UNC ANTH 270 Final Review

Autonomy

free will, and respecting the free will of others

Allied Health Professionals

Provide additional care alongside another/multiple practitioners (Ex. therapists, dental hygienist, and radiographers)

Beneficence

duty of the physician to always do things that are for the benefit of the patient

Bioethics

concerned with the moral implications and controversies of medical research and procedures/applications

4 pillars of bioethics

1. autonomy

2. beneficence

3. non-maleficence

4. justice

The Belmont Report

first nationally organized statement on the treatment of human subjects with core principles of autonomy, beneficence, justice

Caring and competence

our biomedical system juxtaposes caring and competence. Caring is just being willing to care for others versus competence is actually having the capacity and capital to do so.

Conferred Status

Deals with medical professional capital will confer on someones prestige/ respect in a society. Particularly when the individual grows capital in all 3 areas

Clinical Hierarchy

The hierarchy that is established in a clinical environment that is usually dictated by social and cultural hierarchy.

Good reasons for hierarchy:

1. clear chain of demand

2. helps prevent people from doing things that they cannot or should not do

3. decreases liability

4. delegating

Negative outcomes of hierarchy:

1. most doctors are specialists

2. fosters cowboys and not pit crews

Medical Error; Causes

1. Healthcare complexity (drug interaction)

2. System design

(inadequate communication between healthcare providers, or between providers and the patients has root cause of over 50% the serious adverse events in hospitals)

3. Training and supervision

(the July Effect)

4. Fatigue

(sleep depravation, overwork, and burnout)

Medical Error; Reporting and prevention

1. Self-reporting and review

2. Admitting mistakes to patients

3. Reporting the mistakes of other physicians

4. mortality and morbidity conferences

Cultural Capital

the knowledge, habits, and tastes learned from parents and family that individuals can use to gain access to scarce and valuable resources in society

(this includes the school a physician went to, whether their parents are also physicians)

Social Capital

the networks of relationships among people who live and work in a particular society, enabling that society to function effectively.

Institutional Review Board (IRB)

Committee designated to approve, monitor, and review biomedical, clinical, and behavioral research

The July Effect

in July when interns and how residents start, and it puts patients at risk and would have a greater risk of medical error

(Only real dip is in prescribing errors)

Medical Residency

-graduate medical training

-provides in depth training within specific branch of medicine

Medical Pluralism

the intersection of multiple cultural approaches to healing

-Using multiple medical healing systems to appeal to cultural and religious beliefs

M&M Conferences

Mortality and Morbidity Conferences

-Special conferences where physicians (especially in teaching hospitals) meet and go over the cases of medical error that occurred over a set period of time

Mid-Level Provider

-More narrow scope of practice than physicians

-Advanced Practice nurses (Masters-level minimum and some move to doctoral-level schooling)

-Physicians assistants (2-3 years of specialized program, post-bacc and some can move on to specialize in a residency

Non-maleficence

duty to do no harm

Paternalism

decisions are taken by a health care professional in order to benefit the patient or society as a whole; can sidestep a patient's autonomy

-They will always have the patient's best interest in mind and can even make consentual decisions on the patient's behalf based off their own training/practice.

Risk/Benefit

Understanding the cost and what can be taken from certain research studies and medical practices

(EX: The Belmont Report and Informed Consent)

Surgical Checklist

A set checklists for procedures for a surgeon to follow. Believed to help decrease medical error. Not widely implemented

Critical Medical Anthropology

Theoretical approach in anthropology

-often applied toward social change

Tuskegee Experiment

-Goal was to track the natural progression of untreated syphilis

-about 600 participants

-was stopped after a press release that exposed the wrong things about the experiment

Meaningful Work

Physicians doing work thats meaningful to them

ex. potential for a physician to make financial or career sacrifices

ex. error prevention through checklist, "stepping out the box" or ideas to improve care

Kleinman's Approach

Approach to clinical care

-alternate approach to cultural competency model

-ideal approach but difficult to alter clinical encounter

-one of the ways to tailor care in a way that will help individuals better with attention to cultural issues and issues of respect, patient dignity, and power in clinical interactions

Patient Centered Models

3 Types

1. Informative (doctors tell patients of treatment options and relevant medical information but patients select their own treatment)

2. Interpretive (doctors helps patients explore their health-related values, presents options, and patients selects the treatment that best fits their values)

3. Deliberate (doctor helps patients explore health related values, doctors share their own morals and medical views with the patients in the discussion process)

Cultural Competency Model

-federal mandates and recommendations

-required to adhere if receive any federal funding

-learned in training and workshop settings but also used in medical schools as they are moving to the clinical space. Also found in publications to boil down a race or religious group.

-Long definition: Cultural and linguistic competence in a set of congruent behaviors, attitudes, and policies that come together in a system.

Science and Technology Studies

-science as a social act

-interdisciplinary study of science and technology as socially embedded processes

Informed Consent

an ethical principle that research participants be told enough to enable them to choose whether they wish to participate