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Professionalism/Ethics > Ethical Conduct > Flashcards

Ethical Conduct Flashcards

1
Q

What is a fiduciary relationship?

A

Special legal term that acknowledges an unequal distribution of power between the two parties

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2
Q

Who is involved in a fiduciary relationship?

A

Patient & provider

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3
Q

What is fiduciary duty?

A

Duty to care, based on trust of the patient

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4
Q

When is fiduciary duty breaches?

A

When the provider violates trust by promoting his/her own self-interests or the interests of third parties

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5
Q

Examples of financial conflicts of interest

A
  • Personal investments in medical facility, medical equipment, drug
  • Pharmaceutical gifts/drug samples
  • Reimbursement incentives (insurance - HMO, unnecessary tests/procedures)
  • Production incentives
  • Medical equipment or medication sales
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6
Q

Examples of personal & professional conflicts of interest

A
  • Research & development of clinical guidelines
  • CME sponsorship
  • Learning/training of new procedures
  • Treating employees, coworkers, ,family members
  • Disclosure of medical errors
  • Impaired professionals
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7
Q

What are the potentially problems assoc. w/ conflicts of interest?

A
  • Pt. outcomes may be compromised
  • Violates the integrity of medical judgement (pt. care)
  • Undermines trust of the medical profession
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8
Q

How to manage conflicts of interest

A
  • Reaffirm patient’s interests
  • Develop conflict of interest policies @ work
  • Disclose any potential conflicts
  • Take precautions to protect patients
  • Prohibit certain actions/situations
  • Recognize/ask “is the patient being compromised” OR “ would the situation stand up to legal scrutiny?”
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9
Q

Patients have the right to do what regarding the consent form?

A

Challenge it’s validity

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10
Q

How do we minimize the risk that the consent form is challenged by the patient?

A
  • Ensure form is readable, detailed, & procedure specific
  • Ensure the form is witnessed
  • Obtain consent on 2 separate occasions
  • Emphasize the significance of the form to the pt.
  • Document! (“pt agreed to proceed”, pt. education, pt. questions)
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11
Q

If the patient and/or surrogate is unable to consent, the provider…….

A

May initiate treatment

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12
Q

If a provider initiates treatment without consent in an emergency situation, the patient/surrogate should be updated and consent should be obtained

A

ASAP

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13
Q

If consent is obtained for a specific provider, can it be changed without patient notification?

A

No

- Patients may refuse or chose who performs a surgery or procedure

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14
Q

What is decisional capacity?

A

Patient has the ability to understand medical information, consider the situation and potential consequences as well as reason various medical options AND communicate a clear decision/choice

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15
Q

Who determines if a patient is incapacitated?

A

The treating physician(s) and/or psychologist

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16
Q

How many providers must sign off on deeming a patient incapacitated?

A

2

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17
Q

Is incapacity temporary or permanent?

A

It can be either

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18
Q

Once incapacitated, a surrogate decision-maker is needed such as…..

A

D-POA, guardian, family member, or “intimate” associate

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19
Q

A surrogate decision maker should base decisions on

A
  • Patient’s expressed preferences about advanced directives
  • Patient’s views on life, attitudes/beliefs about illness or certain medical procedures, etc.
  • If patient’s wishes are unknown, decisions should be made in the pts. best interest (risk vs. benefit, QOL, etc.)
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20
Q

A surrogate decision maker’s decision may require

A

Involvement of the ethics committee

21
Q

Informed consent/decision making in the context of minors involves

A

The patient to the level s/he is able to participate AND the parents/legal guardian
- Emancipated minors (e.g. military members, married individuals may consent

22
Q

Minors may consent to the following in the state of WI

A

<18YO: Contraceptive care, pregnancy testing, STI dx & tx, rape, sexual assault
>14YO: HIV testing
>12YO: ADODA outpt eval or detox <72hrs (or <12 if parent cannot be found)

23
Q

What entity requires consent from BOTH minor AND parent/guardian for individuals <18YO in WI

A

Abortion

  • Unless they are emancipated
  • There are exceptions: emergency, sexual assault, suicide risk, incest, parental abuse
24
Q

What if a minor becomes a parent?

A

Minor child becomes “legal adult” for the newborn

25
Q

What is HIPAA

A

Health Insurance Portability and Accountability Act (1996)

26
Q

What does the Health Insurance Portability portion of HIPAA ensure?

A

Continuity of insurance coverage

27
Q

What does the Accountability portion of HIPAA serve to do?

A

Combat fraud, waste and abuse of healthcare delivery and insurance

28
Q

What is administrative simplification?

A

Billing simplification and move to electronic transactions

  • Privacy & security of pt. information
  • Established NPI # for providers
29
Q

What is protected health information + examples

A

Identifiers of health information

  • Name
  • SS #
  • Addresses
  • DOB
  • includes any information that would enable another to identify a patient
30
Q

What is the HIPAA privacy rule?

A

Governs use and disclosure of protected health information

31
Q

What is the HIPAA security rule?

A

Governs only protected information in the electronic form

- Provides safeguards for access to and transfer of patient information

32
Q

Who completes an investigation if a HIPAA privacy rule Is violated?

A

Health & human services -> fines, referral for criminal prosecution and imprisonment
Civil lawsuit -> pt. sues

33
Q

Be cautious when releasing information to WHO without patient consent

A

3rd parties e.g. relative/family member, court subpoena, employers

34
Q

Basic principle of the HIPAA privacy rule

A

Limit circumstance where PHI can be used/disclosed

- “Minimum necessary” rule

35
Q

What are examples of permitted disclosures under the HIPAA privacy rule?

A
  • The patient
  • For the purposes of treatment, payment, operations
  • To protect public interests/legal or emergency situations
  • Limited data for research
36
Q

What is an example of treatment that is protected (e.g. not shared) even though treatment is considered a permitted disclosure?

A

Psychotherapy notes

37
Q

Example of permitted disclosure - treatment

A

Consults & referrals

38
Q

Example of permitted disclosure - payment

A

Determine coverage & obtain reimbursement or payment for services

39
Q

Example of permitted disclosure - operations

A
  • Care coordination/mgmt
  • Medical reviews/audits
  • Legal services
  • Insurance
  • Administrative
40
Q

What is informal permission?

A

Merely asking the patient’s permission

41
Q

If unable to obtain informal permission/emergency, a provider may make disclosures based on

A

Professional judgement

42
Q

Informal permission can cover disclosures to who?

A

Family & friends

43
Q

Examples of disclosure required by law

A
  • Public health (e.g. communicable diseases, abuse, domestic violence)
  • FDA (e.g. adverse events)
  • Worker’s comp/OSHA/employer (work related illness/injury)
  • Court ordered
  • Law enforcement (e.g. ID a missing person)
  • Funeral direct, coroner, medical examiner
  • Organ donation/transplant
  • Threat to patient or public (e.g. suicide or homicide)
  • Essential government fcns (e.g. military intelligence)
44
Q

In general, disclosure of PHI for minors to “personal representatives” is allowed, but there are special cases where minor’s confidentiality/right to privacy is protected. What most often dictates these special cases?

A

State law

45
Q

In WI, mental health treatment for minors in a facility requires

A

BOTH minor and parental consent

46
Q

Patients may do the following in regards to their medical record

A
  • Request restrictions and access to records
  • Inspect and copy records
  • Request amendments
  • Request a list of disclosures
  • Revoke prior authorizations
  • Request an alternate means of communication
  • Decline listing in directories
  • File a complaint
47
Q

What is the only tool a provider should use or means of record transfer & communication?

A

Organization EHR

48
Q

DO’s and DON’Ts of record transfer & communication

A

DO: protect your password

DON’T: text, public email, use the internet, look up health info on people/patients if you do not need it to perform job

49
Q

T or F: patient’s can read what is documented in the EHR

A

True

Professionalism/Ethics (4 decks)

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