Final Exam Review (Ch. 1-10) Flashcards
(106 cards)
1
Q
Ethics
A
- Branch of philosophy related to morals, moral principles, and moral judgement
- Morality is being virtuous: practicing right conduct
- Uses reason and logic to analyze problems and find solutions
- Concerned with actions and practices that improve welfare of people in a moral way
2
Q
Utilitarianism
A
- Utiliarianism is the greatest good for the greatest number
- Impact of actions on welfare of society as a whole, rather than merely the individual
- EX: Medicare
- Weakness
- The rights of some people, such as the poor or ill, may be ignored
- Can be result in biased allocations
- The vulnerable may be ignored
3
Q
Utilitarianism Weakness
A
- The rights of some people, such as the poor or ill, may be ignored
- Can be result in biased allocations
- The vulnerable may be ignored
4
Q
Rights-based Ethics
A
- Emphasis on individuals’ rights
- Rights belong to all people
- Weakness
- May result in individualist, selfish behavior—even anarchy
5
Q
Rights-based Ethics Weakness
A
May result in individualist, selfish behavior—even anarchy
6
Q
Justice-based Ethics
A
- Based on a “veil of ignorance” to allow decision-makers to be impartial in their decisions
- Weaknesses
- Unfair for the healthy to subsidize the unhealthy
7
Q
Justice-based Ethics Weakness
A
Unfair for the healthy to subsidize the unhealthy
8
Q
Duty-based Ethics
A
- Focuses on performing duty
- Explores depending on professional role
- Weakness
- Difficult to know who determines one’s duty
9
Q
Duty-based Ethics Weakness
A
- Difficult to know who determines one’s duty
10
Q
Virtue-based Ethics
A
- Emphasis on people, not decisions or principles involved
- Based on character traits such as integrity
- Virtues are good habits
- EX: fairness, honesty, courage, and justice
- Weakness
- A person may become too trusting and complacent
11
Q
Virtue-based Ethics Weakness
A
A person may become too trusting and complacent
12
Q
Medical Ethics
A
- Concerns issues related to practice of medicine
- Explores and promotes principles guiding conduct of healthcare professionals
- Involves the welfare and consideration of others in deciding how to act
13
Q
Why Study Law, Ethics, and Bioethics?
A
- Illegal is almost always unethical
- EX: Although marches during the Civil Rights were illegal, they were certainly not unethical- Basic understanding of law as it applies to medical practice is essential
- It helps to protect patients from poor medical care
- Helps protect employee and employer from lawsuits
- Assists medical professional in making decisions based on reason and logic rather than on just emotion
- We live in a litigious society
- unreasonably prone to go to law to settle disputes
14
Q
Medical Law
A
- Addresses legal rights and obligations that affect patients and protect individual rights, including rights of health care employees
- Provides yardstick to measure of judge actions
- Punishes unlawful actions
- Laws are rules or actions prescribed by a government authority that have a binding legal force
15
Q
Quality Assurance
A
- Gather and evaluate information about services
- Examine results
- Compare information against a standard
16
Q
Felony
A
- Serious crime such as practicing medicine without a license
17
Q
Misdemeanor
A
- Less serious crime such as a traffic violation
18
Q
Medical Practice Acts
A
- Establish state medical boards
- Provide baseline for practice of medicine
- Determine prerequisites for licensure
- Forbid practice of medicine without a licensure
- Specify conditions for renewal, suspension, and revocation of licenses
- Vary from state to state
19
Q
Managed Care Organization (MCO)
A
- Gatekeeper— Primary physician
20
Q
Health Maintenance Organization (HMO)
A
- Offers a wide range of services to members for a predetermined fee by a limited group of providers
- Capitation rate
21
Q
Preferred Provider Organization (PPO)
A
- Patient must use a medical provider who is under contract with the insurer for an agreed-upon fee
- Copayment
22
Q
Exclusive Provider Organization (EPO)
A
- Combines the concepts of HMO and PPO
- Fee for service (FFS)
23
Q
Types of Medical Practice
A
- Solo Practice
- Sole Partnership- Partnership
- Share responsibility for financial and legal matters
- Associate practice
- Share facility, but not accounting or legal responsibility
- Group practice
- Three or more physicians
- Share same facility
- Practice medicine together
- Can be designated as HMO or IPA
- Professional corporations
- Managed by board of directors
- Shareholders
- Protection of individual assets and liability
- Partnership
24
Q
Solo Practice
A
- Sole Partnership
25
Partnership
- Share responsibility for financial and legal matters
26
Associate practice
- Share facility, but not accounting or legal responsibility
27
Group practice
- Three or more physicians
- Share same facility
- Practice medicine together
- Can be designated as HMO or IPA
28
Professional corporations
- Managed by board of directors
- Shareholders
- Protection of individual assets and liability
29
Fee splitting
- One physician offers to pay another for referral (unethical and illegal)
30
Franchise
- Business run by individual to whom franchisor grants exclusive right to market product or service in certain market area (ethical)
31
Franchisees
- Persons or companies that hold a franchise
32
Physician’s Rights
- Right to select patients
- Right to refuse service to patients
- Right to determine type of services provided
- Right to be paid for services rendered
- Right to withdraw from relationship
- Right to vacation and time off
33
Physician’s Responsibilities
- Be professionally competent
- Treat all patients equally
- Not to take “kickbacks” of money or other benefits in exchange for referrals
- Follow AMA code of ethics
34
Physicians’ Duties
- Patient welfare above financial interests
- Professional courtesy
- Report any unethical conduct by other physicians
- Recommend second opinions when necessary
- Do not engage in sexual conduct with a patient during the physician-patient relationship
- Do not treat family members except in emergencies
35
Duty to Treat Patients with AIDS
- Unethical to refuse to treat, work with, or provide housing for person who is HIV positive or has AIDS
- Physician, by law, must make full report to state about any patient who is HIV positive or has AIDS
- Ethical dilemma
- Report required regardless of consequence
- Ethical considerations
- Persuade patient to inform his or her partner
- Notify authorities if concerned that patient will not inform others
- As last resort, notify patients partner
36
Minor
- Person under the age of maturity (18 is most states)
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In loco parentis
- Person assigned by court to stand in place of parents
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Parents patriae
- State takes over care for minor
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Mature minor
- Person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent
40
Emancipated minor
- Person in mid to late teens who legally lives outside parents’ or guardian’s control
- Proof should be included in medical record
41
Duty to Treat Indigent Patients
- “Dumping crisis”
- EMTALA
- Require patient stabilization in an emergency
- Physician has right to select which patients to treat
- Physician does not have right to drop or abandon patients once treatment is agreed upon
42
Professional Negligence and Medical Malpractice
- Professional misconduct or demonstration of an unreasonable lack of skill with the result of injury, loss, or damage to the patient
- Negligence
- Unintentional action that occurs when a person performs or fails to perform an action that a reasonable person would or would not have committed in a similar situation
43
Feasance:
Performing an act or duty
44
Malfeasance
- Performing a wrong or illegal act
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Misfeasance
- Improperly performing on otherwise proper or lawful act
46
Nonfeasance
- Failure to perform a necessary action
47
Four D’s of Negligence
- Duty
- Responsibility established by physician-patient relationship
- Dereliction
- Neglect of duty
- Direct to proximate cause
- Continuous sequence of events, unbroken by an intervening cause, that produced injury and without which injury would not have occurred
- Damages
- Injuries caused by the defendant
48
Duty
- Responsibility established by physician-patient relationship
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Dereliction
- Neglect of duty
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Direct to proximate cause
- Continuous sequence of events, unbroken by an intervening cause, that produced injury and without which injury would not have occurred
51
Damages
- Injuries caused by the defendant
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Affirmative defense
- Denial, assumption of risk, contributory negligence, comparative negligence, borrowed servant, statute of limitations, and res judicata
- Allows defendant to present evidence that patient’s condition was the result of factors other than negligence
53
Denial defense
- Plaintiff must prove defendant did wrongful or negligent act
- Most common defense
- Jury must determine if defendant caused injury
- May bring in expert witness
54
Assumption of risk
- Prevents plaintiff from recovering damages if plaintiff voluntarily accepts a risk associated with the activity
- Plaintiff must know and understand risk involved, and choice to accept risk must be voluntary
- Should have signature to document that patient authorizes procedure, understands the risks, and consents to treatment
55
Public Health Records and Vital Statistics
- Important events in person’s life
- Used by government to determine population trends and needs
- Mortality rate: Death rate ratio of the number of deaths to population in a given location
- Morbidity rate- The number of sick people or cases of ds. in relationship to a specific population
- Public duty of physicians to report vital events
56
Birth
- Physicians must sign certificate of live birth
- Certificate is filed at county clerk’s office in state birth took place
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Death
- Date and time of death
- Cause of death
- How long deceased was treated before dying
- Presence of absence of pregnancy
- Whether autopsy took place
- Death certificate
- Usually must be signed within 24 to 72 hours of death
- Proof that a death has occurred
- Often required to confirm information
- Settling an estate
58
Coroner
- Public health officer holds inquest if death from unknown or violent cause
59
Medical examiner
- Physician (Pathologist) who investigates unexplained deaths and can perform autopsy
60
Autopsy
- Examination after death to determine cause of death by examining the organs and tissue
61
Certain deaths require a coroner’s signature:
- No physician present at time of death
- Violent in nature
- Homicide, suicide, accident
- Death as result of criminal action
- An unlawful death
- Assisted suicide
- Result of undetermined causes
- Caused by electrical, radiation, or chemical injury
- Caused by criminal abortion
- Includes self-induced
- Occurring less than 24 hours after hospital admission
- Of a person who had no physician in attendance within 36 hours of death
- Occuring outside a hospital or licensed health care facility
- Suspicious death
- Fall
- Of a person whose body is not claimed by friend or relative
- Of a person of unknown identity
- Of a child underage of two if death is from unknown cause
- Of a person in jail or prison
62
Duty to Report AIDS, HIV, and ARC Cases
- All states require reports of these cases to local or state department of health
- Who shall report the case varies from state to state (attending physician, laboratory, etc.)
- Many states have confidentiality statutes
63
Disclosure to Patients of Health Workers’ HIV Status
- Health care workers consider disclosure an invasion of privacy
- All blood and tissue donors tested
- Patients have desire to know if they are at risk of HIV infection
64
Child Abuse
- Child Abuse Prevention and Treatment Act: Requires reporting of all child abuse cases
- All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers
- Probable cause: A reasonable belief that something improper has happened
- Physicians have been held liable for not reporting cases
- Persons reporting is protected by law from being sued by parents and others
- Battered child syndrome— Describes a series of injuries, fractures, bruises, and burns. Signs of neglect, malnutrition, poor growth, poor hygiene
- Parental neglect
- States generally refrain from involvement
- State may have to intervene when a child is not receiving proper medical care
65
Elder Abuse
- Older American Act (1987)
- Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older
- Protects residents of nursing home facilities
- Protects against financial abuse or exploitation
66
Spousal Abuse
- Laws governing the reporting vary by state
- Local police may have to become involved when spousal abuse is suspected
- Court may issue restraining or protective order prohibiting abuser from contact with victim
67
Signs of Abuse
- Repeated injuries
- Bruises and unexplained swelling
- Signs of inadequate nutrition
- Unexplained fractures
- Bite marks
- Unusual marks
- Bruising or swelling in genital area
- Venereal disease and genital abrasions
- Makeup to hide bruises
- Sunglasses worn inside to hide blackened eyes
68
Substance Abuse
- Abuse of prescription drugs is reportable immediately according to law
- Violation of controlled substances laws is a criminal offense
69
Food and Drug Administration (FDA):
An agency within the Department of Health and Human Services that ultimately oversees and enforces laws regarding drug sales and distribution
70
Controlled Substances Act of 1970:
A federal statute that regulates the manufacture and distribution of drugs that are capable of causing dependency
71
Medical examiner:
A physician, usually a pathologist, who can investigate an unexplained death and perform autopsies
72
Cultural Considerations
- Background and experience heavily influence personal beliefs
- Stereotyping: Negative generalities concerning specific characteristics about a group are applied to an entire population
- Bias: Unfair dislike or preference against someone, can prevent a health care professional from making an impartial judgement
- Do not judge a person
- Different cultures have their own practices for personal hygiene
- Ethnocentric people: Tend to believe that their way of viewing and experiencing the world is superior to other’s views
- Communication can be a challenge for many people who do not understand English
- Non-English-speaking patients need brochures and handouts in their own language
- Cultural restrictions can pose difficult situations
73
Religious Considerations
- Patient autonomy
- Conditions can result in confusion for the medical professional
- Guardianship may have to be established
- It is never appropriate to judge another person's customs or beliefs
- Employer has a legal obligation to accommodate religious practices
74
Equal Employment Opportunity and Employment Discrimination
- Laws that affect recruitment, placement, pay plans, benefits, penalties, and termination
- People must be judged primarily by job performance
75
Employment-At-Will Concept
- Employment-at-will: The employment takes place at either the will of the employer or the employee
- Employment takes place at will of either employer or employee
- Employment may be terminated at will at any time for no reason
- Employee may quit at any time
- Exception for a specific employment contract in which employment cannot be terminated during contract period
76
Equal Credit Opportunity Act:
Prohibits businesses (including hospitals) from denying or granting credit based on race and gender, referred to as discrimination
77
Equal Employment Opportunity Act (EEOA):
Authorizes the EEOC to sue employers in federal court on behalf of people whose rights have been violated under Title VII
78
Title VII of the Civil Rights Act of 1964
- Prohibits discrimination, or unfair treatment based on race, color, religion, gender, or national origin
- Forbids discrimination in all aspects of patient care in institutions that receive federal financial assistance
- Makes sexual harassment a form of unlawful sex discrimination
- Equal Employment Opportunity Commission (EEOC)
- Equal Employment Opportunity Commision (EEOC): The group that monitors Title VII of the Civil Rights Act
- Sexual harassment is a form of unlawful sex discrimination
- *Quid pro quo:* Something for something (Ex: Sexual favor in exchange for job advancement)
- Affirmative action programs: To remedy discrimination practices in hiring minority group members. Also covered under Title VII
79
Age Discrimination in Employment Act (ADEA):
- Protects persons forty years or older against employment discrimination because of age
- Protects persons 40 and older against discrimination
- Applies to employers with 20 or more employees
- Mandatory retirement prohibited except for certain exempt executives
80
Americans with Disabilities Act (ADA):
- Prohibits employers who have more than fifteen employees from discriminating against disabled individuals
- Americans with Disabilities Act of 2008 (ADAAA): Broadened and clarified the definition of “disability”
- Americans with Disabilities Act (ADA) of 1990, Amended in 2008
- Prohibits employers who have more than 15 employees from discriminating against individual with disability
- Employer must make reasonable accommodations
- Exception if undue hardship for employer to make accommodations
- AIDS patients protected under this statute
81
National Labor Relations Act (NLRA):
- Prohibits employer actions, such as attempting to force employees to stay out of unions, and labels these actions as "unfair labor practices.”
- National Labor Relations Act (NLRA) of 1935, Amended in 1947
- Gives employees right to form and join unions, to bargain collectively, and to strike for better benefits and working conditions
- Purpose of law is to protect employees
- National Labor Relations Act (NLRA) of 1935
- Establishes rights for both employees and employers, and defines some prohibitive acts by employers, called unfair labor practices
- Also called the Wagner Act
82
Occupational Safety and Health Act (OSHA):
- Requires an employer to provide a safe and healthy work environment; the employer must protect the worker against hazards
- Occupational Safety and Health Act (OSHA) of 1970
- Employer required by law to provide safe and healthy work environment
- Must protect worker against hazards
- Occupational Exposure to Bloodborne Pathogens Standards
- Standards refer to urine, stool, sputum, nasal secretions, vomitus, and sweat if there is visible evidence of blood
83
Health Maintenance Organization (HMO) Act of 1973, Amended in 1996
- Requires company with 25 or more employees to provide HMO alternative to regular group insurance if HMO is available in area
- Under HMO, patient has limited choice of doctors
- Patient may have to get a second opinion and permission from HMO for major procedures
84
Consolidated Omnibus Budget Reconciliation Act (COBRA):
- Offers government financing for health insurance coverage continuation after an employee has been laid off their job
- Company with 25 or more employees must provide extended health care insurance to terminated employees for as long as 18 months
- Usually at employee's expense
85
Equal Pay Act:
- Makes it illegal for an employer to discriminate on the basis of gender in payment to men and woman who are performing the same job
- Equal Pay Act of 1963
- Amendment to Fair Labor Standards Act (FLSA)
- Illegal for employer to discriminate on basis of gender if performing same job
86
Worker's Compensation Act
- Protects workers and families from financial problems resulting from employment-related injury, disease, or death
- Employers pay into a fund to help cover costs when employee has work-related injury or disease
- Goal to get employee back to work as soon as possible
87
Medical record:
- All the written and computer generated documentation relating to a patient
- Also called the health record
- All written documentation relating to patient, including:
- Past history
- Current diagnosis and treatment
- Correspondence relating to patient
- A legal document
- May be subpoenaed
88
Purpose of the Medical Record
- Record of patient from birth to death
- Document for continual management of patient's health
care
- Provides data and statistics
- Tracks ongoing patterns of patient's health
89
Contents of the Medical Record
- Personal information about patient
- Clinical data or information
- Records of medical examinations
- X-rays
- Lab reports
- Consent forms
- Referrals: PT/OT
- Prescriptions and refills
- Admitting diagnosis
- Evidence of a physician examination
- Not more than seven days before admission or 48
hours after admission to a hospital
- Documentation of any complications
- Signed consent forms
- Consultation reports
- Physicians' and health care professionals' notes
- Discharge summary, with follow-up care
- Should never contain irrelevant material
90
Corrections and Alterations
- Errors require correction
- Nothing should be deleted
- Note in the margin of the record why the change was
made
- Use black or blue ink
- Draw one line through error
- Write correction above error
- Date and initial change
- Do not erase or use correction fluid
- Electronic health record (EHR) corrections
- Falsification of medical records is grounds for criminal indictment
91
Timeliness of Documentation
- Medical records must be accurate and timely
- All entries must be made as care occurs or as soon as
possible afterward
- Should be completed by physician within 30 days following patient's discharge from hospital
92
Completeness of Entries
- Medical records document type and amount of patient care that was given
- In eyes of court, "if it's not documented, it wasn't done"
93
Reporting and Disclosure
- State laws require disclosure of some confidential medical record information without patient's consent
- Reporting and disclosure are duties of the physician
94
Improper Disclosure
- Health care providers and institutions may face civil and criminal liability for releasing medical records without proper patient authorization
95
Subpoena Duces Tecum
- Written order requiring person to appear in court, give testimony, and bring information described in subpoena
96
Electronic medical record (EMR):
Fully computerized method of record-keeping
97
Corrections and Alterations
- Errors require correction
- Nothing should be deleted
- Note in the margin of the record why the change was
made
- Use black or blue ink
- Draw one line through error
- Write correction above error
- Date and initial change
- Do not erase or use correction fluid
- Electronic health record (EHR) corrections
- Falsification of medical records is grounds for criminal indictment
98
HIPAA’s Five Titles
- Title I: Protects health insurance coverage for workers and their families when they change or lose their jobs
- Title II: Known as the Administrative Simplification provisions
- Requires national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
- Title III: Sets guidelines for pre-tax medical spending accounts
- Title IV: Sets guidelines for group health plans
- Title V: Governs company-owned life insurance policies
99
Who is affected by HIPPA
- Public health authorities
- Health care clearinghouses
- Self-insured employers
- Private insurers
- Information systems vendors
- Various service organizations
- Universities
- Health care plans
- Treatment, payment, and health care operations (TPO)
100
Protected health information (PHI):
Any individually identifiable information that relates to the physical or mental condition or the provision of healthcare to an individual
101
Can Protected Health Information (PHI) Be Deidentified?
- To “deidentify” patient information, remove:
- Patient’s name
- Address, including e-mail
- Telephone and fax numbers
- All dates, including birth (except year), admission, discharge, and death
- Social security number
- Medical records numbers
- Health care insurance numbers
- License numbers
- Facial photos
- Other identifying numbers or characteristics
- E-mail and website address
- Motor vehicle registration numbers
- Facial photographs, such as found on driver’s license
102
Title I:
Protects health insurance coverage for workers and their families when they change or lose their jobs
103
Title II:
Known as the Administrative Simplification provisions
- Requires national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers
104
Title III:
Sets guidelines for pre-tax medical spending accounts
105
Title IV:
Sets guidelines for group health plans
106
Title V:
Governs company-owned life insurance policy
