INVESTIGATIVE ACTIVITIES ∙ UNIT 3
1.(For this exercise, consult Figures 7-1, 7-2, and 7-3 from the textbook.) A physician–patient contract is terminated when the patient discharges the physician, the physician formally withdraws from patient care, or the patient no longer needs treatment and is formally discharged by the physician. What is the appropriate legal and ethical action when each patient responds as follows to receipt of a letter terminating the patient–physician relationship?
A. After telephoning Dr. Winston Lewis to complain about his treatment and to threaten to find a new doctor, Jim Marshall receives a letter from Winston confirming that Jim has discharged him as his physician. Jim is outraged. He calls office manager Marilyn Johnson, CMA, to insist on making an appointment, claiming he never intended to find a new doctor but only to get Dr. Lewis to prescribe a more effective medication to control his high blood pressure.
Action: ______
______
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______
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B. Two months after receiving the letter confirming that Dr. James Whitney has withdrawn from Lenny Taylor’s case because the patient will not follow the medical plan for his care, Lenny, who suffers mild dementia, still refuses to contact a gerontologist or to take the medications James had prescribed previously. In desperation, his son, George Taylor, calls James to plead with him to take his father back as a patient.
Action: ______
______
______
______
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C.Rhoda Au writes to Dr. Mark Woo to inform him that she has found a physician trained in both Western and traditional Chinese medicine who is more willing to integrate both approaches into a treatment plan for her. She cites Mark’s skepticism in pursuing alternative treatments and his sole reliance on Western drug therapies to treat her diagnosed case of lupus erythematosus as the reason why she refused to follow his treatment plan. Rhoda goes further to say that she feels Mark has forgotten his heritage; she supplies the new physician’s name and address.
Action: ______
______
______
______
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2. A tort is a wrongful act that results in injury to one person by another. Malpractice is the unintentional tort of negligence; that is, a health care professional either failed to act in a reasonable and prudent manner and caused harm to the patient or did what a reasonable and prudent person would not have done and caused harm to a patient.
A. Define the following three examples of torts common in the ambulatory care setting.
Battery:______
______
______
Defamation of character:______
______
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Invasion of privacy:______
______
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B. There are two doctrines of negligence. Define each.
Res ipsa loquitur:______
______
Respondeat superior:______
______
3. Advance directives, living wills, and durable powers of attorney for health care are legal documents patients can execute to protect their treatment wishes in the event that they cannot communicate for themselves because of serious illness or injury. Medical assistants are asked to attach these documents as a permanent part of the patient’s medical record. Most states have their own forms, and legal requirements vary from state to state. These documents should be initialed and updated periodically to ensure their enforceability.
The decision to withdraw or administer treatment is intensely personal and will differ vastly from patient to patient. Individuals hold strong beliefs regarding medical treatment and life-saving measures that must be respected by medical assistants and all health care professionals. Read through the health care directive presented in Chapter 7 of your text, and answer the questions it asks.
4.Child abuse, spousal abuse, and elder abuse are all too common in our society today. Physician–patient confidentiality does not apply in cases of abuse; health care professionals must report suspected abuse to the appropriate authorities or face criminal or civil charges for the failure to do so. Careful charting and maintenance of the medical record in each case of abuse is critical, because the medical record becomes the legal document of care that will be considered by a court of law.
Medical assistants have a responsibility to the patients they serve and to the community at large to respond with professionalism, empathy, and compassion to any victims. Patient education and community awareness are two ways medical assistants can help become involved.
A. List one organization in the community where you live that provides information and services as a strong advocate for the protection of children, older adults, and battered women.
ChildrenOlder Adults
Name: ______Name:______
Address: ______Address: ______
______
______
Phone: ______Phone: ______
Battered Women
Name: ______
Address: ______
______
______
Phone: ______
B.Contact one of the organizations above for literature and information about the services provided. Obtain information about the services provided to the organizations by community volunteers. Bring the information to class and discuss ways that health care professionals can contribute to community awareness. Discuss the legal responsibilities of health care professionals to victims of abuse.
5. Statutes, or laws, govern licensure, standards of care, professional liability and negligence,confidentiality, and torts. Some states regulate personnel who may be employed in the ambulatory care setting. For example, the scope of practice of medical assistants can vary from state to state. Some states require additional certification or licensure to perform certain clinical duties. Investigate the laws in your state regarding the scope of practice, or duty of care, of medical assistants. As a class, have each student choose one other state to investigate any scope of practice for medical assistants identified in that state. Bring the information to class and discuss how state requirements differ and how the requirements might affect employment opportunities in the medical assisting profession.
6.Ethics are defined in terms of what is morally right and wrong. Personal ethics will vary from person to person. There are many ethical issues related to health care and medicine, however, that are shared across the life span. For each life passage below, list one problem or issue of concern relating to medical ethics. Then pose your own solution to the ethical problem.
Infants or Children
Ethical issue: ______
______
Ethical solution: ______
______
Adults
Ethical issue: ______
______
Ethical solution: ______
______
Senior Adults
Ethical issue: ______
______
Ethical solution: ______
______
7. Define surrogacy. What deeply held societal beliefs does the bioethical issue of surrogacy challenge in our society?
______
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8.Define genetic engineering. Name one medical benefit and one potential danger of genetic manip-
ulation. In your opinion, are the benefits of genetic engineering greater than the risks and dangers? Why?
______
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9.Bioethical issues in the field of medicine have a powerful impact on the lives of patients. Many of these issues engage the highly charged emotions and deeply held beliefs of patients, caregivers, and health care professionals. As a medical assistant, you will participate in situations involving bioethical dilemmas. By answering the questions that follow, you will begin to explore your own comfort levels with bioethical dilemmas such as allocation of scarce medical resources, abortion and fetal tissue research, genetic engineering and manipulation, artificial insemination and surrogacy, end-of-life treatment, and HIV/AIDS. The system of medical ethics involving these issues is constantly changing and evolving as society comes to grips with the implications and challenges of bioethical dilemmas. Many of the questions listed have not yet been resolved; there is often no one right or wrong answer. Circle the response that most closely matches your own personal ethical position. If you hold a differing opinion, write it in. Place a check mark by any in which the three ethics check questions helped you make your decision.
A.I believe Medicare/Medicaid patients should:
a.receive the lowest level of competent care medically necessary
b.receive the full benefit of treatments made possible by costly medical technology
c.receive the same care as any other patient, regardless of their Medicare/Medicaid status
d.______
B.I believe the only unscheduled patient appointment of the day should be:
a.given to the first patient who asks for it
b.reserved for emergency patients only
c.reserved for rescheduling purposes if patient appointments need to be shuffled in the course of the day
d.______
C.I believe life begins:
a.at the moment of conception
b.at some point during the development of the fetus in the womb
c.at birth
d.______
D.I believe fetal tissue research and transplantation:
a.should be allowed as a potentially life-saving treatment for patients with serious, life-threatening illnesses
b.encourages women to have abortions and should not be allowed
c.should be allowed, but only under certain conditions and with close government regulation
d.______
E.I believe that the results of laboratory blood tests to screen for the presence of genes associated with certain serious life-threatening illnesses should:
a.be used to establish preexisting conditions if the results are positive; test results should be accessible to insurance companies to determine individual coverage of benefits
bbe held in strict confidence between physician and patient with no authorized legal release of information to any third party
c.be used to encourage preventive health measures without any penalty or restriction of coverage imposed by insurers
d.______
F.I believe genetic manipulation:
a.holds the potential to prevent or cure disease and prolong the life span
b.is humankind’s dangerous attempt to manipulate nature and determine the course of its own evolution
c.holds too many possibilities for abuse and destructive purposes
d.______
G.I believe adoptive parents should have the right:
a.to information regarding the medical history of the biological parents
b.to adopt an infant even if one or both spouses is older than 50 years
c.to choose surrogacy as a viable alternative to parenthood
d.______
H.I believe artificial insemination should be performed:
a.for heterosexual couples only
b.for heterosexual couples and single women only
c.for heterosexual couples, single women, and lesbians
d.______
I.I believe that elderly people with chronic and serious health problems should:
a.live with and be cared for by their children
b.be cared for in long-term care facilities that provide assistance and skilled nursing services
c.be allowed to stay in their own homes with the assistance of qualified home health aides
d.______
J.I believe physician-assisted suicide:
a.violates the medical code of ethics dedicated to upholding life
b.is a responsible answer to the unnecessary prolonging of life made possible through advances in medical technology
c.is acceptable only in the most extreme cases of human pain and suffering
d.______
K.I believe that physicians and health care providers who are HIV-positive should:
a.be entitled to the same right to confidentiality as patients who are HIV-positive
b.be required to reveal their HIV-positive status to patients and coworkers
c.be required to register their HIV-positive status with Occuptional Safety and Health Administration (OSHA), with the guarantee that information will be held confidential from any third party
d.______
L.I believe experimental drug therapies for patients with AIDS should:
a.be accessible to any patient whose case qualifies for their use, with full coverage guaranteed by insurers
b.be restricted only to participants in federal- or state-approved research studies
c.be covered by Medicare and Medicaid to make treatments accessible on a wider scale to an increased number of patients
d.______
10.Educating patients and the general community about the responsibility to be prepared for addressing emergency situations is one role the medical assistant can perform in the ambulatory care setting. Health care professionals should encourage patients to keep complete emergency reference information in an easily accessible place in the home. Furthermore, patients should be encouraged to receive training in first aid and emergency procedures, including CPR, and to learn about strategies for creating a safer home environment. Complete the sample emergency information sheet below with the resources closest to your home and essential medical information relevant to your family.
As a class, designate one student to contact each of the six resources listed—fire department, poison control center, police department, ambulance service, local hospital emergency department, and primary care physician’s office—to ask about emergency procedures and services each provides and to obtain any literature that is available about preventing or treating emergencies. Bring the information to class for discussion.
EMERGENCY INFORMATION FOR THE ______FAMILY
Address:______
______E-mail address:______
Telephone:______Cell phone:______
Emergency Medical Services (EMS): Dial 911. If 911 is busy or does not answer, dial “0” (Operator) and ask for help. TDD/TTY for the Hearing Impaired, dial 311.
Fire DepartmentPoison Control Center
Address:______Address:______
Telephone:______Telephone:______
Web site:______Web site:______
Police DepartmentAmbulance Service
Address:______Name:______
______Address:______
Web site:______Web site:______
Telephone:______Telephone:______
Local Hospital Emergency DepartmentPrimary Care Physician
Name:______Name:______
Address:______Address:______
Telephone:______Telephone:______
Web site:______Web site:______
Names and ages of family members and any medical conditions or medications emergency medical professionals should know about.
1.______
______
2.______
______
3.______
______
4.______
______
5.______
______
6.______
______
Person, not at the household address, who should be contacted in case of emergency.
Name:______Relationship to family:______
Address:______Telephone:______
______Cell phone:______
______E-mail address:______