Professionalism and Ethics Exam 2

Formal Practice

Systemic meditation practices that cultivate mindfulness skills (brief or intensive).

Informal Practice

Application of mindfulness skills in everyday life; generalize what is learned in formal practice.

Formal Practice Examples

Sitting Meditation, Mantra Meditation, Body Scan, Walking Meditation, Mindful Yoga, Eating Meditation.

Sexual Violence

Unwanted sexual contact through intimidation, physical control, an extends to an act of sexual contact with a person who is incapacitated to the point of being unable to voice consent or their lack of consent.

Violence

Physical contact through any act of violence, physical control, and/or intimidation through threat of violence.

Clery Act

Requires institution of higher education to report crime statistics, notify the campus community of threats, and compile and distribute an annual campus security report to the campus community, prospective student, and employees.

When was the Clery Act created?

1990

Security Role Includes:

Confidentiality, Integrity, Availability

Privacy Rule:

"Individual health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care to protect the public's health and well being".

Who is Covered by HIPAA?

Covered entities- healthcare providers

Business Associates- provide services to healthcare providers

What does the Privacy Rule Permit?

Appropriate disclosures- patient or authorized rep., healthcare providers involved in patient care, healthcare entities for operation, etc.

What does the Privacy Rule Prohibit?

Disclosure of PHI except as defined in the Privacy Rule or authorized in writing by the individual or his/her representative.

What can covered entities do to protect PHI?

Written policies and procedures

Designed Privacy officers

Annual education

Business Associate Agreements with covered entities

Covered Entities must make reasonable efforts to use, disclose, and request only the … amount of PHI needed to accomplish the intended purpose of the use.

Minimum

Patient Rights with Respect to HIPPA:

Inspect and obtain copies of ….

Amend information the patient believes is … subject to organizational approval.

Accounting of … other than for treatment, payment or healthcare operations.

To request … on what information is provided to others.

To request that … communications are provided by a particular means or location.

Medical records, incorrect, disclosures, restrictions, confidential

Disciplines of those who violate HIPAA policy:
… warning with retraining

… warning with more retraining

…

Referral to …

Oral, written, termination, law enforcement

Ethical Duty to Confidentiality

The obligation to protect a patient's PHI unless otherwise required by law or consent by the patient is given.

When can confidentiality be breached?

As required by law (statute, regulation, court order)

Victims of abuse, neglect or domestic violence

Serious threat to health or safety

What information may be omitted in the medical record?

Irrelevant historical information

Inactive problems

What are risks to omitting information?

May compromise care

Important clinical information will not be available in an emergency

Appropriate documentation is required for reimbursement

Five Requirements for release of information:

Written, signed, and dated by requestor

Valid

Specific

Time-limited

Right to revoke

Genetic Information Act of 2008 (GINA)

Protects a patients genetic information from employers, and does not allow employers to make decisions based on genetics.

Recognize that osteopathic physicians predominantly choose to train and practice in primary care vs non primary care

DO principles align with better outcomes at the primary care level.

Identify the major requirements regarding training in osteopathic principles and practice necessary for AOA and AACOM to collaborate with the ACGME in forming the Single Accreditation System (SAS) for Graduate Medical Education.

AOA and AACOM entered under the ACGME. Culiminated in the SAS; a process for accreditation by ACGME, of all residency training programs in the US.

Identify the major leadership positions developed to give members from the AOA and AACOM to collaborate witht he ACGME in forming a Single Accreditation System (SAS) for Graduate Medical Educaton.

The position of Senior Vice President, Osteopathic Accrediation was established by Lorenzo Pence, DO. Created were the Osteopathic Recognition Committee and the Review Commitee for Osteopathic Nueromuscular Medicine. Osteopathic physicians have been appointed to each of the specialty program Residency Review Committees.

With the establishment of SAS, discern what was changed and what remains the same between the osteopathic and allopathic professions as it relates to residency training programs, accreditation, board certificatons, licensing examination programs.

Collaboration was limited only to the ACGME accreditation process for residency training programs . Osteopathic and allopathic would continue to maintain the integrity of their respective institutions. Board certs, undergraduate medical educaton, predoctoral education, licensing examinations and CME all remained the same.

Licensing Exam vs Board

Licensing exam: gets you a medical degree (DO or MD)

Board certification: signifies expertise in medial specialty/sub specialty. Completion of GME training. 

Distinguish the role of the State Medical Boards in regulating the practice of medicine

To protect the wellbeing of patients, and to safeguard the autonomy of the physician the medical profession must effectively deal with the small number of incompetent and unscrulopous physician. If the medical profession cannot accomplish this, another entity will do it for them. 

Three functions: Licensing, Discipline, and Regulation.

Medical Practice as a Privilege vs Right

10th Amendment vs 14th amendment. States rights vs No person should be deprived of life, liberty or property without due process of law.

Identify the minimum requirements to become licensed to practice medicine and prescribe controlled substances.

Graduation from approved Medical School
Passage of an approved High Stakes Licensing Exam 
Completion of Post-Graduate Training

Identify the evidence behind the determination that the COMLEX USA and USMLE are valid for their intended purpose.

The FSMB undertook extensive statistical testing to establish the validity of both COMLEX and USMLE medical licensing exams. The FSMB House of Delegates in 2008 recognized the USMLE and COMLEX as valid examinations for their intended purposes.

Distinguish the role of Federal Agencies in regulating the practice of medicine.

The US Department of Justice Drug Enforcement Administration is to enforce the controlled substances laws and regulations of the US, bring the crimina and civil justice system and to support programs aimed at reducing the availability of illicit controlled substances.

Discern elements defining the 5 schedule of drugs established by DEA

Schedule 1 controlled substance: high potential for abuse; have no currently accepted medical use.
Schedule 2 controlled substance: high potential for abuse which may lead to severe psychology or physical dependence.
Schedule 3 controlled substance: have a potential for abuse less than 1 or 2.
Schedule 4: Low potential for abuse relative to substances in 3.
Schedule 5: Low potential for abuse relative to substances in 4.

Distinguish behaviors that constitute physician misconduct

Substandard care, improper prescribing, boundary violations, impairment
disruptive, medical fraud and abuse, commiting a felony, sanction by another state, aiding unlicensed practice, false advertising

Indicate the role of the AMA code of medical ethics

Routinely cited in legal cases, frequently referenced, adopted by state licensing board to determine if physicians behavior constitutes misconduct. The code has persuasive authority with judges and state licensing board as standards of professional conduct.

Impairment

Any situation in which the health of a physician negatively impacts their ability to provide safe and effective healthcare. 

Dialectical Behavior Therapy (DBT):

Helps improve emotion regulation, distress tolerance, and ability to be mindful.

Mindful-Based Cognitive Therapy (MBCT):

8-week program aimed at treating depression, particularly relapse prevention.

Approximately …% of students experience burnout and …% experience suicidal ideation.

50%, 10%

Mindful-Based Mind Fitness Training (MMFT):

Trauma-sensitive, evidence-based recovery and resiliency training for professionals in high stress environments.

Acceptance and Commitment Therapy (ACT):

Conducted individually; helps reduce aviodant coping styles.

Burnout:

In many cases is measured by emotional exhaustion, depersonalization, and reduced sense of personal accomplishment.

A “…" is activated during meditation which can elicit many clinical benefits including improving sleep, decreasing BP, reduces stress, etc.

Relaxation Response

Physician burnout … the amount of patient safety incidents.

Doubled

… risk increases when judgement is impaired due to intoxication, especially those suffering from an affective disorder.

Suicide

Web-based Cognitive Behavior Therapy (wCBT):

An effective method in decreasing suicidal ideations in physicians.

Physicians markedly have … suicide completion rates than the general public, due to their knowledge and access to lethal means.

Higher

Medical students with Honor Board violations have been found to be disciplined by a medical board in midlife more often:
Decrease in ability of self-improvement: …x risk.
Severe Irresponsibility: …x risk.

3x, 8x

Around …% of physicians that entered a professional health program continued to practice afterward.

72%

Physicians often avoid getting help due to fear of consequences related to mental health/susbstance use questions. However, this is often the opposite effect, Health boards have limited the amount of intruding questions. This is a “…” where physicians can get confidential assessment and treatment.

Safe Harbor

VCOM student impairment policy: … advisors are available for meetings/counseling. When concerned with medical impairment, meet with … or the dean to arrange a medical leave of absence.

Mental Health, Student Services

What percentage of physicians report burnout? What percent of 3rd year students report burnout?

60%, 50%

What percent violated HIPAA? What percent violated patient confidentiality?

8%, 13%

What percent of osteopathic physicians practice in primary care?

57%

What percent of medical students are in osteopathic programs?

28%

How many colleges of osteopathic medicine are there in the US?

43 (69 campuses)

What percent of medical students suffer with depression or another related mental illness?

43% anxiety, 23% depression

What percent of residents suffer with depression or another related mental illness?

28%

Success rate percentage of physicians who enter professional health programs?

78-81%