Updated: 4/10/2019

Legal and Ethics

Topic
Review Topic
0
0
Questions
78
0
0
Evidence
51
0
0
Videos
10
https://upload.orthobullets.com/topic/9074/images/screen_shot_2017-07-04_at_9.01.43_pm.jpg
Informed Consent
  • Health Information Portability and Accountability Act (HIPAA) 
    • Provider does not need consent from patient to communicate HIPAA protected information to other treating providers 
  • Process for obtaining informed consent for patients included in clinical trials is mandated by the Institutional Review Board (IRB)  
  • Elective procedures
    • informed consent for an elective surgical procedure is best obtained by the physician in the office/clinic setting a few days before the scheduled procedure 
    • the surgeon must provide to the patient all information that is needed for the patient to make an informed decision
      • who will be performing surgery should be disclosed  
    • must understand the important risks and benefits as well as the indications for and alternatives to a procedure
    • origin of surgical implants should be discussed with patients 
      • this may have implications for their use based on a patient's religious background
        • in Hinduism, use of bovine derived implants should be discussed 
        • in Judaism and Islam, use of porcine derived implants should be discussed
  • Emergent procedures in absence of legal consent 
    • confirm necessity of procedure  
      • in situation of required surgery for life threatening injury without available legal consent the surgeon should confirm and document the necessity of care with a fellow orthopaedic surgeon or colleague 
      • in non-life threatening injury, consent must be obtained prior to intervention (e.g. language barrier, pediatric patient)
Physician errors
  • Communication errors are the leading cause of wrong-side surgeries, medication errors, diagnostic delays or loss to follow-up   
  • Wrong site surgery 
    • prevention 
      • involving the patient in identifying correct side in the pre-operative area and prior to induction 
      • displaying pertinent imaging in the operating room
      • marking the correct site with the surgeon's initials visibly in the surgical field
      • performing a time-out with the operating room team prior to incision
    • response when performed
      • address by immediate discussions with family revealing errors 
      • apologize and accept responsibility, but not blame  
  • Surgical "time-out" 
    • should include the following according to JCAHO   
      • identify correct side, site, and patient
      • verify the correct procedure
      • surgeon is most effective OR team member at reducing complications when using surgical checklist and "time-out"
    • all members of the team should be present for the time out; alternatively, it can be repeated 
  • Medication prescribing errors
    • reduced when physicians use computerized order entry 
    • errors in medical documentation
  • It is illegal to alter the medical record for any reason 
    • no one has the authority to authorize a physician to alter the medical record
    • errors can be noted and addendums can be added
  • Second opinions
    • the second opinion surgeon is ethically required to disclose the effect of medical errors on patient outcome 
    • the patient can only unilaterally decide to transfer care to the second surgeon; ethically, the surgeon is not to seek out transfer of care of the patient
Litigation
  •  Overview
    • medical liability lawsuits involving orthopaedic surgeons rose by 13 percent from 2003 to 2008
      • thought to be related to aging population
    • orthopaedic surgery has the seventh highest # of lawsuits compared to other specialties
    • ~33% of all orthopaedic surgery claims results in payment to plaintiffs
    • the average cost associated with defending orthopaedic surgery claims is ~ $47,000USD
  • Procedures associated with lawsuits (as of 2008) 
    • "improper performance" makes up 45% of lawsuits
    • the most commonly associated procedures 
      1. operative procedures of joint structures (not including spinal fusion)
      2. open reduction of dislocation
      3. closed reduction of fractures
      4. operative procedures on bones
      5. operative procedures on cranial and peripheral nerves
  • Most common clinical diagnosis associated with orthopaedic lawsuits (as of 2008)
    1. osteoarthritis (21%)
    2. disorder of joint, not including arthritis
    3. fracture of femur

Legislation

  • Patient Protection and Affordable Care Act - 2010
  • Physician Payments Sunshine Act - 2010
    • Requires collection and reporting of financial relationships between physicians / teaching hospitals and businesses (manufacturers of drugs, devices, medical supplies)
    • All payments beyond $10 must be reported to Centers for Medicare and Medicaid Services 
 

Physician Impairment 

  • Impairment of a healthcare professional is the inability or impending inability to practice according to accepted standards as a result of substance use, abuse, or dependency (addiction). 
  • A surgeon (resident, fellow or attending) who discovers chemical impairment, dependence, or incompetence in a colleague or supervisor has the responsibility to ensure that the problem is identified and treated. 
Medical Negligence
  • Negligence is the failure to provide the standard of health care resulting in medical injuries
  • A second-opinion physician has an ethical obligation, but not legal obligation, to disclose if the standard of care has been breached by a treating physician. 
  • A successful patient-plaintiff lawsuit for medical negligence against a physician requires that the following FOUR elements be alleged and proven in a court of law 
    • duty
      • the duty of the physician is to provide care equal to the same standard of care ordinarily executed by surgeons in the same medical specialty.
    • breach of duty
      • breach of duty occurs when action or failure to act deviates from the standard of care.
    • causation
      • causation is present when it is demonstrated that failure to meet the standard of care was the direct cause of the patient’s injuries.
    • damages
      • damages are monies awarded as compensation for injuries sustained as the result of medical negligence
Workers Compensation
  • A Workers' Compensation patient is determined to reach maximum medical improvement when further restoration of function is no longer anticipated and can then settle his/her claim.   
  • Ability for worker's compensation patients to choose their own physician varies by the statutes of each state. 
  • Legal definitions
    • impairment
      • loss of function resulting from an anatomic or physiologic derangement.
    • disability
      • limitation of an individual’s capacity to meet certain personal social or occupational demands.
Relations with Industry and Hospitals
  • Acceptable Standards of professionalism  
    • practicing orthopaedic 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
    • must disclose relationships with industry to patients, colleagues, and their institution
    • can only receive gifts with a market value under $100
    • no direct kick-back can be given to a physician from industry or hospital systems
    • physicians cannot refer patients to centers in which they have a financial interest (Stark II laws)
Patient Satisfaction & Complaints
  • Patient complaints 
    • a formal written patient complaint regarding quality of care requires a letter of response to the patient from the surgeon
  • Communication
    • when surveyed, patients and colleagues describe orthopaedic surgeons as "high tech but low touch"
    • orthopaedic surgeons are described as having poor communication skills and empathy for their patients  
    • as communication issues are the number one cause of medical litigation, this is an area where orthopaedic surgeons need to improve
      • On average, most doctors interrupt patients during an interview within 23 seconds  
    • translation services can be provided by employees fluent in the languange, commercially available telephonic services, professional interpreters, and volunteer translators  
      • inappropriate for family members to act as translator unless patient offers or agrees
Medical Innovation
  • Royalties
    • if an implant is used by which the surgeon is receiving royalties, this information must be disclosed to the patient 
Patient Transfer
  • EMTALA 
    • all patients must be appropriately screened 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
  • Advertising by physicians becoming more commonplace 
    • AMA and AAOS can't 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
  • Important to understand cultural differences  
    • patient-physician relationships are enhanced
    • disparities in health care are eliminated
    • access to orthopaedic care is optimized
  • Important to understand your own implicit biases 
    • Implicit bias is present when your unconscious prejudices or stereotypes influence the care delivered to the patient.
    • Implicit bias is a determinant of health disparities.
Access to Healthcare
  • Access to healthcare
    • type of health insurance has been shown to be a determinant of healthcare access in the pediatric population 
Surgical Safety Checklists
  • WHO implementation of surgical safety checklists began in 2009   
  • Implementation has demonstrated measureable improvements in:
    • surgical mortality 
    • in-hospital complications
    • adherence to surgical plan in OR crisis situations (e.g., massive hemorrhage, cardiac arrest)
 

Please rate topic.

Average 3.8 of 28 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (78)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ13.250) A 38-year-old female with a grade IIIB open tibia fracture is scheduled to undergo definitive fixation and subsequent flap coverage with the orthopaedic and plastic surgery teams. She is met in the pre-operative area by the surgical intern and paperwork is completed per institutional protocol. She is then brought back to the operating room. Which of the following is true regarding the pre-surgical timeout? Review Topic

QID: 4885
1

The surgical intern must be present because he brought the patient to the operating room

6%

(151/2384)

2

The timeout cannot begin without the implant representative

2%

(44/2384)

3

If both the orthopaedic and plastic surgical teams are present, a single timeout is sufficient for the entire procedure

86%

(2059/2384)

4

The timeout may be completed as long as the attending is in an adjacent operating room

1%

(14/2384)

5

The pre-surgical timeout has not been shown to decrease complication rates

4%

(98/2384)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ13.178) A 25-year-old Spanish speaking male presents to the emergency department 6 hours after sustaining the injury seen in Figure A. He is grossly intoxicated and screaming in pain. Physical examination reveals a closed injury with overlying muscular compartments that are extremely firm to palpation. After sedating the patient, measurements of the intracompartmental pressures were all found to be >75mmHg. His wife is Spanish speaking and expected to arrive to the hospital in 2-3 hours with a relative to help with translation. No medical translator is available. You attempt to outline the risk and benefits of surgery to the patient, but the he repeatedly interrupts you and yells out ,"No surgery!". An English-Spanish speaking friend is with the patient and says that he has known the patient for over 2 years and will help with any decision making. What would be the next most appropriate step in the management of this patient? Review Topic

QID: 4813
FIGURES:
1

Delay surgery to monitor the patient for impending compartment syndrome

0%

(9/1988)

2

Proceed with surgery with urgent fasciotomy after documenting the necessity of treatment without consent

84%

(1678/1988)

3

Delay the surgery until the wife arrives and able to give informed consent with the aid of a translator

7%

(144/1988)

4

Proceed with surgery for urgent fasciotomy after obtaining informed consent from the patients friend

6%

(120/1988)

5

Respect the patients autonomy and reassess the patient in the morning when he demonstrates capacity to accurately comprehend the proposed treatment

1%

(19/1988)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ07.109) When a Workers' Compensation patient recovers after an injury to a point that further restoration of function is no longer anticipated, he or she is said to have reached which of the following? Review Topic

QID: 770
1

Functional capacity

12%

(139/1157)

2

Maximum medical improvement

80%

(925/1157)

3

Permanent disability

5%

(53/1157)

4

Impairment rating

1%

(17/1157)

5

Predesignation

1%

(11/1157)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

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

QID: 959
1

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

0%

(6/1442)

2

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

1%

(20/1442)

3

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

2%

(23/1442)

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%

(1373/1442)

5

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

1%

(11/1442)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(SAE07SM.68) A player on a professional football team sustains a knee injury and is diagnosed with an anterior cruciate ligament rupture. When employed as the team physician, your ethical obligation is to inform Review Topic

QID: 8730
1

the player but not the team.

32%

(20/63)

2

the team but not the player.

2%

(1/63)

3

neither the team nor the player.

0%

(0/63)

4

both the team and the player.

67%

(42/63)

5

the team, the player, and the media

0%

(0/63)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(SAE07SM.52) A 21-year-old collegiate scholarship football player has an episode of transient quadriplegia. An MRI scan of the cervical spine reveals cord edema and severe congenital spinal stenosis. The athlete has aspirations of playing on a professional level and demands that he be allowed to play. The team physician should give what recommendation to the college? Review Topic

QID: 8714
1

Do not allow the athlete to return to football.

93%

(77/83)

2

Allow the athlete to participate.

1%

(1/83)

3

Allow the athlete to play only if he signs a waiver.

2%

(2/83)

4

Suggest that the college and atahlete enter binding arbitration.

0%

(0/83)

5

Allow the athlete to play with special equipment.

1%

(1/83)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(SAE07PE.1) A pediatric orthopaedic surgeon refers a child to a neurologist. The neurologist’s office requests the office records of the pediatric orthopaedic surgeon. To maintain Health Insurance Portability and Accountability Act (HIPAA) compliance, what must the surgeon obtain from the parent(s) prior to sending records? Review Topic

QID: 6061
1

No additional consent needed

57%

(4/7)

2

Verbal approval

0%

(0/7)

3

Written approval

29%

(2/7)

4

Written approval with notarization

0%

(0/7)

5

Telephone consent witnessed by a nurse

0%

(0/7)

N/A

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(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? Review Topic

QID: 6012
1

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

28%

(28/99)

2

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

30%

(30/99)

3

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

24%

(24/99)

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

10%

(10/99)

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%

(7/99)

ML 5

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

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

QID: 562
1

Medical knowledge

4%

(20/460)

2

Social gatherings

4%

(18/460)

3

Technical skills

84%

(385/460)

4

Communication

5%

(23/460)

5

Empathy

3%

(13/460)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ08.28) It is considered optimal to obtain written informed consent for an elective surgical procedure in which of the following clinical settings? Review Topic

QID: 414
1

By the hospital risk manager upon admission

0%

(2/409)

2

By the nurse in pre-op holding

0%

(1/409)

3

By the surgeon in pre-op holding

18%

(73/409)

4

By the surgeon's scheduler greater than 7 days prior

1%

(4/409)

5

By the surgeon in the office within 7 days prior

79%

(325/409)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ07.146) The operative report of a recent patient incorrectly documents the timing of peri-operative antibiotic administration. How should the medical record be legally altered? Review Topic

QID: 807
1

Obtain written approval from the hospital medical director

3%

(13/457)

2

Obtain written approval from the risk management team

7%

(33/457)

3

Obtain written approval from your lawyer and the senior partners of his law firm

1%

(3/457)

4

No approval is needed, as you were the treating surgeon and have identified the error

14%

(64/457)

5

It is illegal to alter the medical record, but an addendum can be made

74%

(339/457)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ05.50) A 50-year-old male sustains a closed head injury and closed femur fracture after falling off of a ladder. His GCS is currently 15, and he only speaks Spanish; he has several family members in the waiting room of the hospital. Which of the following is true regarding informed consent for fixation of his femur fracture? Review Topic

QID: 86
1

Patient must be able to read the consent form

28%

(135/489)

2

Patient must be able to sign the consent form

11%

(53/489)

3

Patient does not need to be able to communicate in any manner to give his or her own informed consent

6%

(29/489)

4

Patient must not be on any antidepressant medication prior to verbal or written informed consent

3%

(14/489)

5

Patient should give verbal informed consent prior to narcotic administration

53%

(257/489)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 5
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

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

QID: 474
1

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

10%

(40/394)

2

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

3%

(10/394)

3

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

4%

(15/394)

4

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

4%

(15/394)

5

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

78%

(309/394)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

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

QID: 493
1

Complaint should be taken seriously

0%

(1/515)

2

Written response by the physician is required

11%

(55/515)

3

Physician mandated to retain an attorney to address the formal complaint

82%

(421/515)

4

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

3%

(13/515)

5

Law mandates that the physician respond to the formal complaint

4%

(23/515)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(OBQ13.159) The origin of bovine derived grafts is particularly important to which of the following religious groups? Review Topic

QID: 4794
1

Christianity

0%

(6/2373)

2

Islam

9%

(213/2373)

3

Hinduism

82%

(1935/2373)

4

Buddhism

2%

(42/2373)

5

Judaism

7%

(167/2373)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ07.138) In which of the following scenarios should a physician be relieved of their duties? Review Topic

QID: 799
1

After 24 hours of continuous work

3%

(19/566)

2

A significant error in care is noted

2%

(10/566)

3

The physician appears fatigued

1%

(5/566)

4

Physician is recovering from an ankle fracture

0%

(2/566)

5

Chemical impairment is suspected

93%

(529/566)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(SBQ07PE.1) An orthopaedic surgeon is a team physician for a college football team. In which of the following scenarios is it appropriate to discuss a 19-year-old collegiate football player's lumbar spondylosis without additional consent from the player? Review Topic

QID: 1486
1

Discussing with the player's mother

9%

(38/405)

2

Discussing with the player's treating chiropractor

85%

(346/405)

3

Discussing with the player's long-time highschool football coach

4%

(15/405)

4

Discussing with a reporter from a local newspaper

0%

(2/405)

5

Discussing with the player's fiancee

0%

(2/405)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ07.61) A busy orthopaedic surgeon enters the operating suite to a prepped and draped patient who is scheduled for a right knee ACL reconstruction. During the diagnostic arthroscopy, the surgeon sees an intact ACL. The MRI is reviewed and found to be of the left knee. Wrong site surgery could have been likely avoided if which of following was done? Review Topic

QID: 722
1

Confirmation of the operative procedure with the circulating nurse

2%

(10/481)

2

Confirmation of the correct site with the resident taking care of the patient

0%

(2/481)

3

Examining the patient the day before in the office

1%

(5/481)

4

Confirming and placing initials on the operative extremity with the patient in the pre-operative holding area

96%

(460/481)

5

Giving the patient instructions to mark their own extremity the night before surgery at home

1%

(3/481)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ05.263) A 60 year-old male was brought into the operating room for total hip replacement. Before making the incision, what precautionary procedure must be performed by the entire staff to minimize surgical error? Review Topic

QID: 1149
1

Mark the word "No" on the nonoperative extremities

0%

(0/508)

2

Use intraoperative fluoroscopic imaging

1%

(5/508)

3

Perform "timeout"

98%

(499/508)

4

Have blood products ready in the operating room

0%

(1/508)

5

Use the newest prosthesis

0%

(0/508)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ07.32) Which of the following terms is defined as a loss of function resulting from an anatomic or physiologic derangement? Review Topic

QID: 693
1

Disability

39%

(179/462)

2

Impairment

52%

(240/462)

3

Injury

6%

(27/462)

4

Apportionment

0%

(1/462)

5

Incapacitation

3%

(14/462)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ06.76) What function does computerized physician order entry have on medication monitoring? Review Topic

QID: 187
1

Reduces the rate of medication errors

88%

(373/422)

2

Improves physician satisfaction

2%

(7/422)

3

Decreases narcotic requirements by patients

1%

(6/422)

4

Increases rates of allergy related medication errors

3%

(12/422)

5

Improves physician knowledge about the drugs they are prescribing

5%

(20/422)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(OBQ04.198) The Stark II regulations limit which of the following activities for physicians who accept Medicare and/or Medicaid insurance payments? Review Topic

QID: 1303
1

Direct use of implant manufacturer financial support for non-CME courses

12%

(54/432)

2

Use of in-office durable medical equipment for patient care

3%

(11/432)

3

Physician office space rental at fair market value prices

2%

(10/432)

4

Direct physician employment by a hospital system

2%

(7/432)

5

Referral of patients to entities in which the physician has a financial relationship

80%

(344/432)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(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? Review Topic

QID: 2958
1

"Bloodless arthroscopic surgery"

1%

(3/410)

2

"Board Certified in Joint Replacement Surgery"

60%

(244/410)

3

"New carpal tunnel release with relatively little pain"

33%

(137/410)

4

"Injections to Cure Your Arthritis"

4%

(16/410)

5

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

2%

(8/410)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ09.249) A 13-year-old girl with a displaced proximal tibia fracture is brought into the emergency department by her adult cousin. The fracture needs surgical management. The child is living with her cousin's family while her parents are in Germany. While the child speaks fluent English, her cousin and her parents are German-only speaking. How should you consent this patient? Review Topic

QID: 3062
1

No consent is needed given the urgent nature of the injury, proceed with surgery

1%

(7/467)

2

Talk with the cousin, using the child as a translator

0%

(0/467)

3

Talk with the cousin, using a German-translator

5%

(22/467)

4

Call the parents in Germany, using the child as a translator over the phone

1%

(5/467)

5

Call the parents in Germany, using a German-translator over the phone

92%

(431/467)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ11.217) Which of the following statements is inaccurate in describing the origin and purpose of the Institutional Review Boards (IRB)? Review Topic

QID: 3640
1

Began with the Nuremberg Code of Medical Ethics, which was developed by the Nuremberg Military Tribunal after the investigation of Nazi physicians

7%

(39/539)

2

Fetuses, pregnant women, and children are considered vulnerable populations but prisoners are not

73%

(395/539)

3

Emphasizes dignity and autonomy, and encompasses informed consent (quid vide)

6%

(30/539)

4

The process for obtaining informed consent for patients included in clinical trials is mandated by the Institutional Review Board (IRB).

6%

(34/539)

5

Requires fair selection of subjects and equal distribution of the benefits and burdens of research

6%

(34/539)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2

(OBQ06.164) You are caring for a 50-year-old male who is 2 years status-post a work related pilon fracture. Since this is a workers compensation case, your patient is interested in settling his claim. When can his claim be legally settled? Review Topic

QID: 350
1

Once the fracture has united

1%

(2/387)

2

2 years post-injury

5%

(18/387)

3

Following release to light duty work

1%

(5/387)

4

Following release to full duty work

6%

(25/387)

5

Not until maximum medical improvement is declared by you as the treating physician

85%

(330/387)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

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

QID: 2888
1

Insurance level must be discussed with the accepting facility

1%

(15/1158)

2

All appropriate laboratory workup must be completed

3%

(32/1158)

3

The patient must be medically stable for transfer

41%

(469/1158)

4

Exiting facility must not have resources to properly treat

53%

(619/1158)

5

Cost(s) of transportation must be within reason

1%

(14/1158)

ML 4

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ11.197) As part of the "time-out" protocol recommended by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), all of the following are required EXCEPT? Review Topic

QID: 3620
1

Identify correct patient identity

0%

(6/1772)

2

Identify correct side of procedure

2%

(43/1772)

3

Identify correct site of procedure

6%

(101/1772)

4

Identify correct preoperative antibiotic

80%

(1420/1772)

5

Agreement on the correct procedure to be done

11%

(187/1772)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ11.157) Which of the following determines when a patient involved in a Worker's Compensation claim is allowed to choose their treating physician? Review Topic

QID: 3580
1

Federal statute

12%

(238/2005)

2

Health insurance carrier policy

10%

(199/2005)

3

County statute

1%

(15/2005)

4

State statute

67%

(1340/2005)

5

Employer human resources policy

10%

(200/2005)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

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

QID: 3508
1

Long waits for patient visits

13%

(278/2146)

2

Refusal to refill narcotic prescriptions

2%

(52/2146)

3

Lack of technical skills by provider

0%

(7/2146)

4

Lack of medical knowledge of provider

1%

(11/2146)

5

Lack of empathy by provider

84%

(1796/2146)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

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

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%

(5/341)

2

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

0%

(0/341)

3

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

1%

(4/341)

4

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

95%

(323/341)

5

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

2%

(6/341)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ04.108) A hospital has recently moved from a paper to a computerized physician order entry (CPOE) system. Compared to the previous safety auditing reports, the hospital can now expect which of the following? Review Topic

QID: 1213
1

A decrease in nephrotoxic drug dosing

71%

(364/513)

2

No improvement in prescribing behaviors

7%

(37/513)

3

An increase in patient satisfaction following use of patient controlled analgesia (PCA)

3%

(13/513)

4

An increase in sentinel events

9%

(48/513)

5

No effect on physician prescribing errors

9%

(48/513)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 1

(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? Review Topic

QID: 650
1

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

0%

(1/373)

2

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

0%

(0/373)

3

disclose your financial relationship to the patient before performing surgery

98%

(366/373)

4

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

0%

(0/373)

5

refer the patient to another surgeon

1%

(5/373)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ08.206) A patient is consented for a right wrist open reduction and internal fixation. After the patient is prepped and draped, a skin incision is made. It is recognized intra-operatively, however, that a skin incision was made on the incorrect side (left). Subsequent right wrist open reduction and internal fixation goes uneventfully. What is the next best course of action? Review Topic

QID: 592
1

do not tell the patient or family

0%

(1/514)

2

contact the Risk Management department

10%

(51/514)

3

immediately discuss the situation with the patient and family

90%

(462/514)

4

alter the medical record

0%

(0/514)

5

only discuss the situation with the patient if he or she brings it up.

0%

(0/514)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ10.267) Effective communication between physicians and patients has been shown to affect all of the following EXCEPT? Review Topic

QID: 3250
1

Patient satisfaction

0%

(4/1542)

2

Patient adherence to treatment

3%

(40/1542)

3

Physician satisfaction

9%

(142/1542)

4

Incidence of malpractice suits

5%

(70/1542)

5

Incidence of Stark II litigation

83%

(1276/1542)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ04.208) All of the following are desired goals of improved diversity and cultural competence in orthopaedics EXCEPT: Review Topic

QID: 1313
1

Understand cultural differences so that patient-physician relationships are enhanced

2%

(7/441)

2

Reduce disparities in healthcare

1%

(5/441)

3

Establishment of quotas for minority and female medical students

95%

(421/441)

4

Access to orthopaedic care is optimized

1%

(5/441)

5

Better serve the nation's diverse population

0%

(0/441)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3

(OBQ09.100) An orthopedic surgeon meets with an attorney because a malpractice claim has been filed against him. Which of the following diagnoses is most likely to result in a malpractice claim? Review Topic

QID: 2913
1

Fracture of the radius

6%

(55/944)

2

Femur fracture

14%

(134/944)

3

Meniscal tear

2%

(16/944)

4

Herniated intervertebral disc

28%

(266/944)

5

Osteoarthritis

50%

(468/944)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ07.267) Which of the following terms best describes failure to exercise the degree of diligence and care that a reasonable and prudent person would exercise under similar conditions? Review Topic

QID: 928
1

Intent

1%

(5/928)

2

Causation

1%

(12/928)

3

Standard of care

26%

(241/928)

4

Breach of duty

71%

(663/928)

5

Damages

1%

(5/928)

ML 5

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ08.233) A 25-year-old man sustains a Grade III-A open tibial shaft fracture secondary to a motorcycle accident. The patient is unconscious and has no family members who can be reached for consent. What is the most appropriate course of action? Review Topic

QID: 619
1

Document the necessity for treatment and proceed immediately with definitive fracture care

27%

(115/422)

2

Proceed with a preliminary irrigation and debridement in the emergency department, apply a splint, and wait for him to regain consciousness before proceeding with definitive treatment

4%

(17/422)

3

Contact a hospital administrator for approval of care

0%

(1/422)

4

Confirm and document the necessity of care with a colleague with similar expertise and knowledge prior to proceeding with surgery

67%

(283/422)

5

Proceed immediately to the operating room for definitive treatment without further documentation

1%

(4/422)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 4

(OBQ09.159) A 65-year-old man sustains the reverse obliquity intertrochanteric fracture as shown in Figure A. He undergoes fixation with a sliding hip screw construct and his 3 month postoperative radiograph is shown in Figure B. His treating surgeon states that the "standard of care was performed for his fracture pattern" and the patient asks you as a consulting surgeon for a second opinion. Each of the following statements regarding your legal and ethical obligations as the consulting surgeon providing a second opinion are true EXCEPT? Review Topic

QID: 2972
FIGURES:
1

Second-opinion physicians have an ethical obligation to discuss the standard of care for reverse obliquity hip fractures

4%

(20/479)

2

Second-opinion physicians have a legal obligation to become an expert witness for the patient/plaintiff in a negligence lawsuit against the treating physician

64%

(308/479)

3

Many states have mandatory or voluntary medical-error reporting systems that the consulting surgeon is ethically mandated to utilize

3%

(15/479)

4

Second-opinion physicians do not have a legal obligation to disclose errors made by other physicians

13%

(60/479)

5

It is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients

15%

(74/479)

ML 3

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (74)
VIDEOS (10)
Topic COMMENTS (3)
Private Note