Topics on exams
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- Bu səhifədəki naviqasiya:
- Definition of clinical ethics
- (4 Ds) of Malpractice
- 2) Dereliction of Duty
- 3) Damages
- Features/Facts of Malpractice Cases Features of Malpractice cases
- Common reasons for suits
- Facts about Medical Malpractice Cases
- Medical Malpractice Insurance Crisis
- Solutions to Crisis
- How to Avoid Malpractice Suits •Why do some patients sue after adverse
- Important Note: Documentation
- Establishing a Duty : When does a physician-patient relationship exist • Do informal consults create a PPR
- Does acceptance of a referral create a
- Was there a PPR with the orthopod
- Does having a patient drop-in to your
- Was there a PPR
- Does a PPR exist with a patient who was
- This trend is changing, as per more
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4th semester 2006 Midterm 1 BS/Ethics Review OUTLINE TOPICS ON EXAMS: What I did: Here is the outline of the review. At the end of the review, is the complete review based on the outline. Good luck. I wish you the best. 50 questions: 40 behavioral science 25 BS made by Dr. Omar & 10 ethics Omar Therefore 15 additional questions made by other professors. Topics for medical ethics:
Termination of pregnancy 1st trimester: PT has right for abortion, regardless of reason 2nd trimmest: have right of abortion if it is not endangering their life: 3rd trimester: abortion is illegal, unless continuation will cause some threat for the mother before 21 weeks, PT can go for abortion After 21 weeks, PT cannot have abortion
Tyrel Dueck: 1999
ROE vs WADE: -child may have meningitst: mom calls and says baby has meningitis: brief history of PT and symptoms, then maybe child may have meningitis: meningoc cocus is important Neisir. Mengingitis and can cause skin rash:
For behavioral science we will discuss those on Thursday; for BS 09-02-06 BS review tt1 There are 40 questions from BS: What to focus on: All 40 are not from topics, but most of them from the things I’m telling you: if you focus on this you’ll be alright
Transference: counter transference Illusion
delusion hallucination formation on how you would develop a rapport with your patient
focus on developmental milestones: very important: interpret the age of the pt depending on the mile stone and the age and the findings and development of milestones Tannis stage of development:: what stage has child reached: stage 1, 2 or 3: depending on findings of examination of extragenital: be able to differentiate the different stages Learning theories and conditions: Difference between operant and classical conditioning Psychoanalytic theory and ALL THE DEFENSE MECHANISMS!!! Should be able to differentiate: some examples and asked what defense mechanism is showing: Then Freud’s theory: toprogialh and Super ego, ego: what’s the difference between superego and ego, What the difference is between conscious, unconscious Differentiate between amnesia: i.e. mini status examination Biological assessment of psychiatric PT’s: Ie.. significance of CT scan, GCS (glascow scale) what are the scoring system: Then aging death and bereavement: Cobler Ross: Stages of death and dying: -she intervied many PT what the response wherei ie.. denial, anger, bargaining, how you would differnetiatewhether they are grieve or major depression and focus on the class i.e.major depression i.e. committing suicide and different between grieve and major depression. How you manage a person or person: loved one died in family: what support you can provide for those circumstances Gorss anatomy and biochemistr y and behaviour: focus on anaomtical difference based on gender: in CNS: if you do a CT scan: anatomically differences: Maybe few neurotransmitters that play an important rule in psychiatry -role of neurotransmitter
Mental status examination: What is the significance of a MMSE: why do we do it? And what is the significance if it’s impaired…!!! How do you differentiate between dementia and pseudodementia Then sleep: EEG is very important: asked what are the finding in different cases of sleep: REM, nonREM sleep what are the phases, what are the EEG finding? What are th changes that do occur that correspond to the phases of the sleep: i.e. REM, PT may move eyelids: i.e. excitation of body, palpitations, bodily changes that occur
All the disorders discussed by DR. Gall: i.e. sleep disorders You can leave CFS and Neurostamia: I WILL BE SUCCESSFUL NOW FOR THE REAL COMPETE REVIEW Topics for medical ethics:
Definition of clinical ethics- Clinical ethics is the systematic identification, analysis and resolution of ethical problems associated with patient care. Its goal includes protecting the rights and interests of patients, assisting clinicians in ethical decision making and encouraging co-operative relationships among patients and those close to patients, clinicians and health care institutions. Introduction & principles Medical Ethics Course objective • Intended to develop a knowledge base of the basic legal & ethical principals which govern practice in the USA. • Review established legal parameters in US court system & engage student in a personal debate over issues which physicians face daily. • Issues: death,dying, end of life care, living wills, power of attorney, malpractice • Medical insurance & hospital based committee which insure physician & patient protection from abuse • Series of cases reviewed which throughout history have added to the practice guidelines in place today Defining clinical ethics • Clinical ethics is an interdisciplinary activity to identify,analyze, & resolve ethical problems that arise in the care of particular patients (Fletcher,1991) • Jonsen(1998),LaPuma(1990) Introduction • A set of principles guiding a person in his/her professional decision Making • Moral is personal and Law is social; Ethics is between the two • Law prescribes restriction on behavior; Ethics is enhancement of appropriate behavior • What is legal not always ethical and vice versa • Hippocratic Oath Medical ethics • More traditional term than CE • Ambiguous though
Clinical ethics • Similarly, this term which is an outgrowth of ME can refer either to uncontroversial codes of conduct governing all clinicians or to ethical dilemmas. Advent of Medical ethics • Hippocratic Oath- dates back around 2,500 yrs ago • Historical purposes but not technically binding
• Graduations I solemnly pledge myself to consecrate my I solemnly pledge myself to consecrate my life to the service of humanity; I will give to my teachers the respect and gratitude which is their due; I will practice my profession with conscience and dignity; The health of my patient will be my first consideration; I will respect the secrets which are confided in me, even after the patient has died; I will maintain by all the means in my power, the honour and the noble traditions of the medical profession; My colleagues will be my brothers; I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patients; I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity; I make these promises solemnly, freely and upon my honour.
• Physician- Patient sexual relationship • AIDS risk/testing/etc. • Advertising • Fee Splitting • DNR
• The impaired physician • Resource allocation • Conflict of interest 
malpractice and 4 D’s associated with malpractice – Dereliction or negligence [i.e. deviation from normal standards of care], duty (established patient- physician relationship that causes damages), damage (i.e. injury), directly to the patient [i.e. the damages were caused by the negligence, not by another factor. Legal Issue: Malpractice Malpractice •Definition •Features/Facts •Consequences •Solutions •Avoiding Litigation •Establishing a Duty of Care •Emergencies & Non-Patients •Medical Student Liability Malpractice: Any deviation from accepted medical standard of care that causes harm to a patient. (4 Ds) of Malpractice •Duty •Dereliction •Damages •Directly Key Elements of Malpractice 1) Duty of care: Was there an established physician-patient relationship? • What actually creates a PPR– having seen the patient? Scheduling the patient? Giving advice about a patient who you’ve never seen?
2) Dereliction of Duty (negligence): Was there a deviation from the accepted medical standard of care? • need testimony from expert witnesses to establish current medical custom (i.e., the
• often must bring in expert from another community (this can become expensive) • ethical obligation to participate if asked 3) Damages: Was there harm to the patient? 4) Direct (causation): Was the harm directly due to the physician’s dereliction of duty? (not all adverse outcomes indicate malpractice— need to show that damages resulted from negligence) ��If any of 4 Ds are not proven, then there is no judgment of malpractice. Features/Facts of Malpractice Cases Features of Malpractice cases •malpractice is a tort (i.e., a civil wrong resulting in personal injury) •results in financial costs (not jail time): • compensatory damages (including actual costs & “pain and suffering”) •& sometimes punitive damages. •Malpractice cases are increasing (more informed, less tolerant pts.) •44,000-98,000 deaths/yr due to medical mistakes •Common reasons for suits: •Improper dx, failure to dx or to reveal dx ��Surgical error ��Lack of informed consent ��Medication errors (wrong prescription, dose, etc.) 1500 pts/yr with tools Boston Globe Health Columnist, died of chemo OD, ‘94 •Surgeons, anesthesiologists & OBGYN most accused of malpractice •States are passing legislation to make malpractice history public knowledge
Confidential list of suits that have resulted in jury awards or $ settlements
•Time Involved: 1-2 years to resolve a case •Typical Cost: $40,000-$75,000 •Mediation: A settlement conference often occurring before a trial. Many cases are settled out of court in this manner. Medical Malpractice Insurance Crisis •Rates have increased dramatically in the last few years (rate depends on specialty and location) – rates range from $5,000/yr to over $200,000/yr. •Due to: •Large number of suits •Large jury awards •Example: •Across the U.S. •Median jury award in 1999 was $800,000 •45% of awards from ‘98-’99 were $1 million or more
• argument that still want ability to award large sums if an egregious error was made (physicians are striking in various states in protest of rising premiums– hoping to catalyze tort reform) Jessica Santillan, heartlung transplant patient (wrong blood type)
��Important Note: Documentation: Essential to demonstrate that care was given. Defense cases are often compromised due to inadequate documentation (re: phone calls, consults) ��“if it wasn’t documented… ” •Example case: patient denied informed consent about procedure, but medical records had proof that sketch was given. 10 
• Communication. • Acronyms • SOB
• MS • Acronyms. • FLK • GOK
• OAP • TF BUNDY 11 •Establishing a Duty: When does a physician-patient relationship exist? •Do informal consults create a PPR? •Case: Professor lectured to hospital-based physicians and subsequently gave surgical advice regarding patient •professor sued treating physician and professor for malpractice •Was there a PPR with the professor? •Court said NO •No direct contact, no control over treating physicians 12 •Courts have generally ruled that consulting physicians are NOT liable for subsequent harm, even if treating physician relied on negligent advice of consultant. (liability does exist if consulting physician accepts a referral, writes orders, or provides treatment to the patient) •Does acceptance of a referral create a PPR, even if physician never saw patient? •Case: Physician saw pt in ER •X-ray showed malignant neoplasm in knee •Surgeon referred patient to orthopod but didn’t tell patient the diagnosis •orthopod was told the patient’s diagnosis and accepted referral •pt cancelled appointments (x3) and patient refused to reschedule • Pt died— malpractice suit filed by estate •Was there a PPR with the orthopod?
•How could have orthopod discharged his duty? 13
private-practice office create a PPR? •Case: man brings newborn baby with respiratory problems into private practice •physician refused care but referred to peds hospital •baby died, lawsuit followed •Was there a PPR?
(insurance companies, employers, Workers’ Compensation Boards) 14 •Case: Pt referred by insurance co. to internist after woman applied for disability benefit •Hilary mass on X-ray was found and reported to insurer but not to patient (or patient’s physician)– just employer. •Did a PPR exist between the patient and the examining physician? •Court said No! Physician’s duty was only to the agency that requested the evaluation. •General: performing an exam at the request of a 3rd party generally does NOT establish a PPR. •However, if a physician offers medical advice or treatment beyond the scope of the 3rd-party exam (thus acting as a physician with an expectation of treatment by the individual), then courts have found the physician liable. •This trend is changing, as per more recent court decisions in which PPRs are considered to be established during 3rd Yüklə 0,87 Mb. Dostları ilə paylaş:
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