2024 Study Guide for Patient Best Interests - ACE Rolf

2024 Study Guide for Patient Best Interests, Fiduciary Duty, Informed Consent Autonomy, Decisional Capacity, Futility Teamwork, Teambuilding and High-Performance Teams Patient Best Interests, Fiduciary Duty, Informed Consent 1. Explain what kind of relationship we have with our patients as...

2024 Study Guide for Patient Best Interests, Fiduciary Duty, Informed Consent Autonomy, Decisional Capacity, Futility Teamwork, Teambuilding and High-Performance Teams Patient Best Interests, Fiduciary Duty, Informed Consent 1. Explain what kind of relationship we have with our patients as their Fiduciary (what is that relationship based on) and what we do for our patients in our role as Fiduciaries Fiduciary duty: act in patient's best interests Fiduciary= trust Fiduciary duty and patient’s best interests is why we promote our patients' best interests in the doctor-patient relationship ○ fidere= trust ○ fiducia= confidence Dentists are fiduciaries: special trust relationship w/ people ○ As fiduciaries, we hold our knowledge and skills in trust for patients To watch out for and protect patients from harm To use our specialized knowledge to benefit patients Place patients best interest first and above all other interests Protect patients and do what is best for them 2. If your patient has rejected and/or refused treatment that you have recommended, that is in their best interest, describe how you should respond to the patient, while still acting in their best interest. Dentists should recommend what they believe is the best for the patient, from the patient’s perspective and then negotiate a mutually acceptable plan of care with the patient If patient rejects treatment, act in PBI by attempting to persuade pt towards best txt choices, without deception, threats, or badgering to “convice” pts to change their minds ○ Don't deceive patients by not explaining other treatment plans or saying an option is no treatment Don't use statements/actions to intentionally mislead “ only way to treat this is_____” ○ Don't threaten patients “ if you don't have this txt, research says you can get a heart attack and die” ○ Don't badger “When are you finally going to get those crowns done, those teeth look awful” ○ Don't misrepresent, withhold, or lie about clinical facts  “ jones, you have a little oral cancer here” Fear of telling pt bad news like you made a mistake, withholding of complete diagnosis, prognosis 3. Describe the primary ethical significance of keeping promises with patients. Pts trust is to provide them with care that is in their best interest We promise to do everything possible to help them, and while we are doing that, we promise not to hurt them ○ Keeping promises= beneficence and nonmaleficence When we break promises, pts feel ○ Disappointed, let down, betrayed ○ Loss of trust, can't trust ○ Person’s word is no longer good 4. According to the Lo text, when a patient’s situation or outcome is out of or beyond your direct control, how do you respond to the patient and/or family, in terms of making promises to them? “Don't make promises to pts or their families about situations or outcomes that are out of/beyond your direct control” “Underpromise and overdeliver, don't overpromise and underdeliver” 5. According to the Lo text, while we want to please our patients, how do we manage situations where patients want or demand treatments that aren’t in their best interests? We want to please pts… but understand you don't have to promise or do things that patients want or demand that aren't in their best interest! 6. What is the primary purpose of informed consent? To protect the patient from… ○ From harm: “do no harm” ○ Being coerced, pressures, or forced into tx ○ By providing the patient: Time, information, answers to questions, 2nd opinions to have peace of mind in making the decision to accept or reject treatment. 7. Regarding the basics of Informed Consent: describe what the patient is being informed about. Informed ○ Pt is apprised/informed of the nature and risks of a proposed treatment, including no treatment or observation describe in clinical terms what consent means. Consent i. And then accepts/rejects a treatment plan (consents) 8. What are the three core parts of the informed consent process? Definition: the process where a fully informed patient can participate in choices about their healthcare The ethical and legal right the patient has to direct what happens to their body The ethical duty of the doctor to involve the patient in their care” 9. As we discussed in lecture regarding the communications process of informed consent, what does the word “informed” mean in “informed consent”? Informed = truth telling by the doctor ○ Truthful information: Needed by pt: Dx, Tx, Outcome Needed by dr: Med Hx, Meds 10. In participating in the informed consent process with a patient, who discloses & discusses all the diagnostic, treatment, risk, benefits and treatment options to the patient? Informed by doctor 11. According to common law, describe the legal consequences of treating a patient without their consent. Common law: illegal and constitutes as battery Inadequate informed consent according to dental board: Negligence Below the standard of care Violates the dental practice act 12. What are some examples of a patient giving implied consent? Implied consent- consent given by the pt’s behavior ○ ex) roll up sleeve for venipuncture/blood draw ○ ex) patient opens mouth for exam 13. In the 2005 JADA Article by Dr. Daniel Orr, Obtaining written informed consent for the administration of local anesthetic in dentistry, what do patients need to be specifically informed about local anesthetic injections? This is the reason why we should obtain informed consent from patients prior to giving them a local anesthetic injection. Due to complications from anesthetic injection Common complications ○ Pain, swelling and bruising Rare complications  ○ Permanent numbness or abnormal sensation, as well as death Autonomy, Decisional Capacity, Futility 1. Describe both the ethical significance and legal significance of patient preferences. ○ Patients have a legal right to control what is/what isnt done to them Informed consent Patient autonomy ○ Patients can’t demand unethical, illegal treatment We can challenge pt’s decision-making if it will harm the pt = our fiduciary duty 2. Are patient preferences part of evidence-based dentistry and evidence-based decision-making? Why? Yes Goal of EBD: to help dentists provide optimal patient care 3. According to the JSW Clinical Ethics text, explain why patient preferences are essential to good clinical care. Patient preferences are essential to good clinical care Patient cooperation, outcome and satisfaction reflect the degree that medical intervention fulfills the patients choices, values and needs 4. In terms of the limits of patient preferences: a. explain why patient preferences are limited by certain ethical obligations we have to patients. Patient preferences are limited by our obligations: ○ Nonmaleficence, beneficence, fiduciary duty b. describe the kinds of treatments that patients may demand, but represent forms of treatment we are not obligated to deliver, because these treatments are not in the patient’s best interests. Patients can't demand: ○ Contraindicated treatment ex) “take all my teeth out” “crown all my teeth” ○ Unethical, illegal treatment ex) demanding narcotics for pain w/out diagnosis ○ futile, clinically non-beneficial treatment ex) pt demands dr to “do everything: to save teeth with a hopeless prognosis Extreme makeovers that are not needed? ○ Pts don't understand the consequences involved ○ Treat for need not for greed  5. As doctors, what do we do for patients who lack decisional capacity? Ask: who has authority to decide on behalf of this patient? ○ Surrogate (family) 6. Describe the ways that we, as doctors, need to assess a patient’s ability to give consent. According to the Lo Text (Chapter 10) in terms of communication skills, what are the 3 questions we doctors need to ask ourselves when we are assessing a patient’s decision-making capacity? 1. Does the pt understand the information? a. “Tell me what you think is wrong with your mouth/teeth?” b. “What is this treatment likely to do for you?” 2. Does the pt appreciate the consequences of choices? a. “What do you think will happen if you don't have this tx?” b. “I’ve explained the risks/benefits… how would your quality of life be affected if these benefits/risks occurred?” 3. Does the pt use reasoning to make a choice? a. “ tell me how/why you reached your decision” b. “Help me understand how you decided to refuse treatment” 7. Describe futile interventions from the clinical perspective. According to the Lo Text (Chapter 9) describe the strict and loose definitions of futile treatment. According to the Lo Text (Chapter 9) describe procedural safeguards that should be used to insure that a futile treatment decision is appropriate. (Go to page 3) Strict definitions: Treatment has no pathophysiologic rationale ○ Futile intervention would be “let’s try anyway” The treatment has already failed in the patient Loose definitions: Likelihood of success is very small (1 in 100 chance) Prospect of benefit of tx “not with effort /resources” “Not medically/dentally indicated.. Contraindicated” Procedural safeguards -> more discussion, not less Recommend a second opinion ○ Confirm the findings and confirm treatment is futile Make sure to discuss the futile/ CNBI aspects of the proposed intervention with the patient/ family Teamwork, Teambuilding and High Performance Teams According to Patrick Lencioni and as discussed in his book, The Five Dysfunctions of a Team: 1. Name the 5 dysfunctions of a team. 1. Inattention to results a. Symptom: Status and ego 2. Avoidance of accountability a. Symptom: Low standards 3. Lack of commitment a. Symptom: Uncertainty 4. Fear of conflict a. Symptom: Artificial harmony 5. Absence of trust a. Symptom: Invulnerability 2. What is the foundation of real teamwork? TRUST 3. What is the ultimate team dysfunction? What causes this? Ultimate team dysfunction -> compromised results Individual needs ahead of the team 4. What characteristics can turn an “ordinary” team player into a “superstar”? “Great teams birth superstars from the ranks of ordinary players who happen to have extraordinary attitudes” 5. What is the most important team leadership trait that we avoid? “Vulnerability is the most important leadership trait that we avoid” - patrick lencioni 6. When a team avoids accountability, what does this produce? Low standards 7. What is the source of team dysfunction that explains why teams are inherently dysfunctional? Human nature makes our teams dysfunctional