Physician-Patient Relationship

Question 1

Physician has the responsibility to inform patient of what?

Answer 1

1. Probable course if untreated

2. Available and recommended treatments

Question 2

What are some additional responsibilities of a physician in regards to patient care?

Answer 2

1. Must respect patient’s decision

2. Act in best interest of patient

Question 3

What should the physician tell the patient about drug side effects? Should they list every side effect??

Answer 3

1. Common side effects
2. Serious Side Effects
   (hell no not every side effect)

Question 4

What should a physician do if they are placed in a situation where the patients best interest is being challenged either due to patients beliefs or whatever reason?

Answer 4

Always…..Default in the best interest of the patient

aka wake your boss up and ask him if you dont know what to do

Question 5

When may the physician refuse to perform certain treatments?

Answer 5

Physician May:

1. Refuse to perform act that conflicts with personal, moral, or ethical principles
2. Has responsibility to respect patient’s wishes and make a referral

Question 6

Is it okay to date or get into a relationships with former or current patients?

Answer 6

once a patient always a patient

Soooooo hell no

Question 7

According to the patients Bill of Rights of 1972, patient has the right to….?

Answer 7

1. Receive complete information
2. Refuse treatment unless deemed incompetent
3. Know hospital’s possible financial conflicts of interest

Question 8

Is forming a relationship with a patient illegal or unethical?

Answer 8

Unethical, not illegal

Question 9

If you are a pediatrician, is the mother or father also your patient?

Answer 9

yes, mother or father are your patients as well

aka just dont fuck your patients parents

Question 10

If patient refuses treatment, what must the physician do?

Answer 10

Have a psych consult (to make sure its not a psychological issue)

Question 11

what does informed consent say?

Answer 11

patient has the right to:

1. Refuse or accept medical care
2. execute an advance directive concerning their care or designate a proxy
3. Full, accurate and understandable explanations from physician

Question 12

What are the limits of confidentiality?

Answer 12

Physician cannot share patient information without their consent unless:

1. He/she is concerned patient will harm themselves or others
2. Situations that involve mandatory reporting (child abuse, communicable disease)

Question 13

What are the guidelines for protecting confidentiality?

Answer 13

1. Conduct interview in private
2. Tell patients with whom and under what circumstances information will be shared
3. Teach or consult about patients in private
4. Override confidentiality if safety of patient is a concern

Question 14

If the police have a court order for records, can you talk about the patient?

Answer 14

No, they only have permission to take the records, not for you as the doctor to talk about it.

Question 15

If a patient admits to being a serial killer in the past, can you report that?

Answer 15

No

Question 16

If a patient rapes someone in the past can you report that?

Answer 16

NO

Question 17

Crimes committed abroad or to kids, can you report those?

Answer 17

yes

Question 18

As a doctor is it illegal to treat a family member?

Answer 18

Not illegal but it is unethical to treat family members.

Question 19

Is it acceptable to break confidentiality if MD gets a subpoena?

Answer 19

yes

Question 20

In regards to gifts, what are the limits???

Answer 20

Symbolic meaning not necessarily amount

just be realistic…dont accept gifts that are suggestive

Question 21

In regards to physician patient relationship what is accurate empathy?

Answer 21

ability to transiently resonate with the emotional state of the patient.

to understand patient’s illness experiences from patient perspective

to communicate this understanding to patient

Have this understanding confirmed by patient

Question 22

What are some factors that may lead to boundary crossing????

Answer 22

1. Failure to be aware of TRANSFERENCE of patient towards physician. (aka something IN THE PATIENT that you as the physician triggered based on patient experiences and beliefs)…POSITIVE OR NEGATIVE
2. Failure of physician to understand COUNTERTRANSFERENCE. (aka something IN THE PHYSICIAN that is triggered, can be NEGATIVE OR POSITIVE)

Question 23

Can transference be negative and positive?

Answer 23

yes can be both

Question 24

Can countertransference be positive or negative?

Answer 24

yes can be both

Question 25

What are some Impediments to communication?

Answer 25

Sensory impairment
Language and cultural differences
Age effects
Gender Effects

Question 26

What are the two main fears in patients?

Answer 26

1. Losing bodily integrity
2. Becoming dependent
3. Becoming a burden

Question 27

Influences to patient’s adherence to treatment recommendations, depend on patient’s belief that:

Answer 27

1. Illness warrants treatment
2. Treatment is effective
3. Cost of treatment is reasonable given benefits
4. Treatment is feasible

Question 28

What is the formula for compliance?

Answer 28

compliance= adherence and concordance

Question 29

What is adherence?

Answer 29

Complexity of regime
Persistence of symptoms
Frequency and quality of contact with physician

Question 30

What are the factors that increase compliance?

Answer 30

1. Good Physician-Patient relationship
2. Feeling ill
3. Limitation of usual activities
4. Written instructions for taking medication
5. Acute illness
6. Simple treatment schedule
7. Short time spent in the waiting room
8. Recommending one change at a time
9. Benefits of care outweigh costs
10. Peer Support

Question 31

What are the factors that decrease compliance?

Answer 31

1. Poor Rapport
2. Has few symptoms
3. Little disruption of activities
4. Verbal instructions
5. Chronic illness
6. Little peer support
7. Complex treatment schedule
8. Long time spent in waiting room
9. Recommending multiple changes at the same time
10. Believing costs outweigh benefits

Question 32

There are six methods for supporting participatory decision making, what are they?

Answer 32

1. Present options for how patient can participate in decision making
2. Present options for how clinical details presented to the patient
3. State info regarding clinical procedure in terms of absolute risk since relative risk reduction
4. Carefully weigh order in which info is presented
5. Carefully present time frame of treatment outcome
6. In presenting outcome rates, use proportions rather than percentages