Social Sciences/Ethics

Question 1

What are acceptable exceptions to maintaining pt confidentiality?

Answer 1

Suspected Child or elder abuse
knife or gunshot wounds
dx of a reportable communicable dz
Pt is at risk of harming themselves or others

Question 2

What is a requirement for referring a pt to hospice?

Answer 2

Terminally ill pt with a prognosis

Question 3

When can a paren’ts authority to make medical decisions for their child be challenged?

Answer 3

When a child is at significant risk for harm. Physicians can obtain a court injunction to proceed with life-saving medical tx for the child (ie bacterial meningitis)

Question 4

What do you do with a pt that is temporarily incapacitated (ie drunk or high)?

Answer 4

They should not be allowed to make important health care decisions and should be reassessed when sober

Question 5

If spousal abuse is identified, what questions should the physician ask?

Answer 5

Ensuring the pts safety through referrals and development of an emergency safety plan

Question 6

In a pt requiring intensive care, what is an appropriate topic to ask the family about?

Answer 6

Presence of advance directive and pt’s wishes for end of life care
Ideally these are initiated as part of their outpatient care, but should be inquired about during ICU admissions to ensure the health care team follows the pts wishes

Question 7

Two components of an advanced directive

Answer 7

1. Living will

2. Health care proxy

Question 8

If a physician suspects child abuse while interviewing a pt, what is the appropriate next step?

Answer 8

Seek permission for the parents to leave the room and interview the child alone. Parental refussal is considered concerning for abuse (same is true for a potential case of elder abuse).
Following full evaluation, the physician should contact child protective services immediately if they still suspect abuse

Question 9

A pt seeks advice about a health care plan with the lowest monthly payments (she is employed full time)

Answer 9

HMO
Low monthly premiums, copayments, and deductibles. Low total cost for the pt
However, reduced utilization by having a limited panel of providers, requires referrals to see a specialist, denies payments for services that do not meet guidelines