Professional Issues FInal

Final Exam Review - PT 8351

• The exam format will be similar to the midterm and include multiple choice, short answer questions, and a Respondus Lockdown format.
• There will be approximately 50 questions.
• Topics covered include: ethics, genomics/precision medicine, professional boundaries, evidenced-based practice (EBP), and payment.
• Dr. Ward's lectures and Whitman-Walker Health are not testable.
• The exam assesses topics from implicit bias VoiceThread reflections.

Types of Ethical Challenges

• Dilemma (Right vs. Right): Situations with two possible morally correct choices, but follow-through with one choice may result in missing the other. Possible issues include financial or institutional barriers.
• Distress: Knowing the correct choice of action to take but being unable to act on it due to barriers (financial or institutional).
• Temptation (Right vs. Wrong): Standing to benefit from a morally wrong decision.

Case Examples of Ethical Challenges

• A wheelchair company offers tickets to an NFL game to influence a recommendation, even if the chairs cost more than comparable models.
• An employee is asked to inflate time spent on an official task to increase company earnings, with pay raises as an incentive.
• A patient refuses to disclose information about a family matter to their parents.
• A student notices a surgical resident/practitioner performing a procedure using an inferior implant to increase profit margin at the expense of patient care.

Key Clinical Ethics Concerns

• Autonomy: A patient's right to self-determination/freedom with respect to their choices; adequate informed consent for genetic testing. Fair, equitable treatment and access to clinical care; addressing potential historical exploitation and abuse.
• Beneficence/Non-maleficence: First do no harm, balancing potential risks and benefits in treatment decisions; privacy and confidentiality, including understanding the limits of these duties.

Autonomy

• Patients have the ability to exercise their freedom in a given situation.
• Self-determination (personal agency) is a guiding principle in the medical practice.
• Evidence shows that patients who feel in control and have autonomy are more likely to recover from illness.

Informed Consent

• Informed consent is the process for a healthcare provider to disclose appropriate information to a competent patient so they can decide whether or not to accept treatment.
• Includes the nature of the procedure, reasonable alternatives, risks, benefits, and chances of complications.
• Includes assessing patients' understanding of the intervention, acceptance of treatment terms, costs, and possible alternatives.
• This is a core component of patient autonomy.

Considerations for Informed Consent

• Competency: Patients or surrogates must be competent to make their own decisions.
• Coercion: The patient must participate actively in the decision-making process, not just sign a form.
• Comprehension: The patient must understand the information presented—layman's terms.

Tips in Practice

• Informed consent laws vary by state.
• Consult state statutes and regulations for specific requirements.
• Documentation must include that you informed the patient of the procedure proposed and the patient understood the information provided, and gave consent.

Confidentiality

• Privacy refers to an individual's right to keep their health information private.
• Confidentiality is the responsibility of anyone entrusted with health information to keep that information secret.
• Federal law (HIPAA, 1996) balances the individual’s right to privacy with the health care needs.
• Protected health information (PHI) can be electronic or paper-based.
• Sharing patient information is limited to those whose roles require it for their direct patient care. (Use the "Need to Know" test)
• Follow the “minimum necessary" rule: Only share the minimum amount of information required.

Summary for Confidentiality

• Confirm patient identity at first encounter.
• Never discuss cases without patient or necessary provider permission.
• Protect records and screens from unauthorized access. Use secure communication methods to send protected health information.
• Communicate with qualified interpreters to ensure understanding of confidentiality.
• Track changes, including telehealth practices, and regulatory changes.

Key Trend: Going Beyond Genetics/Genomics

• Focus on individualized treatment for patients at appropriate times with appropriate medical care.
• The Precision Medicine Initiative has received funding to enable this approach.
• Aim to combine insights from biological science with patient characteristics to ensure the best medical care for each patient.

Your Potential Concerns

• School/company policies to ensure the proper handling and storage of sensitive patient data
• Stigmatization, especially related to discrimination concerning genetic information
• Privacy and insurance concerns.
• Ownership concerns
• Capability in making such decisions independently without outside family members
• Evolving research and understanding about genetic markers in interpretation

Genetic Information Non-Discrimination Act (GINA) 2008

• Protects against discrimination based on genetic information by employers and health insurance companies.
• Prohibits employers from requesting, requiring, or purchasing genetic information related to employees or candidates.
• Includes work study students

Genomics Failing on Diversity

• A significant number of studies have focused on participants of European descent, with limited diversity in other groups.
• Asian and African American participation in genome-wide association studies remains relatively low.
• Descriptors for ethnicity are often outdated or lack nuance in many studies.

Sexual Harassment

• Includes unwelcome sexual advances, requests for sexual favors, and verbal or physical conduct of a sexual nature.
• Submission to such conduct is a condition of employment or used for employment decisions.
• Conduct unreasonably interferes with performance or creates a hostile environment.
• Covers employers with more than 15 employees.

Successful Strategies for Inappropriate Patient Behavior

• Distraction
• Avoidance
• Direct confrontation
• Behavioral contracts
• Transfer of care
• Use of chaperones

Hostile Environment Creation

• Open discussions within earshot of others (patients or coworkers) about inappropriate sexual topics.
• Promotion of an employee based on inappropriate sexual favoritism
• Patient consistently asking a therapist for a date.
• Sharing of pornography on an office computer.
• Supervisors or managers ignoring or accepting inappropriate behaviors from coworkers.
• Use of dirty jokes or sexual slang.

Part 1 Review of Payment

• PPO: Offers more choices; incentivized in-network providers
• HMO: Closed-network; lower co-pays compared to PPOs
• HDHP: Shifts costs to employees
• Copay: Fixed patient cost per visit
• Deductibles: Out-of-pocket cost before insurance takes over
• Prospective Payments: Predetermined payment system
• Fee-for-Service: Fixed fee for each service provided; quantity-based
• Includes various insurance terms.

Health Insurance Terms and Definitions

• Premium: Monthly payment for health care coverage (no premium for Medicare Part A and B or Medicaid).
• Benefits: Covered health care services and procedures per plan.
• Deductible: Amount patient pays before insurance covers costs.
• Co-pay: Fixed amount paid for each visit to specialists
• Co-Insurance: Percentage of patient's payment after deductible and co-pay are met.
• Fee-for-service: Fixed fee for services, dependent on the quantity. of services, not quality of care.
• Secondary Insurance: Coverage from additional plans.
• Supplemental Insurance: Additional insurance policies or plans beyond the primary plan.

Managing Financial Risks

• Employer perspective: Increased employee premium costs, limitation of network providers/types, higher co-pays.
• Employee perspective: Use in-network providers, higher/lower deductibles, and co-pays.
• Payer perspective: Coverage restrictions, limitations on visits, clinic documentation and outcomes measurements

Value Based Payment Models

• Pay-for-performance: Financial bonuses from successful care; often implemented as an overlay on fee-for-service payment.
• Bundled payments: Single, predetermined payment for multiple services (e.g., surgery).
• Capitation: Providers assume financial responsibility for a patient population; fixed premium payments.
• Shared savings: Providers share in savings generated by lowering overall service costs
• Shared risk: Providers share in the costs of care exceeding a pre-set budget

EBP Definitions and Steps

• Define EBP
• Hierarchy of evidence levels for research findings
• Types and format for clinical questions
• Intervention vs. Diagnosis vs. Prognosis
• Foreground vs. Background questions
• Searching for evidence (relevant websites, databases)
• Appropriate citation formats (e.g., AMA, APA)

Test your knowledge on key ethical principles in medical practice. This quiz covers topics like patient autonomy, informed consent, and ethical dilemmas in healthcare decisions. Challenge yourself to think critically about ethics in the medical field.