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TERM 3- Postmidterm > Week 4 Bioethics & Health Systems (DLA16, L32, L34, L36, L38) > Flashcards

Week 4 Bioethics & Health Systems (DLA16, L32, L34, L36, L38) Flashcards

1
Q

In the US, what is the most uninsured ethnicity and what is the predominate reason why

A
  • Hispanics, 24% (followed by Black 16%, Asian 15%, Whites 10%)
  • many are only employed in a part-time status
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2
Q

what are the financial barriers causing Underinsurance

A
  • health insurance does not guarantee financial access to care
  • limitations of coverage restricts access to necessary services
  • prohibitive insurance deductables, copayments
  • gaps in Medicare coverage
  • lack of coverage for long-term care
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3
Q

what are the non-financial barriers to Health Care (not the 4 A’s)

A

lack of prompt access, gender, race, literacy, disability, sexual orientation, geography, age

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4
Q

what are the 4 A’s of non-financial barriers to Health Care

A
  • Accommodation: people are busy with work/commitments
  • Availability: appt not soon enough
  • Accessibility: took too long to Dr’s office/clinic
  • Acceptability: Dr/hospital doesn’t take health insurance
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5
Q

describe the parameters of the Children Health Insurance Program

A
  • low income children <19 y/o; not eligible for Medicaid and cannot afford health insurance
  • federal funding covering up to 300% of FPL (Federal Poverty Line)
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6
Q

what is COBRA

A

Consilidated Omnibus Bidget Reconcilation Act (1985)

  • workers who lost their job can continue health coverage for up to 18 mos
  • must continue to pay premium
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7
Q

what is EMTALA

A

Emergency Medical Treatment and Active Labor Act (1986)

  • prevent hospitals from dumping indigent/uninsured patients
  • all hospitals that receive federal payments must screen and stabilize ER patients
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8
Q

Pts with least access to care (uninsured included) in general have the following outcomes

A
  • more likely poor health status
  • less likely receive medical care
  • more likely Dx later
  • more likely die prematurely
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9
Q

what are the causes of health disparities

A

behavioral, environmental, social, biological/genetic determinants of health

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10
Q

what are the two main causes of death in the US (include %)

A
  • tobacco 18%

- diet/activity 17%

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11
Q

list some reasons for why death certificates are important

A
  • burial permit
  • settlement of deceases’s estate
  • life insurance claim
  • obtain death benefits
  • termination of government services/obligations
  • closure / peace of mind
  • public health
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12
Q

crude death rate

A

deaths / population (usually per 100,000)

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13
Q

disease-specific death rate

A

deaths due to one disease / mid-yr population (in given time period- usually per 100,000)

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14
Q

age-specific death rate

A

deaths in age group / mid-yr population (in given time period- usually per 100,000)

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15
Q
  • Neonatal Mortality Rate
  • Infant Mortality Rate
  • Under-five mortality rates
A
  • NMR- deaths during first 28 days of life per 1000 live births
  • IMR- deaths in 1st yr of life per 1000 live births
  • <5- deaths in first 5 yrs of life per 1000 live births
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16
Q

maternal mortality rate

maternal mortality ratio

A

rate: maternal deaths / women of reproductive age
ratio: maternal deaths /live births

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17
Q

case fatality rates

A

deaths by one disease / total number of people with disease (as a percentage)

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18
Q

proportionate mortality rate

A

deaths by one disease / total deaths (as a percentage)

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19
Q

list the 5 bioethic principles

A
  • Respect for persons: fidelity to Pt, respect for dignity/autonomy
  • Beneficence: act in Pt interest
  • Nonmaleficence: avoid harm to Pt
  • Utlility: balance benefit, harm
  • Justice: be fair
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20
Q

list the 3 common bioethic theories

A
  • Duty-based (deontological): act to fulfill moral obligations
  • Outcome-based (consequential): act to maximize outcomes
  • Virtue-based: act from virtuous character and intention
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21
Q

list the 4 professional competencies

A
  • cognitive
  • integrative
  • relational
  • moral
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22
Q

list the 4 goals of medicine

A

1) prevention of disease & injury & promotion / maintenance of health
2) relief of pain & suffering caused by maladies
3) care and cure those with malady and care for those who cannot be cured
4) avoidance of premature death and the pursuit of a peaceful death

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23
Q

list the 3 common types of Justice

A
  • Procedural: fairness of law/policy
  • Distributive
  • Social: improve conditions for those least well off
24
Q

list the 4 elements of Respect for Persons

A
  • Fidelity: loyalty, keeping promises
  • Autonomy
  • Veracity: truth telling (with almost no exceptions)
  • Avoidance of killing
25
Q

what are 4 key ways in showing respect to patients

A

1) attention to needs and individuality
2) empathy
3) information (disclosure)
4) dignity

26
Q

compare positive and negative rights

A

Pos, requires actions: right to good/service, truthfulness (veracity), being fair (justice), acknowledge Pt preference, beneficience

Neg, requires no action: right to be left alone, protect privacy, avoid killing, nonmaleficence

27
Q

list the 4 limits to Respect for Persons

A
  • Harm Principle: actions taken on Pt to avoid harm to others
  • Diminished Autonomy: no capacity to make decisions
  • Paternalism: Dr knows best
  • Public Health Protections
28
Q

list the 5 values and behaviors of medical professionalism (according to WHO)

A
  • responsible
  • pyschologically mature
  • possessing communication skills
  • respectful
  • smart
29
Q

list some of the components of good first impressions

A
  • attire / appearance
  • voice
  • level of attention: eye contact, prescence, friendliness, touch
  • addressing the person: ask 1st, observe titles, cultural considerations
30
Q

medical error is the __ leading cause of death in the US

A

3rd (communication between providers can reduce errors 30%)

31
Q

list some communication basics and techniques

A
  • nonverbal language / active listening
  • adaptive questioning: open/closed-ended Qs
  • facilitation: ‘go on’
  • echoing
  • validation
  • reassuance
  • summarization, empathetic responses
  • highlighting transitions
  • conflict management
32
Q

define Informed Consent

A

process by which the treating health care provider discloses appropriate information to a competent patient so the patient may make a voluntary choice to accept or refuse treatment

33
Q

list the 4 types of medical battery

A

1) no consent to any procedure
2) consent to a different procedure
3) same procedure, different body part
4) same procedure, same body part, different doctor

34
Q

list the 5 elements of informed consent

A
  • voluntarism
  • capacity
  • disclosure
  • understanding
  • authorization
35
Q

what are the 4 components of Informed Consent that a physician must address

A

1) alternatives (including doing nothing)
2) inherent risks: probability, severity
3) who is providing treatment and their role(s)
4) physician experience

36
Q

define capacity

A

ability to understand, make a decision, and communicate decision

37
Q

compare capacity v insanity v competence

A
  • Competence- legal determination (by court), applies to all decisions
  • Insanity- legal determination, applies to criminal responsibility
  • Capacity- clinical determination, decision specific
38
Q

list reasons why a patient would lack capacity

A
  • had it, lost it (ex. dementia)
  • not yet acquired (ex. minors)
  • never had capacity (ex. mental disability)
39
Q

what is the hierarchy in a substitute decision maker

A

1) subjective: follow Pt’s instructions
2) substituted judgement: know the Pt well, decide as if they were the Pt
3) best interests: burden of Tx v benefits assessment

40
Q

list criteria(s) for emancipated minors

A
  • > 13 y/o
  • married OR financially self-sufficient
  • military service (17 y/o) with no parental support
41
Q

list the Tx types where minors don’t need a SDM

A
  • contraception, STDs, pregnancy
  • mental health, EtOH/substance abuse
  • emergency / trauma
  • public health policy
42
Q

describe physician detainment

A
  • used if physician suspects harm to self/others OR infectious disease of great civil peril
  • up to 48 hrs pending court hearing
  • Pts lose the right to leave, right to refuse Tx remains
43
Q

what are the 4 critical components of the patient-physician relationship once a relationship is formed

A
  • standard of care
  • confidentiality
  • non-abandonment
  • informed consent
44
Q

what are the 5 exceptions to confidentiality

A

1) GSW or knife wounds
2) abuse, neglect (low threshold of reasonable suspicion)
3) communicable diseases
4) neurological impairment – affects driving
5) Pt poses threat to others

45
Q

define medical malpractice

A

breach of any duty owed as a physician

46
Q

list the 5 elements of respect for persons related to malpractice

A

1) commitment (don’t abandon Pt)
2) autonomy (informed consent)
3) fidelity (promise keeping & confidentiality)
4) veracity (truth telling)
5) competence (standard of care)

47
Q

list the most prevalent fields by Medical Malpractice claims

A
  • Neurosurgery, 19%
  • Thoracic-CV surgery, 19%
  • Gen. Surg., 15%
  • Family Med., 5%
  • Peds, 3%
  • Psych., 2.6%
  • All Others, 7.4%
48
Q

Inpatient: (1) accounts for 34% of medical malpractice claims

Outpatient: (2) accounts for 46% of medical malpractice claims

A

1- surgical errors

2- diagnostic errors

49
Q

list factors that are high risk for predicting malpractice

A
  • inc age
  • surgical specialty
  • emergency department coverage
  • inc days away from practice
  • previous malpractice suit
50
Q

list factors that are low risk for predicting malpractice

A
  • scheduling enough time to talk to Pts
  • answering phone calls directly
  • satisfactory practice arrangements
  • acknowledge one’s own emotional distress
51
Q

what are methods or characteristics doctors that have never been sued have

A
  • spent 3+ mins longer with Pts
  • more likely to make orienting comments
  • more likely to engage in active listening
  • more likely to laugh during visit
52
Q

what are common reasons patients sue for malpractice

A
  • concern with standard of care
  • need for explanation (how injury happened/why)
  • compensation (for actual losses, pain, suffering)
  • accountability
53
Q

what are the four elements of malpractice litigation

A

1) duty- provide a certain standard of care
2) breach of duty
3) causation- Dr’s actions/negligence inc chances event
4) damages- to Pt

54
Q

list some characteristics of typical Malpractice Patient Profiles

A
  • majority female (60%)
  • median age 38 y/o
  • 20% were newborns
  • ~12% >65 y/o
55
Q

what are the 3 sub-elements of Breach of Duty in relation to Malpractice and lack of disclosure

A

1) had disclosure been made would Pt have consented
2) had disclosure been made would a reasonable person/patient have consented
3) was the materialized risk caused by the intervention

TERM 3- Postmidterm (11 decks)

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