FPC Ethic Presentation Answers and Outline

8/3/2019 FPC Ethic Presentation Answers and Outline

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Chapter 3- Informed Consent

Q1: When your patient informs you that they want to refuse the treatment that you

have suggested, which of the following would most likely avoid this situation?

Answer Choices:

A. Tell patient that this is your area of expertise and its for their own good

B. That they do have the right to refuse intervention, but this will lead to their

eminent death

C. You educate your patients concerning the scenario, correct any

misunderstanding and involve her in the process of their treatment

D. All of the Above

A1: C

Exp1: Shared Decision Making-If you eliminate doubts and misunderstanding and

also including them in the decision-making process eases the patient. This also helpwith the concept of respect patients self determination

Q2: Which of the following should be included in an Informed Consent?

Answer Choices:

A. Nature of the test or treatment

B. Benefits, risks and consequences of the intervention

C. Alternatives and the benefits, risks and consequences

D. All of the Above

A2: DExp2: Table 3-1 include all of these response and this is the physicians duty and

legal responsibility

Q3: Which of the following does not undermine free choices made by patients?

A. Persuasion

B. Manipulation

C. Coercion

D. All of these choices undermine free choices made by patients

A3: AExp3: Coercion involves threats that are intended to control patients behavior and

that the patients find irresistible: ex: threat to discharge pt. if they dont agree with

your recommendation. By manipulation you are misrepresenting the information

and basically misinforming patient.

Persuasion attempts to convince the patient to act in a certain way by providing

RATIONAL arguments and accurate data. Also persuasion respects patient

autonomy, enhances the patients understanding of the situation


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Q4: List some exceptions to informed consent. (At least give 2)

A4: The patient lacks the capacity to make decision, emergencies, therapeutic

privilege (withholding information when patient is suicidal, hx of depression,) and

waiver (patient may not want to participate in making decisions about their care;

its the patients right to waive the right of informed consent)Exp4: in A4

Q5: How would you promote shared decision-making? (At least give 3)

A5:

- Encourage pt to play an active role in decisions: elicit pt perspectives aboutthe illness, build partnership with pt

- Ensure that pt is informed: provide information, try to frame issue withoutbias, interpret the alternatives in light of the patients goals, check that the pt

have understood information.

- Protect the pt best interest: help the pt deliberate, make recommendation- Try to persuade pt

Exp5: Table 3-2

Chapter 4- Promoting the patients Best Interest

Q1: What term best describes our obligation as physician?

A. Medical Paternalism

B. Medical Expert

C. Medical Fiduciary

D. None of theseA1: C

Exp1: This term has been showing up over and over and deals with the topic of

seeking whats best for our patients

Q2: List some of the problems with Promoting the Patients Best Interest

A2: Disagreement over what is best for the patient, Quality of Life judgment, &

medical paternalism

Exp2: Paternalism previously discussed in last block

Q3: What can a physician do in the following scenario:

A college athlete is taking steroid, that tells her physician that she will notdiscontinue the usage of the steroid because she needs them to be competitive, but

the athlete wants the physician to monitor the side effects the steroids

A. Tell her that youre going to report them if they continue the usage of the drug

B. Do nothing and refer her to another physician

C. Try to persuade the patient to discontinue the drug and discuss the harmful

effects of abusing the drug.

D. All of the above


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A3: C

Exp3: Persuasion is the only route to handle this situation. Its a difficult situation

because the patient will continue to use the drug, even when the patient might

decide to no longer see a physician.

Q4: List 2 examples of Promoting the Patients Best InterestsA4: Understand the patients perspective, address misunderstandings and concerns,

try to persuade the patient, negotiate a mutually acceptable plan of care, and

ultimately let the patient decide

Exp4: Above

Q5: Whom did Nelson marry?

A5: Hanna

Chapter 16- Ethics Committees and Case Consultations

Q1: True or False: Ethics consultants should accept secondhand data and are not

required to further inquire about case

A1: False

Exp1: It is the duty of Ethics consultants to clarify the facts about the case in order to

properly execute a decision. (Deals with the Goals of Ethics Case Consultation)

Q2: List some of the goals of ethics case consultations (At least 2)

A2: Clarify the facts of the case, Identify and analyze uncertainty and conflict over

ethical issues, build consensus among stakeholders: Help stakeholders express their

views and concerns, improve communication among clinical caregivers, patient, and

family, provide emotional support, and negotiate an acceptable resolution.Exp2: Above

Q3: WOMP, WOMP, you just lost points

A3:

Q4: From our previous discussion of the goals of ethics case consultations, what

question-type are used by consultants in order to improve the communication

between the physician and patient, in order for both to view each others

perspectives/goals/decisions (Clue: Excessively covered 1styear)

A. Open-ended questions

B. Direct questionsC. Dont remember

D. All of the above

A4: A

Exp4: Random question

Q5: List some of the potential problems with Ethics Consultation (At least 2)


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A5: Lack of participation of patients or surrogates, Bias or perceived bias, unsound

recommendations, and problems beyond the scope of an ethics consultation.

Chapter 36- Ethical Dilemmas Facing Students and House Staff

Q1: True or False: Its okay to introduce oneself as Doctor or Clinical Clerk in a

teaching hospital, knowingly well that we are medical students, in order to protect

patients from unnecessary worry or distrust

A1: False

Exp1: There are situations where we are introduced or we introduce ourselves as

doctors in order to get procedures done without hesitation from the patient, but it is

our duty to not misinform/deceive the patient

Q2: Yay, you get free points

Q3:Okay, youre in rounds: Earlier you treated a patient with pancreatitis who

required a large amount of fluids. Now youre presenting your patient to the

attending physician and then the attending inquires about the calcium level, you

dont want to look stupid and you cant recall the actual value, but you tell yourself

since you dont remember anything outstanding about the calcium, its mostly likely

normal, so you tell the attending that its normal. Is this correct?

A3: Nope

Exp3: As students we feel pressured to have the correct answers all the time, it is

unethical to lie about similar situations and in addition you can put the patient at

risk for complications, so you should be honest about errors that you havecommitted or situations that you have overlooked.

Q4: True or False: Its okay to practice medical procedures such as intubation on

recently deceased patients at a teaching hospital (Explain why your answer choice is

correct)

A4: Either answer, but has to explain why true or false. Its correct if they pick true,

because they can, but it requires consent. If they pick false, okay if they said that

they first need consent

Q5: You observe that an obstetrician performs a tubal ligation on a patient who hadpreviously refuse this procedure and who did not consent to the current ligation

procedure performed, what should you do?

A5: Its your ethical obligation to report this situation.

Exp5: Realistically this is difficult to do because the student can be in danger of

getting a poor grade from this attending if youre doing rounds with them or getting

stigmatized as a whistle-blower. Recommendation: student should get other


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physicians involved and seek help from supervisors before officially reporting

incident.

Chapter 37- Ethical Issues in Pediatrics

Q1: True or False: Autonomy is just as important in peds as in adult medicine

A1: False

Exp1: Because children are immature and vulnerable, they need adults to make

decisions for them

Q2: Who recently had a baby?

A2: Marks wife (Jamie), not Mark

Note: if they say Mark, its wrong

Q3: Which of the choices listed below, allows peds patients to be treated without theconsent of parents:

A. Emergencies

B. Emancipated Minors

C. Mature Minor- approved by pediatrician

D. All of the Above

A3: D

Exp3: A & B: are legal forms. C. Evaluation of pediatrician of maturity of the patient

Q4: What do you do as a physician, when parent refuses treatment for their childthat provides effective intervention with few side effects?

A. Respect the parents decision

B. Call the authorities right away

C. Try to persuade the parent and educated them on the benefits of treatment, if

refusal continues, reporting situation is necessary

D. None of the above

A4: C

Q5: True or false: It Federal law to inform parents after an adolescent has consented

to treatmentA5: False, laws and regulations vary from state to state

Exp5: Most common issue deals with STDs

Chapter 44- Ethical Issues in Cross Cultural Care

Q1: Both teams get 100 pts


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Q2: A Caucasian man comes to ED because of chest pain, Patient is transferred to

CCU to rule out MI. The CCU physician, an African American, come to the ED to admit

the patient. The patient refuses to allow the physician to care for him, calling the

physician names that are racist. What should the physician do?A. Shout back and kick him out

B. Let him stay at ED

C. Ask patient not to use that kind of language and explain to the patient the current

situation that he is in, and if hes not treatedat this moment, hes endangering his

health, and efforts will be placed later to find him another physician

D. None of the above

A2: C

Exp2: Professionalism and patient health is number one, but if patient continues to

be noncompliant, medical professionals or anyone do not have to put up with this

Q3: True or False: For many African Americans, spiritual beliefs are an importantsource of comfort and means of coping with illness & a physician should take that

into consideration

A3: True

Q4: True or False: Physician must not make assumptions about a patients values

based on cultural heritage

A4: True

Exp4: By directly asking the patient about how he or she would like to approach

treatment, and learn more about them thru doctor-patient interaction/relationship

Q5: Scenario: An elderly woman presents to the ED with chest pain and abdominalpain. It is later made aware that she is a devout Muslim. The female patient refuses

any type of physical examination by her male physician. The patient also refuses a

bedpan and bedside commode. How can we treat this patient?

A5: Again, open ended question. Asking her something like: how can we best care

for? will get us far

Exp5: Similar answer acceptable

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