1859: NC Med Board - oldest continuously operating board in US vs 1876: Illinois Board of Health - set minimum qualifications for practice of medicine, issued/revoked med licenses vs 1896: VT. 14. 70
Osteopathic Continuous Certification
1) Active Licensure, 2) Lifelong Learning/Continuing Medical Education, 3) Cognitive Assessment, 4) Practice Performance Assessment and Improvement (1. Attest or submit evidence of participation in quality improvement activities, 2. Complete a Practice Performance Assessment (PPA) module, 3. Complete a verifiable quality-driven or clinically-focused encounter that assesses your clinical acumen)
Timeline
1859: NC Med Board
1874: Osteopathy found/coined
1876: Illinois Med Board = template; set min standards
1892: American School of Osteopathy; ATSU KCOM
1896: VT = 1st state to license DOs
1897: MO and ND granted DOs same rights w/ MDs
1889: Dent vs WV
1903: first AOA accreditation survey of osteopathic schools; mandated 3yr curriculum
1910: Flexner Report
1929: pharmacology included in DO curriculum by AOA HOD
1952: Cline MD
1962: CA Merger
1963: Civil service commission deemed MD and DO equivalent
1966: Sec Def allowed DOs to serve
1966: AOA = allowed to participate in medicare
1968: AMA allowed DO to obtain MD board certification & removed cultist designation of DOs
1973: MS = last state to license DOs
Characteristics of addiction
behavioral dysfunction, social dysfunction, and medical complications
lifestyle figure vs clinical figure vs cultural figure
someone who is a doctor but their account focuses on who they are outside of medicine vs an account that appeals to the healthcare community as a whole vs speak to the general public and are known as doctors
Maintenance of Licensure (MOL) has 3 principles
- reflective self-assessment
- assessment of knowledge and skills
- performance in practice
FSMB vs FSPHP
Federation of State Medical Boards. 2008: COMLEX & USMLE = valid exams for their intended purposes –> 2 professions = distinct, higher COMLEX scores resulted in lower likelihood of receiving disciplinary action. ONLY HAVE PT INTERACTION IN DR/PT RELATIONSHIPS, NOT ONLINE –> PROTECT PT CONFIDENTIALITY AND PRIVACY vs promotes identification, tx, and monitoring ongoing recovery of physicians before they impact pt; SC RPP - confidentiality to self report and refer
Drug Enforcement Administration
enforce the controlled substances laws and regulations of the US, support programs aimed to reduce illicit drug availability and be involved in the criminal/justice system
Code of Ethics sections
- pt confidentiality
- pt autonomy
- dr/pt relationship on mutual respect, trust, cooperation (pt can choose their dr, dr can choose their pt)
- never abandon pts; just TOC min 30 day notice
- life long learning
- self-regulation (maintain prof/ethics, obligation to advocate for osteopathic profession)
- never false ad
- must be licensed
- practice w/in your ability, seek consults if needed
- use arbitration for disagreements
- attending has final say on pt care
- drs = paid for services rendered
- respect the law
- aid general welfare to community
- no sexual contact w/ pts
- sexual harassment is unethical
- don’t accept gifts in exchange for using equipment; med students can’t accept gifts
18 & 19. no intentional misrepresentation of self or research
Breech of Integrity
any severe lapse in judgment or dmg to prof/ethical/moral integrity in VCOM
