AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. June 2005, Volume 7, Number 6.

Test Questions

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Test Questions: Ethics in Family Medicine

Ethics in Family Medicine

June 2005

1. Which of the following barriers to a more efficient continuing medical education (CME) system is (are) enumerated in the journal discussion?

A. CME systems have different goals, conceptualizations, and vocabularies that frustrate attempts to provide CME that uniformly expands physician knowledge and creates practice improvements.
B. The ability to deliver good health care and target specific goals and agents is complex and difficult.
C. The use of credit hours to measure physician learning has proven to be an inadequate reflection of education that leads to patient care improvements.
D. All of the above.
E. A and C.

2. Arguments for shifting the location of residency training in family medicine from the hospital to the ambulatory setting include:

A. The area of greatest need has shifted from acute to chronic condition maintenance, most often managed outside of a hospital setting.
B. In an ambulatory setting, medical students will have greater ability to observe patients longitudinally instead of only seeing them briefly in the hospital.
C. Ambulatory care requires physicians to develop patient care plans that are consistent with the patient's resources and priorities—a valuable skill in this patient-centered health care environment.
D. Physicians in an ambulatory setting tend to have greater access to technology so medical residents in the clinic setting will be more familiar with the most up-to-date equipment and techniques.
E. All of the above.
F. A, B, and C.

3. Arguments for 4-year family medicine training offered in the op-ed are:

A. Reduction in resident work hours has led to a reduction in training time, making it necessary to expand the length of training.
B. Family medicine residents must participate fully in specialty training, so they need additional training time to learn the intricacies of family medicine.
C. Given the aging population of the US, many of whom will generally suffer from 1 or more chronic condition, an added training in geriatrics will be necessary.
D. All of the above.
E. A and C.

4. A physician who has a "dual relationship" (professional and personal) with a patient should:

A. Be careful not to allow the privileges of friendship to enter the exam room.
B. Be careful that the friendship does not lead to questionable clinical judgment.
C. If clinical judgment seems compromised, consider suggesting that the patient see another physician.
D. Refuse to treat the patient-friend because it is best not to mix business with pleasure.
E. A and B.
F. B and C.

5. Which of the following is not a proven way to effectively treat depression?

A. Pharmacotherapy
B. Psychotherapy
C. Social Isolation

6. What are some of the financial obstacles facing family medicine doctors?

A. Increasing threats of lawsuits that add to malpractice premiums and overhead costs.
B. An increase in unfunded legal mandates (ie, HIPAA).
C. Medicare and Medicaid's continued reimbursing of doctors at a decreased rate.
D. All of the above.

7. A family physician has genetic information about patients that may affect the marriage and reproductive choices of their child. The physician knows that the child, also his patient, plans to elope. The parents and their child have not shared their private information with each other. Acceptable options for the physician are:

A. Tell both parties a family meeting is necessary and that, if they choose to attend, all sides should be open and honest about their plans and medical status.
B. Respect the confidentiality of parents and child and make no attempt to facilitate mutual disclosure.
C. Break the parent's confidentiality because genetic diseases are too important to keep a secret especially when the child is planning to marry.
D. Break the son's confidence about his plans to elope in hopes that the parents will see the need to share their genetic status with him.

8. A physician suspects that a patient is clinically depressed; he has declined treatment, fails to show up for appointments, and does not return calls. Acceptable options for the physician are:

A. Wait for the patient to get in touch. Many patients refuse treatment until they really need it.
B. Call the police and ask that they do a "welfare check" on the patient.
C. Call the patient's family to find out how the patient is doing and explain concerns about possible depression.
D. Call the patient's home and leave a message that the patient call the office as soon as possible.
E. A and C.
F. B and D.

9. A physician treats both members of a married couple and is faced with the dilemma of breaching the confidentiality of one of them to protect the health of the other. Which of the following should not be a factor in the physician's decision making?

A. The gravity of the harm that will be brought upon the patient by not disclosing the known risk.
B. Whether there is a means to protect the at-risk patient without violating the confidentiality of the other patient.
C. The affect that the information would have on the relationship between the two patients.
D. The possibility that breaching a patient's confidentiality may anger the patient who may then decide to find another doctor.

10. Charged with the responsibility to prevent (as well as treat) illness, primary care physicians should:

A. Spend as much time as possible discussing all available screening and diagnostic tests with patients so that they can decide which tests they want to have.
B. Discuss only those preventive tests that have proven effectiveness.
C. Discuss preventive services of controversial effectiveness only when patients ask about them, and then devote as little time to the discussion as necessary.
D. Not spend time on the patient's office visit demands until the physician's office visit agenda for that patient is accomplished.
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