Updated: 2/12/2021

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 

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Questions (11)
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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 Tested Concept

QID: 5657
1

certified translator

86%

(2126/2462)

2

patient's husband

1%

(15/2462)

3

your colleague

2%

(43/2462)

4

patient care advocate fluent in the same language as the patient

9%

(222/2462)

5

nurse fluent in the same language as the patient

2%

(40/2462)

L 1 B

Select Answer to see Preferred Response

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

QID: 3508
1

Long waits for patient visits

14%

(325/2386)

2

Refusal to refill narcotic prescriptions

3%

(64/2386)

3

Lack of technical skills by provider

0%

(8/2386)

4

Lack of medical knowledge of provider

1%

(12/2386)

5

Lack of empathy by provider

83%

(1974/2386)

L 1 D

Select Answer to see Preferred Response

(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? Tested Concept

QID: 2958
1

"Bloodless arthroscopic surgery"

1%

(5/579)

2

"Board Certified in Joint Replacement Surgery"

60%

(348/579)

3

"New carpal tunnel release with relatively little pain"

33%

(189/579)

4

"Injections to Cure Your Arthritis"

4%

(23/579)

5

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

2%

(12/579)

L 4 D

Select Answer to see Preferred Response

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

QID: 2888
1

Insurance level must be discussed with the accepting facility

2%

(23/1372)

2

All appropriate laboratory workup must be completed

3%

(44/1372)

3

The patient must be medically stable for transfer

42%

(574/1372)

4

Exiting facility must not have resources to properly treat

52%

(707/1372)

5

Cost(s) of transportation must be within reason

1%

(15/1372)

L 4 D

Select Answer to see Preferred Response

(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? Tested Concept

QID: 650
1

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

1%

(4/514)

2

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

0%

(2/514)

3

disclose your financial relationship to the patient before performing surgery

96%

(494/514)

4

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

0%

(1/514)

5

refer the patient to another surgeon

2%

(12/514)

L 1 D

Select Answer to see Preferred Response

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

QID: 562
1

Medical knowledge

4%

(24/589)

2

Social gatherings

3%

(20/589)

3

Technical skills

84%

(493/589)

4

Communication

6%

(33/589)

5

Empathy

3%

(18/589)

L 1 D

Select Answer to see Preferred Response

(OBQ08.107) All of the following are true regarding a physician responding to a formal written complaint by a patient EXCEPT: Tested Concept

QID: 493
1

Complaint should be taken seriously

0%

(2/771)

2

Written response by the physician is required

11%

(81/771)

3

Physician mandated to retain an attorney to address the formal complaint

81%

(628/771)

4

Patient should be supplied with contact information for the institution's patient representative department

3%

(20/771)

5

Law mandates that the physician respond to the formal complaint

5%

(38/771)

L 1 D

Select Answer to see Preferred Response

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

QID: 474
1

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

10%

(55/568)

2

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

3%

(19/568)

3

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

4%

(22/568)

4

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

4%

(24/568)

5

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

78%

(443/568)

L 2 D

Select Answer to see Preferred Response

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

QID: 959
1

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

0%

(7/1646)

2

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

1%

(23/1646)

3

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

2%

(26/1646)

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%

(1567/1646)

5

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

1%

(14/1646)

L 1 C

Select Answer to see Preferred Response

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

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%

(7/547)

2

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

0%

(1/547)

3

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

1%

(8/547)

4

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

93%

(511/547)

5

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

3%

(16/547)

L 2 D

Select Answer to see Preferred Response

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