AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. December 2004, Volume 6, Number 12.

Test Questions

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Test Questions: Standards of Care: An Ethical Examination

Standards of Care: An Ethical Examination


Which of the following best describes the ethical impact of the historical development of medical standards?

A. Standards developed outside the health care professions have no impact on the professions themselves.
B. One formulation of standards, "continuous quality improvement," creates a conflict of interest because it is imported from industrial settings.
C. Standards developed from within the profession are more reliable than standards developed from the outside, so the primary obligation is always to consider these standards first.
D. Because standards developed from multiple sources, both internal and external to medicine, the question, "What counts as a legitimate guideline source?" becomes important.


A fellow health care professional asks you about adherence to clinical practice guidelines and the risk of medical malpractice. Your response to him might include the following true statement:

A. "No need to worry about that. As far as the law is concerned, the standard of care is just what other people are doing in your community."
B. "Although the role of guidelines in the courts is unclear, attorneys may use them to determine whether a lawsuit is worth pursuing."
C. "Guidelines can be used against you to prove that care was poor, but they cannot be used in your defense to show you adhered to some accepted standard."
D. "If a guideline has been issued, you must follow it exactly in all cases."


Some argue that biomedical research has shifted from the "ethics of protectionism" to the "ethics of inclusion." Which of the following is NOT a reason for this shift?

A. Practically speaking, it seemed important to collect clinical research data on all groups of people, rather than extrapolating from a relatively homogeneous group.
B. Empirical research indicated that clinical trials were not as risky as was previously thought.
C. Basic standards of justice require that "likes be treated alike"; thus, it seemed unjust to exclude certain populations for morally irrelevant reasons.
D. Previously excluded groups have begun to play more of a role in setting the research agenda itself.


Different practice guidelines often exist for the treatment of the same condition, and guidelines themselves are criticized for a number of reasons. Given that this is the case, the most prudent course of action for a physician or health care professional is to:

A. Ignore guidelines completely.
B. Recognize that he or she is not the only decision maker and use the opportunity to communicate with his or her patients about the "best course of action."
C. Pick one guideline consistently, no matter what it is or where it originates.
D. Learn how to systematically analyze and evaluate the differences between and criticisms of guidelines as one way to improve his or her patient care.
E. B and D.
F. B, C, D.


HIV screening of pregnant women has been a controversial topic. Which of the following is NOT a reason for this?

A. HIV testing was available before any suitable therapies existed.
B. HIV testing continues to carry some risk of social stigma.
C. If a woman tests positive, requiring her to undergo treatment before delivery places an undue burden on her.
D. Many have argued about what type of consent (if any) this screening requires.


Why might one argue that cost-effectiveness considerations belong in clinical practice guidelines and medical standards of care?

A. They may help physicians and those in training to understand how care of individual patients relates to overall health care expenditures.
B. Adding cost effectiveness helps one judge the "reasonableness" of the guideline.
C. Without cost-effectiveness information in guidelines, physicians will completely disregard the cost of care.
D. A and B.
E. B and C.


Suppose you would like to implement clinical decision support systems in your medical practice setting. To do this, you will need to convince your colleagues of their benefits, as well as their limitations. Which is true of using clinical decision support systems in patient care?

A. CDSS can provide feedback and instructions at the point-of-care, making delivery of high quality care more efficient.
B. CDSS may aid in staying "up to date" on current standards, thus raising the ethical obligation to maintain a commitment to medical education.
C. CDSS may create an obligation for health care professionals to rationally and reasonably defend deviance from the "standard of care."
D. All of the above.


Suppose you are caring for a patient and find that multiple sets of practice guidelines or "standards of care" exist for the next step in her care. What should you do?

A. Take the conflicting evidence as reason to ignore the guidelines and rely solely on your experience and intuition.
B. Examine the guidelines more closely—only one of them can be right, and the others probably involve a conflict of interest.
C. Use this as an opportunity to communicate with your patient about this uncertainty and share the reasons for your preferred course of action.
D. Take the conflicting evidence to mean that any one of them is acceptable.


According to the Journal Discussion, which of the following is an important ethical criticism of the GRADE working group's evidence-grading system?

A. The GRADE system does not consider the strength of evidence underlying a recommendation.
B. The GRADE system does not include a clear idea of who will be on the grading panel or how they will be chosen.
C. The GRADE system includes an open and transparent process that is too susceptible to manipulation by outsiders.
D.The GRADE system leaves room to consider the cost of care in its recommendations.


Which of the following are ethical bases for evidence-based medicine, practice guidelines, and standards of care more generally?

A. A commitment to reducing the "fallacy of experience" providing optimal care to patients through managing uncertainty.
B. A commitment to the scientific basis of modern health care.
C. A commitment to medicine as a community and the societal obligations of health care professionals.
D. All of the above.
E. B and C.

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