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Found final part 1

the first test's material

Explain three ways a Doctor/Patient relationship can be established; one formal, one informal & one verbal either formal or informal. informal: Relationship on Verbal Communication.Formal:time Pt Registered Dr begins Assessment, If Dr/Pt relationship not established Dr not obligated to treat, After established, continues til services no longer needed/properly terminated
How much of a ‘fee’ needs to be charged before a doctor/Patient relationship is legally established? Explain your answer. Dr/Pt Relationship Does Not Depend on Charging or Collecting a Fee, occurs upon assessment
How can a potential new patient come to your office and not have the doctor/patient relationship created? If individual comes in and either Dr determines can not help individual or Pt decides not to use help
Under what circumstances do you notify the patient of the termination? Pt’s need outside of capability to provide, sometimes referral warranted.- If Pt or Dr feel an unprofessional situation exist.-Non-compliance of the Pt to follow care guidelines or non-payment.
What is required as notice to the patient for proper termination of care? A written notice giving ample time for the patient to seek out another care provider to replace your service.
Are you required to provide a list of other doctors for the patient to seek care? Explain. There is no requirement to assist in the procuring of another provider to replace your service in a termination. However, it may be best to explain what kind of doctor they should look for.
What are the more common three methods used to determine Standards of Care? The Knowledge, Skills and Care Your Community Expects; Published Statements e.g. Licensing Boards, State Associations, Legal System; Unwritten but commonly accepted rules regarding appropriate interaction with patients
What is “Guardian Consent”? Consent by Guardian for Dr to care for Minor/Incapacitated Pts. Future Oral Consent by phone may be desired. Document Signing/Dating the forms. Legally establish who is custodial Guardian in divorce/separation
Can a patient bring a successful complaint in a law suit against you if he/she were given the proper consent information and signed an Informed Consent form, but did not really understand the information? Please explain your answer. may verbally agree to something from fear, perceived social pressure, or psychological difficulty in asserting true feelings, person requesting the action honestly unaware and believe it is genuine. Consent is expressed, not internally given.
If you had the patient sign and Informed Consent Form, and they willingly did so without reading it thoroughly and without an explanation from you, does that prove Informed Consent exists? Please explain your answer. A Dr having signed forms without the associated explanation and discussion does not prove that informed consent exists
What constitutes Informed Consent? Informed Consent is Established by the Patient’s UNDERSTANDING of your recommended plans
What makes Informed Consent invalid? Pt is a Minor/Legally Incapacitated; If Dr/Pt committing Fraud; Pt/Dr withholding material facts; Remember the Dr is giving Consent, too. If the consent is written in technical terms that are not explained and not understandable by the individual Pt.
Can a minor (under age of consent) give Consent for care? Are you sure of your answer? Explain your answer. If the patient is a minor then the consent is invalid
Can a patient that does not speak the same language as you give you consent for care? Explain your answer. If there is a known language barrier (if no translation is provided) that is not addressed then the Consent is Invalid.
What is patient abandonment? Interruption of the normal or recommended course of a health care plan
What are the five elements that are needed to establish patient abandonment? Dr must have an established Duty to Care for Pt; Unilateral Withdrawal by the Dr without Pt Agreement; Pt is in need of Continued Care; Lack of Care must have Adverse Outcome; Injury or adverse outcome must be caused by Dr’s Abandonment
What is the proper method of notification to let your patients know you will be gone on vacation? Inform Pts how they can receive the care they need regarding their management plan or if they just need to see a chiropractor by: Arrange for local Dr to see Pt while gone. Arrange for a coverage Dr to work in office while gone.
Is it considered abandonment if your office hours are so erratic as to disallow the patient the opportunity to complete the agreed to care plan? YES; Inability to comply with Management Plan due to scheduling issues: Not enough open hours to allow Pt to comply with Management Plan. No time availability due to over scheduling. Leads to Non-Compliance on Drs part. Considered abandonment.
List at least 4 personal privacy boundaries you need to be aware of during a routine patient visit. Private Personal Lives entered when discussing case Hx, causation, emo or psych overlay, finance
List at least 4 methods to allow the patient to set the boundaries. Permission to Discuss a sensitive subject/touch them not enough. Understand, Empowered to Refuse. Monitor the Patient’s Response to Actions, Subject, Questions. Limit Discussions: Care Plans, Patient Compliance, Outcomes. Avoid unrelated Personal Issues.
List at least 5 examples of when patients perceive vulnerability. Share Personal Details; Disrobing, Do Not Understand What You Are Telling Them; Dr Flaunts Education/Status; Pt Owes Dr Money
List at least 5 ways to avoid violating boundaries during the exam & adjustments. Gown if disrobe; staff member present when examining private parts (Particularly of Patients of the Opposite Sex); Explain prior to touching; Ask parent present w/ minor; Avoid unnecessary Pt exposure during Inspection or contact; DON’T INTIMIDATE Pt
List the 5 Common Problems in Chiropractic Case management. Vertebrobasilar stroke; Rib Fractures; Misdiagnose or Failure to Diagnose; Medical, Therapeutic, Rehab equipment Failure/Misuse; Improper Treatment Protocols
What are the five most common causes of Malpractice claims? Vertebrobasilar stroke; Rib Fracture; Failure to Diagnose; Over Utilization Claims Considerations; Disc Related Considerations and Issues; Equipment Related Issues; Potential Improper Treatment Issues; Monitor Your Pt Response to Care
What did the NCMIC Examiner, Winter 2005-6 say about stroke events and the causative relations hip of Chiropractic Manipulative Therapy? “The best scientific evidence available has shown no direct causative relationship between chiropractic spinal manipulations (cSMT) appropriately administered and stroke events.”
What are the 4 common failures in diagnosing? appropriate Dx Tests to support suspected Dx/indicated by Hx/Exam? ROS complete? Dx Imaging? Plain X-Ray Film for Bone Path, Frxr, Alignment as indicated by Exam Findings; MRI or CT for Soft Tissue Structures Pathology (Disc, Vessel, Neuro, Tumor)
What are the 4 things to watch for to avoid Over Utilization Claims? Will test ordered assist in Ddx/Tx plan? Medically Accepted? Correct Test for your Suspected Dx? Do you have any Financial Interest in Procedure?
List the two primary functions of medical records. Protects Pt by Gathering/Preserving Info, maintains a care sequence. Protects Dr by Preserving Documentation on how the Pt’s Healthcare was Managed
List the people that will potentially read your Patient records. Pts’ Insurance Claim Adjusters; Attorney; Insurance Fraud Investigators; Judge and Jury in potential litigation case
How long must you keep patient records? vary w/ State. Rules may be different for retaining Documents as opposed to Films, or Test results.may be special laws regarding medical records of patients who die and for records of Minors.
What are the13 general best practices for medical records use & retention? No blank. each item Clearly Identifiable. Unique Forms. Legible. Legend. Consistent unless all change. No Premature/False Data. Never Alter. ID who enter info. Reputable storage. Reimbursement/Records Separate-both Accessible
What is the “Gold Standard” for record keeping? Could another licensed DC of similar training be able to use your medical records to practice
What is the “acid Test” for how your records will be judged? What kind of Medical Records are your DC Peers maintaining? What does the State Law require of your Medical Records?
Created by: stigmatamarty
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