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1. Defense Mechanisms a. Denial- avoid thinking about external reality in favor of internal reality b. Displacement- kick the dog c. Humor- laugh it off d. Intellectualization- learn about it e. Projection- disowning unwanted thoughts and attributing them to another personsexual/aggressive in nature f. Rationalization- bad teacher g. Regression- acting like a child h. Repression- forgetting something- unhealthy i. Sublimination- putting into a socially acceptable behavior j. Suppression- forgetting something for the time being- healthy k. Transference- patient to doctor l. Counter transference- doctor to patient 2. Skin lesions Macule- freckle Patch- big macule, port wine stain Petechiae- those red dots Purpura- 4-5 petechiae Ecchymosis- bruise Spider angioma- spider like, red thing Papule- raised macule, mole Plaque/Scale- psoriasis, dry skin Nodule- in dermis, basically like a hard solid thing in the skin Tumor- bigger nodule Cyst- fluid filled nodule Vesicle- blister Wheal- bug bite Bulla- big blister Erosion- wearing away of skin Ulcer- bedsore Fissure- cracked lips Bloodborne Pathogens Introduction to Ethics a. Hippocratic oath b. Sources of values i. Parents ii. Culture/Society iii. Religion iv. law Confidentiality a. Scenarios b. Why keep confidential i. Privacy ii. Social status iii. Economic advantage iv. Open communication v. Seeking help

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vi. Trust vii. Promotes autonomy c. Disclosure- competing values i. Violent wound report ii. Suspicion of abuse or neglect iii. Danger to self or others iv. Communicable disease 5. Informed Consent a. Capacity- age, maturity, cognition, considered choice, consistent, communication b. Reasonable provider and patient c. Types of consent i. Implied- they are there with gown, not saying no ii. Presumed- unable to speak, do whats best- emergency room principle iii. Waived- patient tells dr to make decisions iv. Proxy- someone else speaks for patient v. Therapeutic privilege- withhold information from patient in their best interest 6. Medical Professionalism- be professional!!! a. Empower patient, help them make informed decisions 7. Structure and function of the interview a. Gain lots of info in the interview! b. Patient satisfaction important c. UCLA- pediatrics d. Canadian- headaches e. 3 basic functions of med interview i. build relationship with px ii. gather clinical data iii. px education and motivation f. PEARLS- partnership, empathy, apology, respect, legitimization, support g. Empathy not same as sympathy h. Open ended questions, let px do the talking, open closed question cone i. Set agenda in first 2 min! j. Anything else question 8. Patient Centered Clinical Method a. Biopsychosocial model b. Disease vs illness i. Disease= the pathology ii. Illness=the experience 9. Stress, Illness and Health a. UCLA melanoma study- having support helps the patient b. Stress= PATIENT PERCEPTION! c. Learned helplessness- cold, cruel world d. Type A personality disorder=DELANEY AND VILJOEN!!! Ultra competitive e. Learned hopefulness- glass half full f. Coping with stress- relaxation and meditation, biofeedback, etc 10. Patient Education a. Compliance- yield to desire, command, cohersion, etc

interaction with peers: fit in with society -Industry vs inferiority. assumptions.3-6 yo.only in males. solution f. you perform. 13. Involve patient. classical vs operant conditioning Childhood Growth and Development a.6-11 yo. Health belief model. Pitfalls.view world from own perspective Formal operations.forming intimate relationship with someone else -Generativity vs stagnation.partnership c.12+. depression. susceptibility. Tanner Stages b. Genital.abstract thought possible.time restraint. employment iii. giving back: become mentor -Ego integrity vs despair. diet v. will you be inferior? -Identity vs role confusion.potty training.self motivated. Erikson. not as active. Education.use representations for objects Concrete operational. dr and nurse say different things Introduction to human dvpt and behavior a. biting 2. Anal.learn based on senses Preoperational.child ventures on his/her own: more autonomous -Initiative vs guilt.psychosocial -Trust vs mistrust. Adherence. problem centered.2 months Adolescent Growth and Development a.developing trust in mother to provide for you -Autonomy vs doubt.who am i? why am I here? Jr high/high school -Intimacy vs isolation. Speak plainly. want positive env e. jargon. Adult learner.adds children Sensory motor. include parent v.seriousness.agree to join. set goals and practice. Ensure followup vi. Interviewing i. Latent 5. Reassure c. Home gratifying relationships with others ii.psychosexual i. experienced.worried about others. Activities iv.b. superego (angel). Sexuality and Safety 11.birth to 3 yo. participate willingly d. Establish rapport ii.older. Participation. Structure of mind. 12. Stages of dvpt 1. come to terms with same sex parent 4. id (devil) b. Freud. . not needed as much in society: why still here? Look back on life to see if you made a difference c. Assess devpt. address confidentiality iii. Assessing risky behavior i. sep from parents iv. Piaget.some never get to this stage d.sucking. bowels 3. Oral.ego (conscience). Drugs. Social smiling.

Psychomotor agitation v.d. Bipolar. There will always be some uncertainty · Understand the difference btwn “process” and “outcome” -PROCESS= coherence. late adulthood. transitions and rights of passage b.onset of depressive symptoms. marry. Death Dying and Grief a. pick the world apart to see how it works -Process Approach . Levensen. Anger. weigh decisions based on how they affect relationships and not right or wrong f. Bipolar I. -lack of time to gather more information about the patient or to search medical literature adds to inherent uncertainty -basically you don’t have enough time or resources available to no EVERYTHING you need to know about a patient. Gilligan. Flight of ideas ii. Racing thoughts iii. Kubler Ross. Dysthimia. suicidal thoughts b.3 or more of the following i. Seasonal affective disorder.each life stage characterized by task to be resolved. psychomotor. mitigation and accommodation. Neugarten.Life Span Model. Excessive involvement in risky pleasurable activities vi.sleep. more caring. interest. Cyclothymia. appetite.womens dvpt. energy. middle adulthood. guilt. etc e. Stages. Weisman. Degree of success in each stage is dependent on success of previous stage. Age 30 crisis.Life Stage model. decline and deterioration and preterminality and terminality 16.Existential plight. fall and winter. eat a lot and sleep a lot. As you get older. SIGECAPS.early adulthood. Acceptance b. Not everyone passes all stages and attains integration c.Denial.Social Clock theory.hypomania and major depression g. Adult Development a.low grade depression for more than 2 years.onset within 3 mo of identifiable stressor and resolution within 6 mo c.who you are vs what you do 15. concentration. you have new demands that you have to deal with individually d. the basic science approach. Bargaining. poor prognosis d. more tuned to relationships.cultures define age boundaries and age appropriate behavior ie when you drive. Adjustment disorder. treatment is light therapy e. Mature minor 14.mild depression and hypomania h. Erikson. Distractable iv. Post partum blues vs depression vs psychosis i. Depression a. TREAT WITH LITHIUM Uncertainty in Clinical Medicine Objectives· Understand the concept of irreducible uncertainty -Irreducible uncertainty is uncertainty that cannot be reduced by any activity at the moment action is required.manic and major depression f. Bipolar II. Depression.

can we get it right without knowing the system. often clarifies the situation  Order more tests  Consult with ppl that know more than you o Patients need to realize that doctors don’t know everything and that they will do their best to help them figure out what is wrong.probability of a disease when indicator is positive o Predictive value negative.· · · · -Strategy.frequency of a disease o Incidenceo Sensitivity. draw conclusions -Goal.probability of a disease when indicator is negative Recognize the ways physicians and patients deal with uncertainty o Physicians vary in their approach  Ignore/deny uncertainty · “you have a viral illness” · “you need an angiogram”  explicit discussion of uncertainty · “the surgical repair is successful in 9 out of 10 patients but medical management is also an option” · “we don’t know the cause of your fainting spells.the proportion of patients with disease who have the clinical indicator for the disease o Specificity. don’t care what the cause of a problem is -Outcomes Approach -Strategy.increase understanding of how the system works -basically study the microorganisms that would be causing a disease in order to diagnose -OUTCOME=correspondence.generate hypotheses. actuarial) methods to predict outcomes -Methods. do experiments. But they must be willing to deal with uncertainty Discuss an approach to the diagnosis and management of up to 3 common problems in primary care involving uncertainty Using case examples.use the scientific method to increase our knowledge base -Methods.develop more accurate methods of predicting outcomes of interest -basically study the signs and symptoms of an illness to figure out the diagnosis *these are not mutually exclusive Define core concepts of epidemiology including o Prevalence. the probabilistic approach. analyze result.uses epidemiological (probabilistic.the proportion of patients without disease who do not have the clinical indicator o Predictive value positive. practice guidelines and/or epidemiological principles as strategies for decision making in the face of uncertainty Sexual Function Objectives· List up to 5 reasons why sexual histories are important in the care of patients . but patients with your type of problem have a normal life expectancy” o Physician strategies in the face of uncertainty  Time is important.collect frequency data and relate outcomes to potential predictor variables -Goal. discuss the application of decision rules.

Extended period of excitement during sexual activity is also referred to as plateau phase o Orgasmic (peak) phase.extreme aversion to and avoidance of genital contact with a partner o Sexual arousal disorders  Female arousal disorder. leukemia. desire for sexual activity o Excitement (arousal) phase. TB.pituitary problems. etc  Genetic. gonorrhea. diabetes.marked by a subjective sense of sexual pleasure. gonadal dysfunction.marked by sexual fantasies. Noonans  Hematologic. thrombosis. fantasies (occurs in up to 50% of females and 25% of males)  Sexual aversion disorders. However.anemia. cardiac failure  Endocrine. during or following intercourse that is not caused by lack of adequate lubrication or vaginismus Identify medical conditions and treatments that can affect sexual functioning o Medical conditions  CV. but patients are often reluctant to initiate discussion of these problems Describe the phases of the sexual response cycle and the physical changes in men and women associated with these phases o Appetitive (desire) phase.failure to attain or maintain erection until the completion of sexual activity and/or lack of subjective sense of pleasure o Orgasmic disorders  Inhibited male and female orgasm.marked by subjective sense of relaxation. sickle cell  Hepatic.genital pain in either gender before.Klinefelters. Men enter a refractory period of variable length in which they are incapable of erection and ejaculation. unwanted pregnancy Impact of medical illness/treatments on sexual functioning and sexual health Past sexual history may be essential to understanding current problem Knowledge of sexual orientation is important providing effective and sensitive care Concerns about sexual well being are prevalent. In women markers include vaginal lubrication.delayed or absent orgasm following normal sexual excitement phase  Premature ejaculation o Sexual pain disorder associated with excitement and/or orgasmic phases of the response cycle  Vaginismus.cirrhosis (alcoholic)  Infectious. Physical markers in men include erection.failure to attain or maintain the lubrication/swelling response until the completion of the sexual activity and/or a lack of the subjective sense of pleasure associated with the arousal and plateau stages  Male erectile disorders. thyroid problems. etc o o o o o .marked by release of sexual tension and rhythmic contraction of perineal and pelvic reproductive organs o Resolution. structural anomalies.involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual activity  Dyspareunia. women can respond to additional stimulation almost immediately Describe the types of sexual dysfunctions associated with different phases of the sexual response cycle in both men and women o Appetitive/desire disorders  Hypoactive sexual desire disorder.· · · Risk of STDs.atherosclerosis. adrenal problems. immunologic. aneurysm.deficient or absent sexual desires. prostatitis.urethritis. swelling of external genitalia.

This could include sexual partners. morbid obesity  Poisoning. etc o Components Marital/partnership status  Current sexual activity (past as well)  Sexual orientation  Type of sexual activity  # of sexual partners  STD risk  Functioning/satisfaction  History of abuse  Contraception history  Male questions (erections.prostatectomy. urethral structure. I make it practice to let all my patients know that I am available to discuss any ?s or concerns you may have. stroke.chronic renal failure. vitamin deficiency. Neurologic. frequency of activity.MS. etc  Nutritional.etc) o To assess patients risk for STDs o When the patient is concerned about sexual health List 2 places in the general medical history where questions about sexual functioning could be asked o Social history o UG review of systems o HPI Provide at least 2 examples of transition statements for introducing the sexual history o “An area of health physicians often neglect is sexual health.respiratory failure  Renal/Urologic.radiation therapy.pelvic fracture. penectomy  Other problems. epilepsy. spina bifida. etc) Be able to articulate circumstances in which sexual histories should be pursued o When pertinent to patients CC for reason of visit (contraception ?s. Do you have anything you would like to discuss?” · · · · . orgasm. concerns about STDs. pain.lead  Pulmonary. bypass.malnutrition. etc)  Female questions (lubrication. etc  Traumatic. premature ejaculation. renal biopsy. cerebral palsy. trauma. CNS infections. any severe systemic problem o Treatments Antianxiety medication  Anticholinergic  Anticonvulsant  Antidepressants  Antihypertensives  Antihistamines  Antipsychotic meds  Narcotics Define the sexual history and list all component parts of a comprehensive sexual history o Sexual history is gathering information about a patients sexual activity. CNS tumors. etc  Surgical. Parkinsons. reproductive concerns. sexual orientation. UG symptoms. urethral rupture.

o “I am going to ask you a few questions about your sexual history. If you wonder why I ask any specific questions. These are ?s I ask all patients. Do you have any questions or concerns about your own risk for these problems?” Identify barriers to conducting sexual histories and describe up to 5 techniques for overcoming barriers to sexual history taking o Barriers  Discomfort with subject  Worry patient will be offended  Not knowing how  Age difference  Lack of justification  Stigma  Perceived as irrelevant o Overcoming Barriers  Delay sensitive questions  Develop rapport  Display nonjudgmental attitude  Provide explanation for why you are asking these questions  Discuss patients feelings about this topic  Provide optimism  Don’t assume! List risk factors associated with STDs o If you are having sex you basically are at risk for an STD bc all men have diseases! o Know NE statues that apply to STDs and contraceptive counseling to underage patients  If the patient is a mature minor.0. planning. motivation . Given a clinical scenario. education. let me know. typical. you can offer STD and contraceptive counseling to underage without contacting their parents  “mature minor” is at discretion of the physician List currently available forms of contraception and know the advantages and disadvantages associated with each method. be able to make a recommendation that fits the scenario and the rationale behind your recommendation o Abstinence  Advantages · Very effective · No technology required · Reduced STD rates  Disadvantages · Failure rate · Hard to teach · · · o NFP. and you don’t need to answer anything that makes you feel uncomfortable.effectiveness.” o “Many ppl are worried about AIDS and other STDs.25  Advantages · No technology required  Disadvantages · Failure rate · Requires knowledge.

o Withdrawl. parous.effectiveness.18. typical.28  Advantages · Limited STD protection · No doctor visit required  Disadvantages · Some experience vaginal dryness/irritation · Some find it hard to insert o Diaphragm.effectiveness: typical nulliparous.3.effectiveness: theoretic-6.20  Advantages · No interference with normal physiology .effectiveness.theoretical 5.21  Advantages· No cooperation from male partner · Can be inserted hours in advance · Does not have to be removed immediately after intercourse · Relatively inexpensive · STD protection  Disadvantages· Less effective than male condom · Less widely available · Slightly more expensive than male condoms · 25% unable to insert properly on first attempt o Vaginal sponge. typical 19  Advantages · Cheap · Available  Disadvantages · High failure rate · Requires high level of trust in partner o Male condom.effectiveness typical 5-12  Advantages · Cheap and available  Disadvantages · Requires planning · Interrupts sexual activity · Irritation · Using >1 time a day may increase risk after HIV exposure o Female Condom.4. typical. typical-14  Advantages · Inexpensive · STD prevention  Disadvantages · Decreased sensation · Planning required · Interrupt sexual activity · Shelf life o Spermicidal Contraceptives.effectiveness.

2% (block tubes with insert) · Advantages o Permanent o No general anesthetic o No incision o Takes ~35 min to do · Disadvantages · . typical. parous.effectiveness: theoretic.effectiveness: nulliparous.vomiting · Wt gain · Menstrual irregularities · melasma Sterilization  Tubal Ligation. depo-provera (shot).. IUD Paraguard T. typical. IUD Merina  Advantages · Effectiveness · Availability · Periods more regular/less dysmenorrheal · Increased bone density · Less endometrial and ovarian cancer  Disadvantages · Thromboembolic disease · CVA · Hypertension · MI · Depression · Nausea.o o o Limited STD protection  Disadvantages · Requires planning · Requires fitting · Increased UTIs Cervical Cap. Lunelle.9..5  Include seasonale.theoretic.effectivness. mini pill.26..1. typical.effectiveness.40  Advantages · Same as diaphragm · Less UTI risk than diaphragm  Disadvantages · Same as diaphragm · Higher rate of failure than diaphragm Combination Oral Contraceptives.4% · Advantages. Othro evra (patch). implantable (Norplant).permanent · Disadvantageso Permanent o Requires general anesthetic o Requires opening the abdomen  Essure. nuva ring (insert ring into vagina).theoretic.20.

but not immediate o Surgical procedure o Questionable associated with prostate cancer o Morning after pill  OCP.1. They offer cash payments for health services regardless of the expenses actually incurred.contraception. Sounds like good insurance.they pay a shitload. capitation. Indemnity insurance—you pay now. Plan B. Pay little…. and fee for service. · . HMOs contract w/ employers to provide comprehensive health services for their employees in exchange for a monthly fee. HMOs provide managed health care—the integration of the financing and delivery of are. Typically. barriers o Open communication of partners o Abstinence · Discuss the emotional and behavioral consequences of HIV and other STDs · Explore your own attitudes and feelings about sexual behavior Who Pays the Bill? 1. point of service plan (POS). PPOs are also characterized by consumer choice of providers. Currently nearly 80% of HMO enrollees are offered point of service option. and expedient settlement of claims. d. POS—these also offer reimbursement for the services of out of network physicians but at a lower rate. a. PhysicianHospital Organization (PHO). Often needed. They often play a broker role between employers and providers. i. Medicare. utilization review.. Preven. preferred provider organization (PPO). c. Participating physicians are asked to provide services for negotiated discounted prices in order to preserve or increase their market share. typical. value. health maintenance organizations (HMO). HMO—represent the most dynamically developing segment of the US health care system. PPO—These are loosely controlled versions of managed health care. are preauthorization for admission to hospital or mandatory second opinions on elective surgeries.. Medicaid. they cover your ass later. Here you have to use clinicians of the plan—physicians are enticed to participate and in return the HMOs really take over and determine the cost. HMOs have a strong financial interest in controlling the cost of care while maintaining and improving quality.theoretic. gatekeeper.) Define and briefly discuss indemnity insurance. quality. where can I get me some of this? b. RU-486 o Abortion  Chemical  Surgical o Permanent o 3-6 mo delay in effect o requires hysterosalpingogram for confirmation Discuss strategies for preventing spread of HIV and other STDs o Safe sex.15 · Advantages o Permanent o Effective o Less invasive than tubal ligation · Disadvantages o Permanent. Male sterilization · Effectiveness. So here physicians may be making their patients pay less but they will be getting more of them b/c of the low prices—everything balances out often in favor of physicians. Champus.

Quality of process—activities of clinicians and assumes that there is a causal relationship between specific clinical procedures and the outcome of care v. There are also deductibles. iii.bastards…Boo those whores. Services. Income is being redistributed from the rich to the poor through this (MY ASS!) ii.e. physician ordered supplies and services. Quality of design—ex appropriateness of surgical procedure to treat a particular medical condition ii. Physician-Hospital organization— Quality— i. and patients w/chronic renal failure are entitled to benefits of medicare i. f. be able to calculate the amts paid by insurance plan and patient respectively . surgical and diagnostic services  2 extra digits  much more specific  procedure codes mostly  format is 12345 (-67) Define insurance coverage items and given a scenario describing services covered for patients with different insurance plans. Fucking HMOs…. l. and various outpt. · So basically POS protects choice. Welfare medicine Champus Fee for service · Demonstrate understanding of billing formats for services rendered based on o HCFA-1506 o ICD9 codes. Part A—finances hospital visits ii. which beneficiaries of the Part B plan paying a monthly premium iv. g. Medicaid—finances health care provided to low income individuals and families i. m. disabled individuals. Capitation—You pay monthly regardless of the amt.current procedural terminology  Uniform language describing medical.45 o CPT. the change in the heatlh status of patient or populations Gatekeeper Value Medicare—persons 65 and older. iv. facilities. classification of diseases clinical modification (ICDCM)  official system of assigning codes to medical and surgical diagnoses and procedures  >12000 diagnoses codes  format is 123. Quality of structure—attempts to measure and influence the quality of care by testing and approving specific resources of care—human resources. j. If you are insured by an HMO and you go to a doctor out of the network. Part B—provides supplementary medical insurance covering physician services. drugs and equipment. Quality of outcome—probably the most attractive quality concept. k. b/c it attempts to assess the real result of health services—ex. of healthcare or shitty health care for that matter that you get. then a POS can offer payment for some of your services. i. and other out of pocket expenses. Financed through payroll tax. Quality of delivery—how good of a doctor are you? iii.

Describe the ways managed care plans may preserve the physicians role and limit ethical conflicts with their patients o The physician’s role is preserved in that he/she is still acting as a healer. ii. Usually expressed as a dollar amt per calendar year. The physician thus is placed in quite the predicament: either keep my low paying HMO shitty ass job. Problem Oriented Medical Record . but he must decide if it is worth it to pay out of pocket to help his patient or if he should bow down to the gods of the HMO and not give the patient what is order for insurance to pay. insured covers 20%) Discuss at least 5 ways in which managed health care plans limit costs o Tell dr how much they can charge for a certain procedure o Limit amt of care that patients can be given o Limit defensive medicine o Limit the lengths of hospital visits. P=Plan—what you’re going to do b. etc that he/she may deem necessary. exam. or do what is best for the patient (which may require more money than the HMO is willing to offer to the patient). S= Subjective—What the patient tells you.division of responsibility for payment btwn insurance company and insured.) Know the basics of SOAP notes and POMR a. limiting the amt of choice that the physician and patient have will limit the amt of argument that comes between them · · · Medical Records 1. The patient therefore can most likely not pick something that is experimental. The physician doesn’t have much money obviously bc he is being paid by fucking HMO. tests. etc. However.o UCR. The HMO will get mad at the physician if he/she spends too much of their precious money and if the physician goes over this amt then they have to pay out of their own pocket for the things that they think may be necessary to help a patient o Ethical conflicts are limited bc basically the physician doesn’t have the ability to offer many options to the patient.the portion of allowable health care expenses which an insured must pay before insurance coverage applies: usually expressed as a dollar pay before insurance coverage applies. The physician still sees patients and is able to give diagnoses and treatment. Eg $250/calender year means the insured must pay $250 of allowable health expenses before their insurance begins coverage by co-insurance o Co-insurance. A= Assessment—Diagnosis iv. etc due to the HMO and will probably just pick the most basic of treatments that is covered by their HMO. the role is limited bc the physician cannot give a number of the treatments. etc so that costs cannot be increased too high o Use gatekeepers. you must have referral of primary care doc to specialist o Drs must pay HMO if they go above and beyond what the HMO will pay Discuss the ethical dilemmas in which managed care plans place physicians o The physician is basically a bitch employee of the HMO so the HMO can basically be like. POMR i. customary and reasonable charge. expressed as a percent eg 80/20 (insurance covers 80%. umm bitch. So.reimbursement determined by the insurance company and purported to reflect the common or prevailing fee for a specific health service in a defined geographic area (may vary among insurance companies) o Deductible.usual. screens. O= Objective—Data. SOAP notes i. iii. no you cant do that about anything that the physician wants to do (boo those whores to HMOs).

V= Vital Signs 2. All records refer back to this master problem list 2. Lab and x-ray results vi. Strength viii. VAN 1. a. ADCA 1. Route ix. Plan of follow up vii. Frequency x. D= Diagnosis 3. Intake and Output c. Reason for Admission iv.) List the major categories to be covered in hospital orders. Length of treatment xi. Discharge Summary i. L= Lab and x-ray studies 5. Condition on discharge viii. This is the master problem list iii. location 2. Indication . Dose vi. Patient name ii. A= Admission order. etc. DIMLS 1.ii. Quantity v. Check glucose. Respiratory 3. A= Allergies ii. iii. Definition of prescription i. Weight b. Medication iv. Hospital course v. Type vii. Discharge diagnosis iii. Other services b. N= Nursing orders a. Date—six months past date and the prescription can no longer be fulfilled iii. Admitting Orders i. D= Diet 2. C= Condition 4.) List the Major Categories of a Prescription a. I= IV orders 3. M= Medication orders 4. S= Special orders a. Discharge instructions b. Admitting diagnosis ii. A= Activity 3.

Refills xiii. states cannot prohibit abortion pre-viability (defined as before 24 weeks)— This means that states cannot prohibit abortion if the pregnancy is 0-23 weeks along. h. but the criteria may be set by the statute.xii. you have to have your d. Here the balance shifts towards the fetus. however. but our preceptors are—they take the fall for our screw HCFA regulations Reproductive Rights (Ethics and Reproduction): A Panel Discussion 1. treat consenting patient for STD patient for STDs and may prescribe prophylactic treatment to prevent exposure. f. Special Instructions 4. States cannot proscribe distribution or use of contraception ii.) Know the relevant Federal and Nebraska state laws on contraception and abortion a. States. we can diagnose. Essentially here as a physician. States can limit or prohibit abortion post-viability (past 24 weeks). Co-signature by preceptors—if you write something in a chart. Any medical document can become a legal document b. Abortion is a decision of the patient and the physician but involves a BALANCE of interests by both 1. To begin with. 24 weeks is defined as the time when a fetus can live on its own w/o mother so defined as a “life”…. FDA regulates product safety of all contraceptives Abortion i. This favors the mother 2. 3. preceptor sign it too Controlled substances Erasures/corrections Students can be named in malpractice actions Malpractice insurance—we are not insured by malpractice. statutes and case law influence available options for minors a. can be thrown off when the life of the mother is in danger. b. Physician signature (make sure to print name) xv. Permanent sterilization of minor/incapacitated requires court order –this is unless the sterilization was an unintended byproduct of a medically indicated treatment to begin with 2. Best defense against malpractice is good charting c.) Be able to list the pertinent legal standards for medical student participation in medical records a. c. NE law allows STD treatment and prevention of STDs w/o parental consent. g. .. can enact safeguards 1. The entire scheme. Viability is a medical decision. privacy is defined as a “penumbral right” (this means it is not explicit but b. Consent or notification of a parent is not required for a minor. it is implied by other explicit rights Contraception is a private decision i. however. Generic status xvi. DEA number xiv. MDs can prescribe oral contraceptives to mature minors (defined by the discretion of the doctor) w/o parental consent c. e.

Liability of father to assist in support even when volunteering to pay for abortion vii. .S. It is our job as MD to explain the nature of the emergency and the need for immediate action c. Medical risks of the particular procedure ii. Emergency also waives consent components. No abortions after viability except to save life or health of the mother iii. if child is born alive. Consent Information given by MD. this is in accord w/ sound medical judgment of the attending 2. Name of the MD to perform procedure (no non-MD can perform— class IV felony) v. PA or RN (can be via phone or in person) and must include the following i. The scope of state control has been the subject of 33 yrs. must receive 24 hours before the procedure or be mailed 72 hours before viii.” It says that all precautions should be taken to insure the protection of every viable unborn child and that all effort should be made to save lives of viable unborn children b. Voluntary informed consent and a 24 hour waiting period is required before the procedure. in accord w/ preservation of maternal life and health 3. in accord w/ sound medical judgment of attending b. voluntary muscle movt.4. All reasonable precautions taken to preserve the life of the child 1. if electing to review. Medical risks of carrying to term iv. h. umbilical cord pulse. MD or agent receives copy of certification before the procedure Abortions post-viability (past 24 wks) i. Possible availability of medical assistance for pregnancy. This is waived only in an emergency. Viability determined by sound medical judgment of attending physician ii. fetus born alive defined as with breath. Of court cases 5. Probable gestational age of the unborn child at the time of the procedure iii. Nebraska’s current statutes regulating abortion a. regardless of gestational age No medical facility is required to perform an abortion and cannot be sued for refusal No person is required to participate in an abortion and employment status can’t be altered for refusal No sale or transfer of living abortuses for experimentation—unless transportation is req’d for saving the life of the child Monthly reports to the health dept include: i. Surpreme Court’s “legislative intrusion”. Name of MD ii. childbirth and neonatal care vi. fetal development 1. States can enact safeguards throughout gestation a. f. Availability of State materials re: abortion alternatives. Basically the preamble just states that NE doesn’t like the decision by the supreme court to “remove the protection afforded by the unborn. g. Location of facility d. all reasonable steps are taken to preserve life a. heartbeat. Preamble deplores the U. e. Woman must certify in writing that the foregoing were furnished ix.

hyperactivity. j. Immediate threat to life or health of woman b. annoying people. Conduct disorder. written notice to parent/guardian. Depression. Proceedings confidential and no court costs are imposed c. disease. delivered personally by MD or agent OR mailed. prevention. Cumulative information (except the MD and facility names) on file at health dept.temper tantrums. seek revenge c.same criteria as for adults d. County pays atty fees e.) . instruments and hands. Refusal must include written findings of fact and conclusions of law h. This form is confidential except on court order in civil or criminal proceeding. Obstetrical history vii. certified or registered mail to usual place or residence delivery deemed to be noon on the next regular delivery day ii.truancy. decision req’d 7 days after petition filed f. Whether emergency situation caused waiver of informed consent requirement completed form signed by MD xi. Bipolar e. Expedited review by NE supreme court 7 days after appeal 3. minor can appeal to Nebraska Supreme Court if not timely decided g. when measurable x. Forms available in courthouses and clerk will assist in filing b.difficult children. emphasize importance of exam and reason for them. Type of procedure v. Oppositional disorder. can lead to antisocial disorder Genital/Rectal/Breast a. drape patient. private dressing/undressing. Abortion w/o parental notice is in the best interests a. defiance. Files sealed except on court order d. part of physical exam. Pregnant minor is mature and capable of giving informed consent 2. State of residence ix. can’t concentrate for long periods b. explain what you are doing and avoid sudden. lying. i.) 3. anger. breast cancer detection. Age of pt. No abortion w/o 48 hrs. STDs b. mean. theft. arguing. (but no names recorded) iv. For minors under 18 y/o or woman under guardianship i. least uncomfortable position. Parental notification/judicial bypass waived under any of the following circumstances a. Person entitled to notice (for example parent) has already given written authorization c. guardian i. patient concern. Judicial bypass of parental notice if judge determines: 1. warm room. direct contact 2. ADHD. Stated reasons for abortion viii.iii. Woman alleges abuse/neglect and MD notifies authorities Childhood disordersa. Perform bc of dysfunction. Comfort patient by acknowledging situation. setting fires. Length and weight of abortus. Minor may represent self or court may appoint counsel. Complications vi. blaming others. include chaperone.

work with patient about non-medical concerns. discharge.permanent change that a family must deal with. socialization iv. shortened life span. cognitive. but must be with a doctor. intimacy and conflict resolution e.) . levels of interventions i. course. chronic illness. finances. Lots of variations on the family structure. support iii. onset.easier to deal with. PTs. Main focus is primary care c. strength. testicular pain/masses.give info about illness ii. dvptal history and self exams d. fertility.most common= single mother home c.dependent practitioners. Can also write scripts. adjust to changes in expectations for each other ix. families vary in level of tolerance iii.urethral discharge. acts as counselor b. mammograms. rectal complaints. Social workers.fatal. Do breast exam sitting and laying down Health Care teama. family rallies. History. acute illness. self exam? Risks ii. history of dvpt. diagnose w/ doctor. react to particular illness behavior vii. can perform minor surgery. Family. sexual functioning.incapacitating. family concerns. perineal pain/masses/lesions. obgyn. degree of disability.28 mo with patient to restore ROM. procreation ii. Traditional family.acute or gradual ii.8% of families d. go through grief-loss process v. non fatal iv.look for denial. OTs.) 5.instruct family to go about normal lives iii. can be very stressfulespecially hard to deal with is relapsing disease g. affective. pap spears. may be predictable points of stress during chronic illness ii. etc to muscles and bones after injury e. components of psychosocial typology i. ab pain/masses. etc 4.masters degree. can manage illnesses and treat simple cases. non-incapacitating i.urinary symptoms. PAs.menstrual history. GI complaints. write scripts. ignorance. assumptions about chronic illness and family i. families under stress hold to previous patterns of behavior iv. breast pain/changes/lumps/discharge. perspective of illness have most influence on ability to cope h. trauma.masters degree. difficulty adjusting to illness viii. outcome. legal and/or emotional ties who have a shared history.make it easier for a patient to live day to day life after an injury/illness Family Crucible of people w/ blood. dvptal questions i. degree of emotional attachment and expected future NP.makes drs live easier d. irregular vaginal bleeding. 4 functions of family i. Female. STDs. Male. behavioral. On their own. relapsing (most difficult) and constant iii. families play very important role in choosing therapies vi. not as much long term commitment f. can work on their own or with a doctor. abuse.

suppresses bronchoconstriction.circ stim.antiviral. bad taste ix. energy boost. increase insulin sensitivity xiii. triggers body’s healing abilities. MSM. Dilute. increases glc utilization xxi. cardiac health. protect cartilage from further breakdown xi. cures like. massage. etc c. homeopathy. elbows. meridians. used to relax.decreased adverse effects and increased potency 2. Valerian. Shake and bang on surface.can cause mania. antifungal.hard touch. give energy. Match to symptoms 4.dilute solutions of substance that in larger amts would cause the same symptoms as the problem being treated e. pain. rolfing. insomnia. anti inflammatory. Garlic. eucalyptus (antiseptic. hyponotic xvii. use pins in the meridians b. anti allergy. therapeutic massage. vasodilator. antiseptic). anti oxidant. antioxidant.odor. etc g.lavender and lemon balm xviii.pyrrolzidine alkaloids. Ginseng. Homeopathy. anti diabetic.treats mild to moderate depression. mother substance and mother tincture 1. treats Alzheimers by inhibiting deposition of b amyloid. relieve stress. Chamomile. Omega 3 FAs. Echinacea. healthy gums and bones viii. must get everything back in order. antidepressant) ii. cancer. don’t use if HTN. chiropractic. decreases lipids. volatile oils and lignans . astringent. anxiety and restlessness xvi. acupuncture. peppermint (antispasmodic.osteoarthritis.sedative. diabetes vii.anti-inflammatory. antispasmodic. vomiting. Green Tea.pain from osteoarthritis.) integrative medicine a. anti cancer. can cause seizures and bleeding in brain xx. St Johns Wort. antioxidant.antioxidant. decreases BP.6. decreased chol and TG. HERB LECTURE OF BULLSHIT i.antiviral. IBS. doesn’t treat symptoms. may thin blood xii. antidepressant). anti-inflammatory.wt loss. anti viral and antibacterial. Glucosamine.3 inches over the patient f.lots of types.used for stress.immune enhancer. Toxic Herbs. osteoarthritis xxii. chamomile (sedative. strengthens blood vessel walls. Potentially toxic iv.GABAnergic sedative. no bad side effects x. Not interchangeable with herbal products 5. flatulence vi. increases GABA and muscarinic receptors.releases energy 3. nausea.stim cartilage growth. Zinc. Sedating herbals. decreases histamine levels. knuckles.Qi. strengths blood vessel walls. ulcers. Chondrotin. decongestant. may increase HDL and LDL. Aromatherapy. low risk. Acupunture.adjustments and manipulation of spinal cord in order to relieve subluxations d. Soy. antibacterial. activates CYP3A4 xiv.used to treat jet lag xix.nonspecific immune stim w/ anti inflammatory. Kava Kava. don’t use with autoimmune disease v. menopause. don’t use if pregnant iii. stimulant).osteoarthritis.used for smoking cessation. Ginkgo biloba. Vitamin C. antidepressant. anxiety. PMS and is antiviral.antioxidant.lavender (sedative. antispasmodic and anti-inflammatory xv.

own nurses. Organ donation i. Christian Science. Blood i. with God. Jehovahs witness. Fundamental Christians. illness is atonement for sins v. Lots you cant take during pregnancy 7. or to save life of mother v. Hinduism. death results from Adams sin viii.acceptable ii. Catholic. Jehovahs witness.before 120 days ok.Gods creation.) Faith and Medicine a. life is gift vi. Catholic. Medical procedures i.acceptable and encouraged iv. Jehovahs witness. Christian Science. Mainline protestant.womans right to choose vi.body owned by God. must maintain your body iii.attention to autonomy vi.acceptable v.must do all necessary and available iii.permitted to save life of mother or preserve health of mother.acceptable v. Fundamental Christians-acceptable vii.acceptable iii. Hinduism. Fundamental Christians.modesty rules. Islam. cleanliness v. Mainline protestant. Catholic. Judaism.most things acceptable viii. conventional medicine. Avoid products from asia and that contain lots of herbs i.acceptable iv.Gods creation. life is gift vii. God gives what you need e. Islam. families give care and support ii.never ok except to save life of mother iv. Use recommended dose j.acceptable vi.Gods creation.only to save mothers life vii. Catholic.made for purpose.acceptable vi.some fundamentalists say no ii. Mainline protestant. Judaism. Hinduism. Abortion i. illness=karma ii. Islam. Fundamental Christians. Jehovahs witness.not acceptable (can use own blood or maybe some blood components) c. or before 40 days iii. Judaism. Judaism.only to save mothers life .not acceptable d.acceptable iii. Hinduism. material is illusion b. Mainline protestant.dispproved except to save life of mother ii. Jehovahs witness.Gods creation. Islam.sacred.h. Life/body i. source of sin.preserve life vii.reasonable medical care is obligatory iv. Mainline protestant. but source of sin iv. temporary vessel. Islam. Fundamental Christians.

Reproductive technologies i. Fundamental Christians.not accepted. Judaism. Hinduism. Christian Science.accepted ii. Islam.reasonable measures to preserve life vi.f. Jehovahs witness. Mainline protestant.don’t have to prolong dying conception ii.40 days iii. Ensoulment i. Hinduism.disapprove of life support. Catholic. pain control acceptable. medical intervention Funeral i.procreation encouraged v. Hinduism.accepted g. Catholic. Judaism. Marriage i.accepted iii.120 days v.procreation is desirable (esp sons) ii.procreation honored but not obligatory vi.procreation and mutual self giving iv. Catholic. Dying i.reasonable measures to preserve life. Fundamental Christians. Judaism. Fundamental Christians. . Hinduism. Islam. Judaism. Christian Science.not accepted iv. Contraception i. Fundamental Christians. non Jewish cant touch body iii.duty to preserve life. Jehovahs witness. Mainline or near conception vi. Christian Science. Fundamental Christians. much debate now. Islam. Mainline protestant.burial k.accepted vi. Jehovahs witness. so conception I guess j.fetus is always perfect image of God. Judaism.artificial life support not encouraged viii.conception iv. Islam.cremation sterilization viii.accepted v. Jehovahs witness.depends on type. dying person face Mecca v. Catholic. Islam. etc.accepted iii. NFP iv. can starve oneself ii. last rites iv.reasonable measures to preserve life vii. no donor or surrogacy donor gametes or genetic counseling i.accepted vii. Catholic.accepted vi. Mainline conception vii.tolerated but not accepted ii.procreation is expected vii. don’t remove tubes. Jehovahs witness. Hinduism. Judaism.companionship and reproduction iii.accepted v.accepted.procreation encouraged h.

Islam.burial or cremation iv. Mainline protestant. Hinduism.some iii. but no official rule vii. Fundamental Christians.iii.allowed vi. Christian Science. Christian Science. Jehovahs witness.burial or cremation vii.if necessary iv. Catholic. Mainline protestant.burial or cremation vi.based on family tradition l. Autopsy i. Judaism.allowed viii. Fundamental Christians.normally not requested . v.wrap in sheets and burial ii. Islam.