Jeef First Aid- Behavioural Part 3

Front 1

61. Medicaid?

Back 1

a. Federal and state assistance for very low income people.

Front 2

62. 4 core ethical principles?

Back 2

1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice

Front 3

63. Autonomy?

Back 3

a. Obligation to respect patients as individuals and to honour their preferences in medical care.

Front 4

64. Beneficence?

Back 4

a. Physicians have special ethical (fiduciary) duty to act in the pt’s best interested. May conflict w/autonomy.
b. If the pt can make an informed decision, ultimately the pt has the right to decide.

Front 5

65. Non-maleficence?

Back 5

a. “Do no harm”. However, if the benefits of an intervention outweigh he risk, a pt may make an informed decision to proceed (most surgeries fall into this category).

Front 6

66. Justice?

Back 6

a. To treat persons fairly.

Front 7

67. What does informed consent legally require?

Back 7

1. Discussion of pertinent information
2. Pt’s agreement to the plan of care
3. Freedom from coercion
b. Pts must understand the risks, benefits, and alternatives, which include no intervention.

Front 8

68. Exceptions to informed consent?

Back 8

1. Pt lacks decision-making capacity or is legally incompetent.
2. Implied consent in an emergency
3. Therapeutic privilege-withholding information when disclosure would severely harm the pt or undermine informed decision-making capacity.
4. Waiver- Pt waives the right of informed consent.

Front 9

69. Consent for minor?

Back 9

a. Parental consent must be obtained unless minor is married or otherwise emancipated.

Front 10

70. Decision making capacity?

Back 10

a. Patient makes and communicates a choice.
b. Patient is informed
c. Decision remains stable over time
d. Decision is consistent with patients values and goals
e. Decision is not a result of delusions or hallucinations.

Front 11

71. Can a patient’s family require that a doctor withhold information from a patient?

Back 11

a. No.

Front 12

72. Oral advance directive?

Back 12

a. Incapacitated patient’s prior oral statements commonly used as guide.
b. Problems arise from variance in interpretation.
c. If pt was informed, directive is specific, patient made a choice, and decision was repeated over time, the oral directive is more valid.

Front 13

73. Written advance directive?

Back 13

a. Living will- describes treatments the pt wishes to receive or not receive if he/she becomes incapacitated and cannot communicate about treatment decisions.
b. Usually, pts direct physician to withhold or withdraw life-sustaining treatment if they develop a terminal disease or enter a persistent vegetative state.

Front 14

74. Durable power of attorney (part of written advance directive)?

Back 14

a. Pt designates a surrogate to make decisions in the event that he/she loses decision-making capacity.
b. Pt may also specify decisions in clinical situations.
c. Surrogate retains power unless revoked by patient.
d. More flexible than a living will.

Front 15

75. Confidentiality?

Back 15

a. Confidentiality respects pt privacy and autonomy.
b. Disclosing information to family and friends should be guided by what the pt would want.
c. The pt may waive the right to confidentiality. E.g. insurance companies.

Front 16

76. Exceptions to confidentiality?

Back 16

a. Potential harm to others is serious
b. Likelihood of harm is great
c. No alternative means exist to warn or to protect those at risk.
d. Physicians can take steps to prevent harm.

Front 17

77. Examples of exceptions to confidentiality?

Back 17

a. Infectious diseases- warn public officials and people ar risk.
b. Tarasoff decision-
c. Abuse
d. Impaired drivers
e. Suicidal/homicidal patients

Front 18

78. Tarasoff decision?

Back 18

a. Law requiring physician to directly inform and protect potential victim from harm; may involve breach of confidentiality.

Front 19

79. Malpractice- What does a civil suit under negligence require? (4 D’s)

Back 19

1. Duty- physician had a duty to the pt.
2. Dereliction- Physician breaches the duty.
3. Damage- pt suffers harm.
4. Direct- The breach of duty was what cause the harm.

Front 20

80. Most common factor leading to litigation?

Back 20

a. Poor communication between physicians and patient.

Front 21

81. Proof needed for malpractice?

Back 21

a. Unlike a criminal suit, in which the burden of proof is “beyond a reasonable doubt,”, the burden of roof in a malpractice suit is “more likely than not”.

Front 22

82. Patient is noncompliant?

Back 22

a. Work to improve the physician-patient relationship

Front 23

83. Patient has difficultly taking meds?

Back 23

a. Provide written instructions; attempt to simplify treatment regimens

Front 24

84. Family members as for information about pt’s prognosis?

Back 24

a. Avoid discussing issues w/relatives w/out permissions of the pt.

Front 25

85. 17-yr old girl is preggers and requests abortion?

Back 25

a. Many states require parental notification or consent for minors for an abortion.
b. Parental consent is NOT required for emergency situations, treatment of STDs, medical care during preg, and management of drug addiction.

Front 26

86. A terminally ill pt requests physician assistance in ending his life?

Back 26

a. Refuse any involvement in physician-assisted suicide.
b. Physicians may, however, prescribe medically appropriate analgesics that coincidentally shorten the pt’s life.

Front 27

87. Pt states that she finds you attractive?

Back 27

a. As direct, closed-ended questions and use a chaperone if necessary.
b. Romantic relationships w/pts are never appropriate.

Front 28

88. Pt refuses a necessary procedure or desires an unnecessary one?

Back 28

a. Attempt to understand why the pt wants/does not want the procedure.
b. Address the underlying concerns.
c. Avoid performing unnecessary procedures.

Front 29

89. Pt is angry about the amount of time he spent in the waiting room?

Back 29

a. Apologize for any inconvenience.
b. Stay away from efforts to explain the delay.

Front 30

90. Pt. is upset w/the way he was treated by another doctor?

Back 30

a. Suggest the pt speak directly to that physician regarding his concerns.
b. If the problem is w/a member of the office staff, tell the pt you will speak to that individual.