AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. March 2004, Volume 6, Number 3.

Test Questions

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Test Questions: Patient Safety and Medical Error

1. A resident who has a problem with the performance of a fellow
resident should not consider which of the following as a first step:

A. Talk to the resident about what is going on.
B. Talk to the attending physician on the service about the perceived problems.
C. Poll the other residents to see who else has had problems with this resident.
D. Talk to the chief resident.
E. Talk to the program director.

2. If the pharmacy makes an error in dispensing a medication and the improper medication or dose is administered, a physician should:

A. Disclose the error only if the patient's health or clinical course was affected
B. Not disclose the error and request a member of the pharmacy disclose the error.
C. Inform the patient of the error and tell the patient that the pharmacy was the cause of the error.
D. Disclose the error only if the patient or family specifically asks if there was a problem or mistake in the course of care.
E. Take responsibility for the error and inform the patient of the error and any potential consequences of the error.

3. When an insurance provider refuses to cover additional inpatient care a physician should:

A. Bow to the wishes of the insurer to keep health care costs low and maximize the hospital's reimbursement.
B. Review the clinical evidence and challenge the insurance company's refusal if clinical judgment indicates the care in
question is needed.
C. Challenge the company's refusal because economics should not play a role in the provision of health care.
D. Discharge the patient after noting in the chart that the team disagreed with the refusal of coverage and is not responsible for any adverse outcomes.

4. The IOM Report To Err is Human:

A. Was a study that showed that 44 000 to 98 000 patients are killed by medical errors annually.
B. Was a policy report that accumulated existing data to draw conclusions and make recommendations about patient safety.
C. Proved that medical error is the 8th leading cause of death in the United States.
D. Was inherently flawed and meaningless to improving patient safety.

5. As pointed out by William Barron, MD and the LUHS's Center for Clinical Effectiveness, institutions can improve patient safety by addressing systems issues through:

A. Auditing individual health care professionals and providing "report cards" that may be considered during future
staffing and employment decisions.
B. Attempting to ensure that clinical guidelines are implemented on patients with defined illnesses.
C. Having physicians input all medication orders themselves electronically to prevent medication errors.
D. All of the above.
E. B and C.

6. Some of the benefits of Computerized Physicians Order Entry are:

A. Decreases in adverse drug events.
B. Physicians save time in order entry.
C. Orders are instantaneously available to ancillary departments.
D. All of the above.
E. A and B.
F. A and C.

7. According to Zhan and Miller's study, "Excess Length of Stay, Charges, and Mortality Attributable to Medical Injures During Hospitalization," the adverse event that was most likely to result in a longer length of hospital stay, higher charges, and a greater likelihood of mortality was:

A. An infection acquired during hospitalization.
B. Postoperative wound dehiscence.
C. Postoperative sepsis.

8. According to Dr. Stephen D. Small's article, "Thoughts on Patient Safety Education and the Role of Simulation," simulation-based learning allows:

A. The student to learn error management skills.
B. Institutions to spend less money on systems' design by focusing on individuals.
C. For greater social justice.
D. Learning to be uncoupled from injury.
E. A, B, and D.
F. A, C, and D.

9. In Patel v Midland Memorial Hospital, the court found that the hospital was justified in suspending a physician's hospital privileges without a
presuspension hearing because patient safety was deemed to be at risk.

A. True.
B. False.

10. In "Cheap Grace," author Nancy Berlinger argues that it is important for individual clinicians to take responsibility for errors that cause harm to patients because:

A. If one person doesn't take the responsibility, all team members are unjustly implicated in the harm.
B. Accepting responsibility and offering compensation respect the humanity of the patient and contribute to the psychological
health of the clinician who caused the harm.
C. The US is primarily a Judeo-Christian culture and the forgiveness rituals from those traditions should be applied in
our country's health care sector.
D. The no-blame, systems approach to medical error has produced no improvements in patient safety, and we must
return to the model of individual accountability.

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