DSA08 - OMM Ethics of Touch

Define the Core Fiduciary Duty of CARE

Physician must be educated and informed about the laws and issues regarding the procedures, conditions, and surgeries they are administering

Define the Core Fiduciary Duty of COMPETENCE

Physician must be fully accredited, must stay up to date on licensing, and stay current on new forms of treatment and new medications

Define the Core Fiduciary Duty of GOOD FAITH & FAIR DEALING

•Must not cheat or deceive a patient.

•Duty of Loyalty

•Must remain loyal to the patient’s interests over one’s own.

Define the Core Fiduciary Duty of AVOIDING CONFLICTS OF INTEREST

Physician must not be unduly influenced in treating or recommending course of treatment

Consent must consist of what?

1. A thorough explanation of the examination or intervention, including the risks, benefits, and alternatives;

2. Ensuring the patient understands and appreciates this information;

3. Ensuring a patient's decision to consent or refuse is voluntary and free from coercion;

4. Documenting the patient's decision and the conversation in the medical record.

What does it mean to say there's "no presumption of consent beyond what the patient specifically consented to beforehand"?

Consent is required for each specific procedure every time (ex: Knee surgery --> CANNT decide to perform tubal ligation without prior written consent)

What are some commonly sensitive areas to be cognizant of in OSEs?

-Breast Tissue

-Coccyx

-Ischial Tuberosities

-Pubic Bone

Define Trauma-Informed Care

an approach to treatment that acknowledges the role that trauma can have on the mental health of individuals; honors a patient's voice, agency, control and choice!

Define Chaperone

Trained person who serves as a support and witness for a patient and a provider during a sensitive exam or procedure

Who is allowed to serve as a Chaperone?

-Provider

-Trained Staff Member

-Preferred that GENDER of chaperone is chosen by patient

Define Informed Consent

Carries throughout the entire sensitive examination or procedure - includes:

•Proper communication with patient about why the sensitive exam is needed

•Clear and consistent communication before and during sensitive exams to explain what to expect from the exam and what will happen during the exam (e.g., explaining physical exam maneuvers, telling the patient what one is doing at each step, keeping patients covered during the examination).

What should be documented to show informed consent was obtain?

•Documentation that patient education was provided;

•Documentation if patient declines any part of exam

•Documentation of chaperone presence or declination of chaperone use

•Chaperone communication to signal the need to pause exam due to obscured view or patient discomfort

•Documentation of consent when taking photographs of sensitive areas

•Two staff, one of whom is a chaperone, should be provided to patients who need assistance with dressing/undressing or toileting before or after an exam.

Who should be present for Sensitive Examinations performed on minors?

-Chaperones

-Parent/Guardian

Under the Texas Medical Practice Act, certain persons must report relevant information to the Texas Medical Board relating to the acts of a physician if, in the opinion of the person or committee, the physician in question does what ?

Poses a continuing threat to the public welfare through the practice of medicine

Which groups are considered Mandatory Reporters?

-Physicians licensed in Texas or otherwise lawfully practicing medicine in Texas

-Physicians engaged in graduate medical education or training

-Medical students

If health care provider (HCP) has cause to believe that a child is being subjected to abuse or neglect, a report shall be made no later than () hours after the HCP first suspects that the child has been or may be abused or neglected or is a victim of the offense of indecency with a child

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As in the case of children and minors, HCPs in Texas are required to report suspected abuse or neglect of who else?

•Elderly;

•Disabled persons;

•Patients receiving inpatient mental health or chemical dependency treatment; and

•Patients receiving medical rehabilitation services.