Principles and Ethics

ethics

process based on moral principle and establishes a code for behavior that governs an individuals actions

primum non-nocere

first, do no harm
it may be better to not do something than to do something that would cause more harm

quid pro quo

this for that

Res Ispa Loquitur

the thing speaks for itself

Allows negligience to be inferred from nature of event

6 principles of medical ethics

beneficence, nonmaleficence, autonomy, justice, fidelity, utility

beneficence

something done when trying to do good

nonmaleficence

duty to avoid doing harm; associated with primum non-nocere

autonomy

means to ”self rule” respecting others right to personal self governance

justice

treating people fairly and without prejudice

fidelity

steadfastness role of the healer where one does not abandon or exploit patients

utility

duty to act in a way that provides the greatest positive consequences and least negative

factors that may interfere with ethical decision making

desire for/abuse of power, poor communication, bad personality/attitude, education/socioeconomic/cultural/value differences

standards of behavior

professionalism, self control, emotional regulation, cognitive self reflection

AIDET

acknowledge, introduce, duration, explain/educate, thank

osteopathic oath

created to guide member physicians, first drafted in 1938

american osteopathic association

created the osteopathic oath; drafted by Drs. Bell and Hayes

VCOM Values

professionalism, integrity, duty, compassion, altruism, knowledge, critical thinking, grit

trust

dependent on physicians professionalism, knowledge, competence, communication. high levels increase adherence to treatment and improved outcomes

3 fundamental responsibilities of the Honor Code Council

education, preservation, interpretation

steps in violation process

report of suspected violation, investigation, HCC Committee pabel or PESB, recommdenation to the dean. At each point charges may be dropped

Honor code council

made of 13 members, 4 from each class and 1 from OMS-4; violations can go on permanent records

Class 1 offense

minor offense, repeated HCCIS infraction

class II offense

significant offense, cheating, plagiarism, unprofessional behavior

class III Offense

major offense of unethical or legal misconduct, will be elevated to PESB

professional and ethics standards board

convened if HCC finds Class 2 or 3 violation

four themes of unprofessional behavior

failure to engage, dishonest behavior, disrespectful behavior, poor self awareness

what the american board of internal med says ethical behaviors are

altruism, accountability, excellence, duty, honor and integrity, respect for others

ABIM unprofessional behaviors

abuse of power, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, conflicts of interest

medical student performance evaluation

deans letter, comprehensive and standardized report on a students performance in the first 3 years. has negative AND positive things

How is MSPE structured

opening remarks from dean, section 1 from the registrar, section 2 academic performance in years 1 and 2, section 3 is clinical year evaluations, section 4 is campus engagement, appendix is professional characteristics and scattergram

medicare

65+ and those with specific diseases (ALS or ESRD)

4 parts of medicare

hospital care, physician/outpatient services, A + B parts managed by private insurance, prescription drugs

Medicaid

based on income and family size, percentage of federal poverty level, also for those with disabilities

premium

cost of insurance for plan year

deductible

what beneficiary pays before insurance pays

co-pay

set fee when certain services are provided

co-insurance

after deductible, percentage the beneficiary pays

formularies

prescription drugs covered by a plan

insurance cost sharing

things like co-pay, deductible, and co-insurance; addresses moral hazard; regressive since impacts lower socioeconomic individuals more

fee-for service model

set fee for specific service

capitation model

fixed fee for certain period regardless of utilization

episode of care reimbursement model

lump sum for all care related to a condition

per diem model

for 1 day of treatment, common for inpatient rehab or psych

value based repayment model

linked to quality, can be used with any of the other plans

discrimination

act of making distinctions between people based on the person belonging to or being from a certain group

Clery Act

requires institutions of higher education to report crime statistics, notify the campus community of threats

Final Rule

Similar to clery act, now specifically for sexual harassment

mandatory reporting

all VCOM employees and staff are considered mandatory reporters, physicians also expected to report but must comply with HIPAA

anonymous reporting

student may report anonymously by calling director of human resources or associate dean

I will be mindful always of my great responsibility to preserve the health and life of my patients

physician is never justified in abandoning patients, make reasonable effort in partnering with patients

to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity

patient privacy; physician-patient relationship must be founded on mutual trust, cooperation, and respect

to perform faithfully my duties

maintain the patients well being as your main focus and primary responsibility

to employ only those methods of treatment consistent with good judgment and within my skill and ability

dont practice beyond your ability, know you limits and be willing to seek consultation

will be ever vigilant in aiding the general welfare of the community

physician will recognize a responsibility to participate in community acivities and services

not engaging in those practices which will in any way bring shame or discredit upon myself or my profession

any fee charged by a physician shall compensate the physician for services and actually rendered

title 9

no person in the united states shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving federal assistance

title 9 coordinator

Gene Harris

illegal behavior reporting

if something occurs, must report it to associate dean for student affairs (Ridgeway) within 72 hours

what happens if you do not report illegal activity within 72 hours

referred to honor code council

FAIR act

AACOM is working on, ACGME action on equitable residency selection

AOA certifying board services

offers 16 board certifications

physician licensure

all doctors must be licensed to practice medicine, COMLEX and USMLE are licensing exams

board certification

signifies expertise in a medical specialty or subspecialty, completion of GME training

physician autonomy

freedom to exercise their judgment, based on the premise that doctors will act competently

self regulation

governments delegate their regulatory and policing power over to the medical professions

Dent V. West Virginia

set up self-regulation, might prompt states to exclude people without licenses from practing medicine; made medical licensure a standardized requirement

10th and 14th amendment

constitutional amendments associated with medical practice as a privilege or as a right

requirements of licensure

graduation from approved medical school, passage of approved high stakes licensing exam (COMLEX and USMLE), completion of post graduate training

DEA and prescribing

physicians must apply for and be issued a DEA number prior to being able to write a prescription

schedule 1 controlled substances

high potential for abuse, no currently accepted medical use

states medical practice act

defines practice of medicine, create legally constituted state medical board, sets standards and qualifications, defines unprofessional conduct, establishes mechanism for disciplinary action

regulations v guidelines

regulations set a minimum standard that must be followed, guidelines are optional but should be followed

ethical duty to maintain confidentiality

derives from the principle of beneficence, fiduciary responsibilities and autonomy

• backed by hippocratic oath, osteopathic oath, and AMA code of ethics

confidentiality must be breached

to protect third parties (child/elderly/domestic abuse), protect patients, as required by law (reportable diseases)

purpose of medical records

enhance patient well being, provide quality care, justify payment for services

5 requirements for release of information

written signed and dated by requestor, valid, specific, time-limited, right to revoke

stigma associated with impairment being addressed as misconduct

cannot discriminate someone based upon history of mental illness, not asking intrusive questions and taking action against

genetic information act of 2008 (GINA)

protects