Usmle Step 1 Fa Behavioral Sciences-Ethic

Front 1

Exceptions to informed consent

Back 1

-Patient lacks decision making capacity or is legally incompetent.
-Implied consent in an emergency.
-therapeutic privelage: withholding information when disclosure would severely harm the patient or undermine informed decision making capacity.
-waiver: patient waives right

Front 2

Two types of written advance directive:

Back 2

(1) living will-describes treatments the patient wishes to or not to receive if he/she becomes incapacitated.
(2) durable power of attorney-patient designates a surrogate to make medical decisions in the event that he/she loses decision making capacity.

Front 3

Exceptions to confidentiality:

Back 3

(1) Potential harm to others is serious.
(2) Liklihood of harm to self is great.
(3) no alternative means exist to warn or protect those at risk.
(3) Physicians can take steps to prevent harm:
Examples:
-Infectious disease
-Tarasoff decision: law requires physician to directly inform and protect potential victim from harm
-Child/elder abuse
-Impaired automobile drivers
-Suicidal/homicidal patients

Front 4

Requirements for civil suit under negligence (malpractice)

Back 4

1. physician had duty to patient (duty)
2. physician breached that duty (dereliction)
3. patient suffers harm (Damage)
3. breach of duty was what caused harm (Direct)

Front 5

Appropriate response:
Patient is noncompliant.

Back 5

Work to improve the physican-patient relationship.

Front 6

Appropriate response: Patient has difficulty taking medications.

Back 6

Provide written instructions; attempt to simplify the regimen.

Front 7

Appropriate response: family member asks for info about patients prognosis.

Back 7

Acoid discussing issues w/relatives without permission of the patient.

Front 8

Appropriate response: a 17 YO girl is pregnant and requests an abortion.

Back 8

Many states require parental notification or consent for minors wanting an abortion. Parental consent is not required for emergency situations, treatment of STD's medical care during pregnancy, and management of drug addiction.

Front 9

Appropriate response:
Terminally ill patient requests ending his life.

Back 9

In the overwhelming majority of states, refuse involvement in any form with physician assisted suicide. Physicans may, however, prescribe medically appropriate analgesics that coincidentally shorten the patients life.

Front 10

Appropriate response: Patient states that he finds you attractive.

Back 10

Ask direct, closed ended questions and use a chaperone if necessary. Romantic relationships with patients are never appropriate.

Front 11

Appropriate response: Patient refuses a necessary procedure or desires an uncessary one.

Back 11

Attempt to understand why the patient wants/does not want the procedure. Address the underlying concerns. Acoid performing uncessary procedures.

Front 12

Appropriate response: Patient is angry about the amnt of time he spent in the waiting room.

Back 12

Apologize to tha ptient for inconvenience. Stay away from exports to explain the delay.

Front 13

Appropriate response: Patient is upset with the way he was treated by another doctor.

Back 13

Suggest that the patient speak directly to that physician regarding his/her concerns. If the problem is with a member of his staff, tell the patient you will speak to that individual.

Front 14

Appropriate response: a child wishes to know more about his illness.

Back 14

Ask the parents have told the child about his illness. Parents of a child decide what info can be relayed about an illness.

Front 15

Appropriate response: Patients continue to smoke believing that cigarettes are good for them.

Back 15

Ask how the patients feel about his/her smoking. Offeradvice on cessation if the patient seems willing to make an effort to quit.

Front 16

Appropriate response: Minor requests condoms.

Back 16

Physicans can provide counsel and contracpetive to minors without parents' knowledge or consent.