Prof & Ethics 2 Flashcards
what is MSPE and its components? how long does it cover? when is it due?
Medical Student Performance Evaluation; 1) opening remarks from dean, 2) info by registrar, 3) pre-clinical academic performance, 4) clinical performance/comments, 5) services by Student Affairs, 6) appendix: professional characteristics/honor code, 7) appendix: scattergram. covers 1st 3 yrs of med school. due on 9/28 of your 4th yr
does each school have its own MSPE?
No, every MD/DO school follows standards for MSPE since 2002. 2016: AAMC introduced new standards for MSPE
ABIM’s ethical vs unethical behavior
altruism - act in best interest and not self-interests, honor & integrity - don’t violate one’s standard of behavior, excellence - exceed ordinary expectation, accountability - being accountable to both pts AND society, respect, duty - commitment to service (ex: being on call at inconvenience) vs lack of conscientiousness - doing more than “just the minimum”, arrogance - superiority, greed - inappropriate aspiration for fame and money, misrepresentation - lying/fraud, impairment - inability to meet expectations and not reporting it, conflict of interest - unethical collabs in industry (accepting gifts/self referral/drug lunch), abuse of power - bias/sexual harassment/breach of confidentiality
discrimination vs harassment vs violence vs sexual violence
making distinctions b/w ppl based on their group (religion, race, ethnicity, sexual orientation) –> VCOM has zero tolerance vs any offensive behavior that demeans, humiliates, annoys, embarrasses, threatens or intimidates someone –> VCOM has zero tolerance vs physical contact over physical control and intimidation vs unwanted sexual contact thru physical control and intimidation
Title IX. Its origin?
no one should be discriminated on basis of sex –> protects from sexual violence, sexual harassment, and gender discrimination. 1972: equity/access for females for financial aid, athletics and admissions
CLERY Act 1990. Its expansions?
Jeanne Clery raped and killed in dorm 1986; requires schools to report crime stats, notify campus of threat and make annual campus security report to community, students and employees. 1992: protect SA survivors; 1998: inc reported crimes (hate, sexual, domestic), renamed Crime Awareness and Campus Security Act; 2000: institutions must give info on registered sex offenders; 2008: after VT shooting, schools must report threats on campus, missing students, timely warnings, fire safety; 2013: report sexual/dating/domestic violence, stalking; 2018/2019: report sexual crimes
What is consent?
it’s informed, affirmative, conscious decision, voluntary, not coerced/threatened; not ambiguous/inferred
Age of consent vs min age of victim
age when someone can legally consent to intercourse vs someone below age cannot consent to intercourse under any circumstances
sexual assault vs dating violence vs domestic violence vs stalking
any sexual act against someone either by force or w/o consent vs any type of assault by person who is in intimate/romantic relationship w/ victim vs felony/misdemeanor crimes by intimate partner/spouse, by someone whom victim shares a kid, by person victim is/has cohabitating/ed w/, by someone against adult/youth victims who’s protected under domestic violence laws of jurisdiction vs engaging in conduct that causes victim to fear for their safety or cause emotional distress
How far can Final Rule/Title IX go? How far does VCOM policy go?
in the US. on facilities owned by VCOM or where VCOM has substantial control
sexual harassment
conduct of basis of sex 1) by employee of institution to aid/benefit/service victim in unwelcome sexual contact or 2) unwelcome contact by someone to be severe/pervasive/objectively offensive that denies victim from equal access to institution
how to report sexual harassment? how to anonymously?
see Title IX Coordinator (Campus Director of HR). 1. Discuss availability of supportive measures, 2. Consider the complainant’s wishes with regard to supportive measures, 3. Inform the complainant of the availability of supportive measures with or without filing a formal complaint, 4. Explain the process for filing a formal complaint. anon can go to Title IX Coordinator or Associate Dean
when should recipient dismiss complaint?
1) if conduct did not constitute sexual harassments, 2) if it didn’t occur in recipient’s institution/education program, 3) if it didn’t occur against a person in the US
mindfulness vs mindfulness outcome
Jon Kabat-Zinn wrote a book: Mindfulness-Based Stress Reduction (MBSR) that says mindfulness - paying attn in particular way - on purpose, in the present, nonjudgmentally vs awareness; art of knowing what you are experiencing in that moment (nothing more or less)
How does mindfulness contribute to well-being physician?
attentive (address pt’s needs), compassion, empathy, build rapport, improve pt compliance, improve quality of care, suspend judgment
physician burnout = assoc w/?
depersonalization, longer post d/c recovery time, inc medical errors, reduced standards for pt care, inc physician/med staff turnover rates, workplace productivity an efficiency, physician depression/exhaustion/substance abuse/suicidal
sitting meditation vs mantra meditation vs body scan vs walking meditation vs eating meditation vs mindful yoga
focus on breathing; breath-counting - count each exhale and note when mind wanders during breaths, deep breathing - focusing on what’s around you (try to clear mind while you use 4 senses) vs focusing on word/syllable/phrase and rpting it over vs inc body sensation to pain/anxiety/discomfort and focus on each body part vs focus on walks and pay attn to feet & lower legs vs observe processing of eating and swallowing, meant to eat alone, maintain focus vs do yoga and focus on thoughts/perceptions and letting them go
5-3-1 (daily) practice
meditate for 5 min, identify 3 good things, do 1 act of kindness
formal practice vs informal practice
ways to improve mindful awareness. actively using those meditation practices vs applying meditation practices to everyday life (reading, driving, pt encounter, grooming)
mandatory reports
all VCOM students and employees must report acts of sexual/violence. a physician = expected to report as well IF person agrees to HIPAA disclosure or if person = in imminent danger or if person = not of age
HIPAA security rule vs privacy rule
Confidentiality – PHI is not available or disclosed to unauthorized persons or processes. Integrity – PHI is not altered or destroyed in an unauthorized manner. Availability – PHI is accessible and usable upon demand by an authorized person vs assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide high quality health care and to protect the public’s health
what does privacy rule permit and not permit? privacy rule principle?
allow disclosures to/for: pt, authorized representatives, drs involved in tx, get reimbursement, healthcare entities for operations (training, QA/case management, credentials/accreditation), informally if pt allows (fam, facility directories). disclose PHI as privacy rule permits or authorize by pt or pt’s representative
what are the 2 groups covered by HIPAA
covered entities (healthcare providers) (use, disclose, and request only the minimum amount of PHI needed to accomplish the intended purpose) and business associates (provide services to healthcare providers like answering services, lawyers, collection agencies and health plans)
What is “individually identifiable information”? Examples of PHI?
info including demographics that relate to: pt’s past, present or future physical or mental condition; provision of care to pt; past, present or future payment for care to pt; or anything that identifies pt. name, age, address, DOB, phone #, dx, tx plans/results, prognosis, med records
Privacy Rule Requirements: you must disclose PHI to…
As required by law (statute, regulation, court order), Public health activities, Victims of abuse, neglect or domestic violence, Health oversight activities, Judicial and administrative hearings, Law enforcement purposes, Decedents (funeral directors, coroners); Organ, eye, tissue donation; Research, Serious threat to health or safety, Essential government functions, Workers’ Compensation (as required by law)
Covered entities protect PHI by…? What else do they do?
Written policies and procedures, Designated privacy officers, Annual education, Business Associate Agreements with covered entities, Limiting access to electronic records, Auditing those who access electronic records, Shredding docs, Screensavers, Fax cover sheets, Providing each patient, a “Notice of Privacy Practices”
They discipline those who violate policy: Oral warning with retraining, Written warning with more retraining, Termination, Referral to law enforcement
Pt’s Rights and exceptions
Inspect and obtain copies of medical records, Amend info the pt believes is incorrect subject to organizational approval, Accounting of disclosures other than for treatment, payment or healthcare operations (reports required by state and federal laws: funeral homes, communicable diseases, vital statistics), To request restrictions on what info = provided to others - except if pt pays cash –> info cannot be released to the insurance company, To request that confidential communications are provided by a particular means or location - except for emergencies.
Copies or amendments may be denied if likely to endanger the life or physical safety of the individual or another person.
Why maintain confidentiality?
Shows respect for patients.
Patients want to control access to sensitive information
Patients expect physicians to maintain confidentiality.
Encourages people to seek medical care
Encourages patients to discuss issues
Complete information results in better treatment
Prevents discrimination and stigmatization
Health care providers liable for breaches
Waivers of Confidentiality DO NOT grant blanket permission
When CAN confidentiality be breached?
Confidentiality may need to be breached to: Protect third-parties from violence, To protect others from the spread of disease. Or as required by law; victims of abuse, neglect or domestic violence; serious threat to health or safety
What’s on an EMR?
Significant illnesses and medical conditions
Medication allergies, adverse reactions
Past medical history: serious accidents, operations and illnesses
Working diagnosis
Treatment plans
16 other elements identified by NCQA
Risks of omitting info on EMR?
May compromise care.
Important clinical information will not be available in an emergency.
Appropriate documentation is required for reimbursement.
In many organizations testing/results can only be ordered/received by computer so omitting potentially sensitive information is not possible.
5 requirements for consent of released info
Written, signed and dated by the requestor Valid Specific Time-limited Right to revoke
Genetic Information Nondiscrimination Act of 2008 (GINA)
Prohibits using genetic information for: Employment decisions such as hiring, firing, promotion, job duties, etc; and Employer acquisition of genetic information
(like obtaining fhx during employment medical exam). Exceptions: Employee or family member with written request, Research compliant with federal regulations, Court order, Government agents investigating GINA compliance, Certification for Family and Medical Leave Act/state leave laws, Public health agency for contagious diseases threatening public health
GENETIC INFO PERTAINS TO PT AND THEIR FAM MEMBERS, EVEN FETUS
how to address healthcare disparities?
Identify and verify a healthcare disparity, define healthcare disparities that have a realistic solution and intervention, inc awareness, set priorities for disparities, give valid reasons to expend resources to reduce and eliminate priority disparities, Implement universal and targeted intervention programs, aim for a faster improvement rate among vulnerable groups
Health Care Disparities
Differences in health and health care between groups that are closely linked with social, economic, and/or environmental disadvantage (sex, income, geo location) –> Higher burden of illness, injury, disability, or mortality experienced by one group relative to another.
Health Care Disparities: Gender vs Race & Ethnicity
Women more likely to have chronic health conditions than men. men more likely to die from a chronic health condition/disease (diabetes, heart disease, cancer) vs can be caused by differences in genetic factors, environments, health behaviors, and systemic racism and bias; Higher rates of chronic disease in minority populations (diabetes, heart disease, cancer)
Health Care Disparities: Sexual Orientation/LGBTQIA+
- Health issues: psychiatric, substance abuse, suicide
- Environmental factors: victimization, violence
- Unique health challenges: access to care, insurance
- Gay and bisexual men=more than half of new HIV infections in US each year
- HIV prevalence in transgendered females exceeds 25% nationwide
- Lesbian/bisexual women receive less routine care than other women, including breast and cervical cancer screenings
- Approx 30% of LGBT youth report physical abuse by family members due to sexual orientation or gender identity/expression
Health Disparities: Income or Education
Groups with lowest income and education levels also have lowest health status; Higher income groups able to take part in healthy behaviors (exercise & eating well); Obesity among the poorest group is 2x level of the richest group
Health Disparities: Disability
Higher rates of obesity, lack of physical activity, and smoking; associated with an increased likelihood of not having a high school education, less likelihood of employment, less access to the Internet, an increased likelihood of having an annual income less than $15,000, and inadequate access to transportation –> less likely to receive preventive care; 3-4x rate of cardiovascular disease vs people without disabilities, 2x as likely as people without disabilities to not receive medical care because of cost in 2009; Additional barriers include common misconceptions, stigma, and attitudes among providers
Health Disparities: Geographic Location - Appalachian Region
Higher rates of Cancer, esp cervical ca, Heart Disease, premature infant mortality, lung dz, People living at or below poverty level, Poor access to medical services, High school drop - out or non-completion
equality vs equity
Equality = Sameness
- giving everyone the same thing
- only works if everyone starts from the same place
Equity = Fairness
- access to same opportunities
- We must first ensure equity before we can enjoy equality
Complex Causes of Healthcare Disparities
social Determinants of Health, Racial or ethnic bias, # of providers, Healthcare infrastructure, Cultural and language barriers, providers unlikely to practice in poverty areas, Health coverage, lack of diversity in providers, Quality of care, lack of communication across providers
Consequences of Cultural Incompetence in Healthcare
Providers may unintentionally provide lower expectations for pts who are in disadvantaged positions and therefore influence patient health outcomes, Providers may employ stereotypes when under time constraints –> poor pt communication, pt may mistrust medical profession → poor adherence → provider cynicism toward the pt→ provider offers pt fewer services
Skills to Develop to be Culturally Competent
Develop knowledge of diversity as it relates to dz processes and tx plan, support Diversity in the Health Professions (Medical Outreach & student organizations), obtain a culturally competent history and physical, Develop understanding of personal biases through introspection, conduct culturally competent patient education, Understand epidemiological data relevant to practicing culturally sensitive medicine
Best Practices to Develop Cultural Competence
Self-Awareness (introspection), Learn the language or colloquialisms, Use a worldview approach (assumptions about reality), Use caution in eliciting help from family/friends in interpretation, Know customs (eye contact, touching, asking questions, space, time), Ask questions—don’t assume, Small talk, self-disclosure, Use the formal name when unsure, Don’t ask “do you understand?”, repeat in own words, Ask permission, Negotiate treatment
What can we do as a health care system to promote cultural competency?
Provide training to increase cultural awareness, knowledge, and skills, Recruit and retain minority staff, Coordinate with traditional healers, Use community health workers, Incorporate culture-specific attitudes and values into health promotion tools, Include family and community members in health care decision making, Locate clinics in geographic areas that are easily accessible for certain populations, Expand hours of operation, Provide interpreter services/linguistic competency extending beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials
Cultural Competence vs Cultural Competence in Healthcare
a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system that enables effective work in cross-cultural situations vs ability of healthcare providers and organizations to meet the cultural, social, and linguistic needs of their patients
Why Cultural Competence Matters in Healthcare
Improve patient care and satisfaction, Decrease malpractice risks and insurance costs, Experience operational efficiency, Increase compliance with state and federal regulations, reduce health disparities, Ability to interact effectively with people of different cultures, inc understanding of differences without bias, Being culturally competent is an “ongoing process” (As the world progresses and becomes more diverse, health care providers must do likewise)
culture vs diversity
person’s learned beliefs, thoughts, and behaviors, values, customs, and traditions, their communication style, their views on relationships, and the different ways they interact with others; shaped by education, socioecon status, eth/nat/herit/race vs distinct qualities that make ppl different from e/o as individuals or groups; influenced by but not limited to eth/nat/herit/race, religion, sexual orientation
Socioeconomic Circumstances vs Mental & Physical Disabilities
an individual’s or family’s economic or social position in relation to others based on income, education and occupation vs A condition that impairs, interferes or limits a persons ability to engage in certain tasks or actions or participate in daily activities
Increased Provider Risk (Lowest to Highest) (insurance)
Traditional fee-for-service Pay-for-performance Bundled payments Episode-based payment Limited capitation Global payments
Brain and Body benefits of mindfulness
Brain benefits: emotional regulation, improved working memory, cognitive control, attention
Body benefits: symptom reduction, improved physical well-being, improved immune function
Confidentiality may breached when ALL are met
Potential harm to third parties is serious
Likelihood of harm is high
No less invasive alternative means for warning or protecting those at risk
Individual at risk cannot take steps to avoid harm
Harm to the patient is minimized and acceptable
Disclosure should be limited to information essential to the intended purpose and only those persons who need to know should receive information
Characteristics of Successful APMs
Processes to manage sickest patients EMR and communications w/ pts Strong hospital and physician relations Care coordinators at practice level Team approach to care Expanded office hours
Systemic racism vs Institutional racism vs Interpersonal racism vs Internalized racism
the idea that racism was built into the very foundation of our society. Because the US was built on the foundation of racist beliefs, it is in the fundamental policies vs a form of racism that is embedded through laws and regulations within society or an organization (ex: stop and frisk) vs a form of racism that occurs between individuals. Their personal racial beliefs will affect their personal relationships vs a form of racism that is within individuals. It is influenced by culture, prejudice towards others, internalized oppression, beliefs about superiority or entitlement
When was HIPAA effective?
It was enacted on August 21, 1996. Required Congress to pass regulations by August 21, 1999. Department of Health and Human Services were to develop regulations if Congress didn’t. Since Congress didn’t: Effective date was April 14, 2001 and Implemented April 14, 2003.
Does HIPAA apply to businesses?
nope, just healthcare (ie. health insurance companies, health care institutions, and health-related parts of the government)
is deactivating cardiac devices akin to physician-assisted suicide or euthanasia?
no. you can deactivate cardiac devices if pt = unconscious and fam desires it
social determinants of health
social and econ factors influencing individual and/or group differences in health status. ex: state legislation denying same sex marriage, schools don’t include sex orient/gen ID/gen expression protection programs, employment discrimination against trans; unequal access to care for LGBT+ ppl, esp poor and HIV/AIDS
4 perspectives of awareness and integration
universalist approach - you don’t see a diff –> comes off as you don’t acknowledge it. silo perspective - person has many identities but 1 ID defines the person and favors over the other. layers/cross-cutting perspective - pt and dr = composed of mult IDs but not integrated. intersectionality perspective - IDs = integrated and pt = influenced by all IDs, may be influenced by social network, exclusion or subordination
do co-pays go towards deductible? towards max OOP?
Nope. Depends on plan
Characteristics of APMs? Types of APMs?
manage sickest pts, longer hrs, improved efficiency/care, care coordinators at practice lvl, strong hosp/physician relationship, team approach to care, EMR and communication to pts. ACOs (medicare), bundled payments, pay for performance (hosp readmission reduction program, hosp acquired conditions, merit-based incentive payment system)
hosp readmission reduction program vs hosp acquired conditions vs merit-based incentive payment system
poor performers lose 3% inpt medicare pay, pt comes in w/ same CC w/in 30d vs lowest quartile/25% lose up to 1% of inpt medicare pay vs poor performers pay high performers, high performers get 4-12% raise
ACO vs bundled payments vs pay for performance
receive fixed payment/enrollee, demonstrate improvements in quality and costs, publicly reported results vs 1 payment for episode of care, payment share b/w all providers, payment tied to quality measures vs provide high quality care or be penalized
Explanation of Benefits (EOB) includes:
description of service, date of service, amount beneficiary pays, amount insurance pays, costs, cost sharing
cost sharing and its impact
when beneficiary pays part of bill. regressive –> hurts low income ppl; contributes to disparities; OOP spending reduces use of in/appropriate use of health services
Value Based Insurance Design (VBID)
min/elims OOP for high cost care; does not necessarily mean low utilization or less expensive. higher value –> you pay less
