claims seeking a judgment for something other than money

example: divorce proceedings, wills, trust, estates, property dispute, adoption proceedings

acronym: OAC

offer

acceptance

consideration

Implied: inferred by law, not created or evidenced by explicit agreement of parties

Express: actual agreement of parties, oral or in writing (but oral not necessarily enforceable)

acronym: CIA

act by defendant

intent

causation

duty

breach of duty

causation

injury

sexual misconduct

assault and battery

intentional infliction of emotional distress

statute of limitations

(usually 2 years)

standard for care

(in VA. med mal cases)

EMT certified by State Board of Health

persons administering CPR

team physicians

health care providers who render care at free clinics

hospice volunteers

dr. intentionally acted in a way that ultimately caused harm to patient

(NOTE: this isn't necessarily an allegation that dr. harmed the patient on purpose)

Class 6 felony

1-5 years in prison

$2,500 fine

respect for the individual and their ability to make decisions with regard to their own health and future

"self rule"

actions intended to benefit the patient or others

considered to be "paternalistic"

actions intended not to harm or bring harm to the patient and others

in common language "negligence"

being fair or just to the wider community in terms of the consequences of an action

Aristotle: "giving to each that which is his due"

autonomy

beneficence

non-maleficence

justice

For minors less than 18 years old, health care decisions are made by someone else on their behalf.

Every state reserves the right to intervene when a child's life, health, safety, or welfare is at risk.

Mature-minor doctrin: in some circumstances a minor can make their own decisions as to medical treatment

Personal behaviors

Community and environment

Publin and Health policy

Clinical Care

What percent of the US economy is spent on healthcare?

and what are the top 3 expenditures?

> 16%

Hospital care (30%)

Physician services (20%)

Prescription drugs (10%)

About how many (or percentage) Americans are without health insurance?

46 million

or 17%

1) heart disease

2) cancer

3) stroke

US HALE

(Healthy Adult Life Expectancy)

69

27 other countires are better than the US

-depleted energy and emotional exhaustion

- lowered resistance to illness

-increased depersonalization in interpersonal relationships

- increased dissatisfaction and pessimism

- increased absenteeism and work inefficiency

-family of origin issues

-personality factors

-doubt or "imposter syndrome"

- exaggerated sense of self-importance

- family stressors and work-home interfeerence

- psychology of postponement

1) to promote health and wellness among physicians

2) to establish appropriate mechanisms to detect impairment

3) to intervene in a supportive fashion

4) to refer and/or report impairment if necessary

1. ask for support from your physician or med student team

2. step up to performance problems vs. avoidance

3. positively influcence nursing and other staff

4. create optimism by exerting influence

5. above all else, maintain priority relationships

6. ask for help

patient factors

institutional factors

provider factors

geographic issues

3 key themes that emerged in the 2009 NHDR

(National Healthcare Disparities Report)

and efforts for improvement

1. disparities are common and un-insurance is an important contributor

2. many disparities are not decreasing

3. some disparities merit particualr attention, especially care for cancer, heart failure, and pneumonia

 train providers, raise awareness, form partnerships to id and test solutions

investing in education

directing more health benefits toward the poor

promoting primary and essential health care

mobilizing community resources

establishing health financing approaches

Nazi medical war crimes (Nuremberg code)

tuskegee Syphilis Study

Jewish chronic disease hospital study

Willowbrook Study

Declaration of Helsinki

experiments conducted by Nazi physicians during WW2 performed on concentration camp prisoners

included deadly studies and tortures

study of black men with syphilis and an examination of the natural history of untreated syphilis

men were recruited without informed consent and were misinformed

newly admitted children were deliberately infected with the hepatitis virus. 

1. respect for persons

2. beneficence

3. justice

prisoners

pregnant women

mentally insane

minority

poor

Denial

Anger

Bargaining

Depression

Acceptance

(stages do not necessary occur in this order)

characterized by shock, denial, guilt, and somatic symptoms.

typically last about 6 months to a year

Culturally sensitive questions to use with grieving persons

4 C's

What do you call your problem?

What do you think caused your problem?

How do you cope with your condition?

What concerns do you have regarding your condition?

you can or must disclose PHI...

(Protected Health Information)

as required by law

victims of abuse, neglect or domestic violence

serious threat to health or safety

law enforcement purposes