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drnieves's version from 2017-06-11 14:30

Section 1

Question Answer
Medicare>65 yrs old, <65 with disabilities, end stage renal disease.
MedicaidFedera/ state health assistance for people with low income.
MedicareABCD: hospital bills, basic medical bills, delivered by private companies, prescription drugs
AutonomyConfidentiality, honesty, informed consent, declining medical care.
BeneficenceOnly autonomy goes over this
Informed consentDisclosure, understanding, capacity (vs competence), voluntariness.
Can be revoked anytimeWritten consent
Exceptions to informed consent1.Pt lacks decision making or is legally incompetent. 2.Emergency 3.Therapeutic privilege 4. waiver
xception for parental consentEmergency Emancipated STDs, contraception, pregnancy, drugs.
Capability of decision making>18 yrs., makes and communicates it, is informed, decision remains stable, not clouded by mood disorder or altered mental status.
Oral advance directiveProblem is a variance in interpretation, but if multiple people were told, it is valid.
Living willDescribes patient's wishes if he/she losses the capacity of decision making.
Medical power of attorneyPerson that the patient designates to make treatment decisions. Can be revoke anytime.
Surrogate decision makerFamily of friends: spouse> adult children>parents>adult siblings>other relatives
Exceptions to confidentiality1. Reportable diseases 2.Child/elder abuse 3.Epileptics 4.suicidal/ homicidal
Tarasoff decisionCalifornia supreme court- physician have to directly inform and protect potential victim from harm.
Patient not adherentTry to ID the reason and willingness to change.
Patient wants an unnecessary procedureTry to understand and address concerns.
Difficulty taking medsWritten instructions; simplify regimens; teach back
Family asking prognosisAvoid discussing without consent.
Family asking not to disclose informationIf the patient has decision making capacity and don't indicate otherwise, information won't be withheld.
Child wants to know more about illnessAsk what parents told. Parents should decide.
Minor request abortionRequire parental consent. Unless there are medical risks, don't try to convince otherwise.
Minor wants to keep child vs parents who want adoptionPatient retains the rights.
Terminally ill requests assistance to end lifeRefuse. However, meds that shorten the patient's life can be prescribed.
Suicidal patientAssess seriousness. Suggest voluntarily admission; otherwise against he/her will.
Patient with mastectomy say she looks ugly.Find out why. Do not offer falsely reassuring statements.
Patient angry about waitingAknowledge, apologize; don't have to explain.
Patient upset about other doctorSuggest patient speaks with that doctor. If it is with someone of the office staff, say you will speak with the person.
Invasive test on wrong patientInform about error.
Patient requires tx not coveredDon't limit or deny care. Discuss all options.
memorize

Section 2