Medical Law & Ethics Week 2 Patient/Physician Relationship 2024 PDF

COPMLE114 Medical Law & Ethics Week: 2 Patient/Physician Relationship  Patient/Physician Relationship  Proper treatment – patient must be truthful. › Not sharing all facts results in serious consequences. › Physician is not liable if patient does not s...

COPMLE114 Medical Law & Ethics Week: 2 Patient/Physician Relationship  Patient/Physician Relationship  Proper treatment – patient must be truthful. › Not sharing all facts results in serious consequences. › Physician is not liable if patient does not share critical information.  Physician Rights  Select patients to see.  Refuse service to patients.  State services they offer.  Office location/hours.  Expect payment for services.  Take vacation/time off.  Patient Rights  Give consent for treatment.  Expect appropriate standard of care.  Confidentiality.  Patient Obligations  Expected to follow physician’s instructions.  Expected to pay for medical services.  ? ? ? ? The Patient Care Partnership (The Patient’s Bill of Rights) ? ? ?  The Patient Care Partnership  Details what a patient should expect during a hospital stay:  High quality hospital care.  A clean and safe environment.  Your involvement in your care.  Protection of your privacy.  Help when leaving the hospital.  Help with your billing claims.  Medical assistants should be able to discuss these rights with patients prior to hospitalization. INFORMED CONSENT  Doctrine of Informed Consent › Explanation of advantages/risks to the treatment. › Alternatives available to the patient. › Potential outcomes to the treatment. › What might occur without treatment. › The use of understandable language. Review the informed consent form on page 51-53 in the textbook. Does the form meet these requirements?  Considerations  What effect would/could the following have on informed consent? › Barriers  Language  Hearing  Visual › Religious influences › False expectation Click here for help http://cstep.cs.utep.edu/research/ezine/Ezine-EthicalIssueswithInforme dConsent.pdf  Medical Assistant’s Responsibility with Informed Consent  Responsible for ensuring a signed consent form has been obtained and placed in the patient’s chart.  Obtain parent/guardian signature for procedures performed on a minor. (the exception is in an emergency) Rights of Minors  A minor is one who has not reached the age of majority and in most states that is 18 but can vary.  Most states will not allow minors to give consent for treatment with the exceptions of: › Pregnancy › Birth control information › Testing/treatment for sexually transmitted diseases › Substance abuse › Psychiatric care  Emancipated Minors – meet any or a combination of the following conditions: › Live on their own. › Married. › Self-supporting › Armed forces Patient Self-Determination Act  Living Will › Patient requests that life-sustaining treatments/nutritional support not be used to prolong life.  Durable Power of Attorney › DOPA › Allows an agent or representative to act on behalf of the patient.  Advance Directive › Generally included the living will but the durable power of attorney  Uniform Anatomical Gift Act card › Persons 18 year or older and of sound mind › Physician performing the transplant operation cannot be the same physician to determine death or time of death.  Money cannot change hands for organ donation. › Card or drivers license indicates they are a donor. › A family can make the decision for the donor if the decision was not done before death.  Critical Thinking Question What are the potential controversies to organ donation?  Documentation – Who/What: › Calls › Visits › Treatments › Medications › No-shows › Appointment cancelations › Prescription refills › Vital signs  If it is not recorded then it did not happen.  Case Scenario  In this case, parents filed a medical negligence case against a hospital for their baby son's death.  Baby D was born with a heart defect and underwent surgery to correct it. Following surgery, he experienced cardiac dysrhythmias. When other efforts to treat the dysrhythmias failed, a physician prescribed digoxin. Because digoxin is a high-risk drug, the hospital controlled access to it, permitting it to be acquired only through a special dispensing machine that required a user name and password.  Baby D was to receive 450 mcg of digoxin. A nurse obtained an ampule of digoxin and administered the initial dose, but incorrectly charted it as 225 mg (not mcg). That this was simply a documentation error wasn't disputed; the ampule contained only 500 mcg. › However, the amount given couldn't be calculated by the amount that remained in the ampule because the unused drug had been destroyed as required by policy. Digoxin doesn't require a destruction record, so no evidence existed to prove the facts.  Baby D's potassium level, which was high to begin with, became even higher and he went into cardiac arrest and died soon after receiving the initial dose of digoxin. Autopsy blood tests indicated elevated potassium levels that could be consistent with a digoxin overdose. Baby D's parents filed a medical negligence case for failure to properly monitor his condition and for administering an overdose of digoxin.  In testimony at the trial, the nurse stated that she'd calculated the dose. She also testified it's her facility's policy to require double-checking the dose of certain drugs, The including trial ended digoxin, with a verdictShe before administration. fortestified the plaintiff, awarding it was her $2have practice to another nurse check the dose before administering these types of high-risk drugs. million in damages. An appeal was applied for.  Litigation is the term for lawsuit tried in court.  Subpoena is a request for medical records. Submit only what is asked. Court Testimony  Be professional  Remain calm, dignified, and serious  Do not answer questions you do not understand  Only present facts  Do not memorize your testimony  Always tell the truth Public Duties of Physicians  Reporting: › Births, Stillbirths, Deaths › Communicable illnesses › Drug abuse › Certain injuries:  Rape, Abuse, Gunshot or knife wounds, and Animal bites Drug Regulations  FDA- Food and Drug Administration › Has jurisdiction over testing approving drugs for public use.  DEA – Drug Enforcement Administration › Regulates sale/use of controlled drugs. › Physicians receive a DEA registration number in order to dispense, purchase, administer, prescribe or handle drugs. › Controlled drugs must be kept on a double- locked cabinet.  Medical Assistants: › Administer medication under the direct supervision of a physician. (follow state regs) › Secure all paper prescription pads. › Check medication 3 times before administering:  Check medication before removing from shelf.  Check the name and recommended dosage before preparing.  Check the label again before returning the medication to the shelf.  Office Management › Treat patients with courtesy and dignity.  Examples: Return phone calls promptly. Explain delays to patients. › Never makes promises regarding treatment. › Explain all fees and responsibilities. › Relay dissatisfaction to office manager/physician. › Ensure patients know who to call when the physician is out. › Document any “withdrawal” of a physician from patient care (dismiss a patient from the practice):  Certified letter  Notes in patient chart  Documentation-must do’s › Sign or initial every note › No-show appointments › Referrals to another physician – follow up › All patient contacts: telephone calls, prescription refills, diagnostic tests, procedures › Record all care and treatment given › Have physician review and initial all diagnostic reports › Provide instructions in writing to patients › Ensure SOAP notes are complete and accurate  SOAP Notes › SUBJECTIVE — symptoms the patient verbally expresses or as stated by a significant other. › OBJECTIVE —observations include symptoms that can actually be measured, seen, heard, touched, felt, or smelled and the results of diagnostic tests. › ASSESSMENT —diagnosis of the patient's condition. › PLAN —health care provider's plan including laboratory and/or radiological tests ordered for the patient, medications ordered, and treatments performed.  Tampering with the record involves any of the following: Adding to the existing record at a later date without indicating the addition is a late entry Placing inaccurate information into the record Omitting significant facts Dating a record to make it appear as if it were written at an earlier time Rewriting or altering the record Destroying records Adding to someone else’s notes.  MA Certification and licensing › Understand the limits of certification and standard of care. › Do not diagnose or prescribe. › Do not call yourself a nurse or allow anyone else to do so. › Participate on continuing education and training programs. Practice, Practice, Practice WHICH OF THE FOLLOWING ARE TRUE FOR INFORMED CONSENT? 1. Explanation of advantages/risks to the treatment. 2. Alternatives available 3. Potential outcomes 4. What might occur without treatment. 5. The use of understandable language. 6. The form must be written in English for all patients. Practice, Practice, Practice WHICH OF THE FOLLOWING ARE TRUE FOR INFORMED CONSENT? 1. Explanation of advantages/risks to the treatment. 2. Alternatives available 3. Potential outcomes 4. What might occur without treatment. 5. The use of understandable language. 6. The form must be written in English for all patients. The last item (6) is incorrect. Forms in other languages should be available for those that do not speak/write in English—an interpretor may also be necessary Practice, Practice, Practice Which of the following are considered tampering? 1. Adding to the existing record at a later date with initials/date/time of addition 2. Placing inaccurate information into the record 3. Omitting significant facts 4. Dating a record to make it appear as if it were written at an earlier time 5. Rewriting or altering the record 6. Destroying records 7. Adding to someone else’s notes Practice, Practice, Practice Which of the following are considered tampering? 1. Adding to the existing record at a later date with initials/date/time of addition 2. Placing inaccurate information into the record 3. Omitting significant facts 4. Dating a record to make it appear as if it were written at an earlier time 5. Rewriting or altering the record 6. Destroying records 7. Adding to someone else’s notes Number 1 is actually the correct way to AMMEND a medical note