Updated: 7/15/2021

Ethics in Orthopaedic Practice

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  • Relations with Industry and Hospitals
    • Acceptable standards of professionalism
      • practicing orthopedic surgeons may accept tuition, travel, and modest hospitality (including meals and receptions) to attend an industry sponsored non-CME course given at a local convention center
      • industry relationships must be disclosed to patients, colleagues, and institution
      • gifts must have a market value under $100
      • no direct kick-backs can be given to a physician or hospital systems from an industry
      • physicians cannot refer patients to centers in which they have a financial interest (Stark II laws)
  • Patient Satisfaction & Complaints
    • Patient complaints
      • formal written patient complaints regarding quality of care require letters of response to patients from the surgeon
    • Communication
      • leading cause of medical litigation
        • on average, most doctors interrupt patients during an interview within 23 seconds
        • orthopedic surgeons are described by patients and colleagues as "high tech but low touch"
        • orthopedic surgeons are described as having poor communication skills and empathy for patients
      • translation services
        • can be provided by employees fluent in the language, commercially available telephonic services, professional interpreters, and volunteer translators
        • inappropriate for family members to act as translators unless patients offer/agree
  • Medical Innovation
    • Royalties
      • surgeons receiving royalties for implants used in surgery must be disclosed to patients
  • Patient Transfer
    • The Emergency Medical Treatment and Active Labor Act (EMTALA)
      • all patients must be appropriately screened and stabilized in the original emergency room/hospital
      • risk of patient transfer must be less than the risk of keeping patient
      • accepting hospital/center must know of and accept patient
  • Physician Advertising
    • Physician advertising is becoming more common
      • AMA and AAOS cannot prevent physicians from advertising services
      • FTC, AAOS, state medical boards can sanction for false advertising
      • things to avoid
        • using terms such as "cure" if no cure truly exists
        • using terms such as "painless" or "bloodless" to describe surgery
        • overstating credentials such as "board certified in joint replacement" if no such qualification exists
        • using terms such as "world renowned"
  • Diversity
    • Understanding cultural differences leads to
      • enhanced patient-physician relationships
      • minimized disparities in health care
      • optimized access to orthopaedic care
    • Implicit biases
      • present when unconscious prejudices or stereotypes influence care delivered to patients
      • determinant of health disparities
  • Access to Healthcare
    • Type of health insurance has been shown to be a determinant of healthcare access in the pediatric population
    • Physician burnout
      • Consist of loss of enthusiasm for work, feelings of cynicism, and diminished feelings of personal accomplishment
      • Affects 45-55% of all US physicians 

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Flashcards (10)
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Questions (17)
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(OBQ14.247) Your colleague, a general surgeon in your practice, brings his mother-in-law to see you for hip pain. You diagnose her with end-stage hip osteoarthritis and wish to discuss surgical options. She does not speak English. Interpretation should be provided by

QID: 5657
1

certified translator

86%

(2224/2578)

2

patient's husband

1%

(15/2578)

3

your colleague

2%

(46/2578)

4

patient care advocate fluent in the same language as the patient

9%

(233/2578)

5

nurse fluent in the same language as the patient

2%

(43/2578)

L 1 B

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(OBQ11.85) Which of the following complaints is most often reported by patients receiving care from an orthopaedic surgeon?

QID: 3508
1

Long waits for patient visits

14%

(339/2478)

2

Refusal to refill narcotic prescriptions

3%

(77/2478)

3

Lack of technical skills by provider

0%

(9/2478)

4

Lack of medical knowledge of provider

1%

(14/2478)

5

Lack of empathy by provider

82%

(2035/2478)

L 1 D

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(OBQ09.145) An orthopaedic surgeon wishes to initiate advertising in a local newspaper to increase awareness of the medical services he provides. Which of the following can be used without being at risk of being deemed unfair, false, misleading or deceptive and subject to heavy penalties by the Federal Trade Commission?

QID: 2958
1

"Bloodless arthroscopic surgery"

1%

(8/646)

2

"Board Certified in Joint Replacement Surgery"

61%

(397/646)

3

"New carpal tunnel release with relatively little pain"

31%

(202/646)

4

"Injections to Cure Your Arthritis"

4%

(24/646)

5

"Patients can return to all sports activity following joint replacement surgery"

2%

(12/646)

L 4 D

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(OBQ09.75) The Emergency Medical Treatment and Active Labor Act (EMTALA) requires which of the following?

QID: 2888
1

Insurance level must be discussed with the accepting facility

2%

(23/1422)

2

All appropriate laboratory workup must be completed

3%

(48/1422)

3

The patient must be medically stable for transfer

42%

(596/1422)

4

Exiting facility must not have resources to properly treat

51%

(729/1422)

5

Cost(s) of transportation must be within reason

1%

(17/1422)

L 4 D

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(OBQ08.107) A 55-year-old patient presents with to your clinic with long-standing knee pain. Radiographs reveal severe tricompartmental osteoarthritis and you discuss total knee arthroplasty with the patient. You review risks and benefits of the procedure and obtain informed consent before proceeding. Six weeks after surgery, the patient presents to the ED with purulent drainage noted to be coming from his incision. You discuss the need for irrigation and debridement and the patient becomes very angry that he needs another surgery. Several weeks later you find out that the patient has filed a formal complaint accusing you of malpractice. Which of the following is true regarding formal complaints filed against a physician?

QID: 493
1

Malpractice investigations are governed by federal regulations

0%

(2/843)

2

A physician's license is automatically suspended until the formal complaint can be resolved

11%

(91/843)

3

The physician should provide a written response to the medical board with all relevant records

81%

(685/843)

4

Physicians should contact the patient's attorney directly to negotiate a settlement

3%

(22/843)

5

Physicians are required to retain an attorney to address formal complaints

5%

(41/843)

L 1 D

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(OBQ08.264) You have helped develop a new total knee prosthesis and receive royalties as a result. You have a patient who you believe would benefit from this new design. What is the most appropriate action?

QID: 650
1

implant the device but do not tell the patient your financial relationship

1%

(7/591)

2

use a device that you feel is inferior to avoid a conflict of interest

0%

(2/591)

3

disclose your financial relationship to the patient before performing surgery

96%

(567/591)

4

do not bill the patient's insurance company for the surgery

0%

(2/591)

5

refer the patient to another surgeon

2%

(12/591)

L 1 D

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(OBQ08.176) According to patients and colleagues surveyed, orthopaedic surgeons are given the highest ratings for their skills in which of the following areas?

QID: 562
1

Medical knowledge

4%

(27/638)

2

Social gatherings

3%

(22/638)

3

Technical skills

83%

(529/638)

4

Communication

6%

(40/638)

5

Empathy

3%

(19/638)

L 1 D

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(OBQ08.88) All of the following are Standards of Professionalism relating to interactions with industry for practicing orthopaedic surgeons EXCEPT:

QID: 474
1

Decline gifts from industry with a market value over $100 (unless they are medical textbooks or patient educational materials)

9%

(62/678)

2

Disclose to the patient any financial arrangements with industry that relates to the patient's treatment

4%

(24/678)

3

Accept no direct financial inducements from industry for utilizing a particular implant

4%

(27/678)

4

Disclose any relationship with industry to colleagues who may be influenced by your work

4%

(29/678)

5

Decline to participate in industry sponsored non-CME courses or conferences

78%

(531/678)

L 2 D

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(SAE07HK.52) There is increasing concern about the ethical relationship of orthopaedists to the orthopaedic equipment industry. Which of the following describes the most appropriate relationship?

QID: 6012
1

Industry-paid travel, hotel (for the surgeon and spouse), and registration at a university-sponsored CME course

28%

(76/276)

2

Industry-paid travel and hotel for a faculty member at an industry-sponsored meeting that is not CME approved

30%

(83/276)

3

Consultation agreement ($50,000/annum) between the surgeon and the company for evaluation of the implant system with required oral reporting of impressions

19%

(52/276)

4

A restricted grant from a company to an orthopaedic residency program with the stipulation that the third year residents be sent to an industry-sponsored course

16%

(45/276)

5

Industry-paid dinner at a premium restaurant ($200/person) for surgeon and office staff at which a new set of surgical instrumentation is presented

7%

(20/276)

L 5 E

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(OBQ05.73) Which of the following best describes the benefits of implementing diversity and cultural competency in orthopaedic training programs?

QID: 959
1

Incorporating foreign languages in the residency curriculum to improve communication with members of diverse backgrounds.

0%

(7/1694)

2

Teaching the social stereotypes of diverse cultures to improve the delivery of healthcare.

1%

(24/1694)

3

Establishing racial and gender enrolment quotas in residency programs to better serve all members of the community.

2%

(27/1694)

4

Enhancing trainees knowledge of diverse cultures to improve patient-physician relationships, optimize patient access to orthopaedic care, and enhance the quality and delivery of care.

95%

(1613/1694)

5

Promoting orthopaedic trainees to travel to other countries to obtain surgical experience in different cultures.

1%

(14/1694)

L 1 C

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(OBQ04.117) Which of the following statements is true regarding the ethical management of orthopaedic implants?

QID: 1222
1

A surgeon who receives monetary gain from a device he/she has developed may not use this device on his/her own patients.

1%

(9/610)

2

Only studies with positive results should be published. Studies with negative findings should be dismissed.

0%

(1/610)

3

It is acceptable to rely on the word of the industry sales representative when choosing an orthopaedic implant during preoperative planning.

1%

(8/610)

4

It is the responsibility of the surgeon to be aware of the implant's clinical track record.

93%

(570/610)

5

Only implants with support from peer-reviewed clinical literature may be used in the operating room.

3%

(18/610)

L 2 D

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