Question

Discussion Week For the discussion board you are required to post one primary post by the irst three days of the Academic Week (Mon-Wed). Yu mat reply to two classmates by the end of the Academie week (Thur-Sun) The posts must be made on (3) separato days to ensu。yor pricipation and for atendance. Remember you need to ads substantively to he conversation The discussion boand is only for the topic being discussed. We have a class cale where you can meet other students and ask them questions and we have an "ask the professor area that you can use to ask me questions Discussion Question(Please ensure all cases are exhausted before repeating them in the forum) Chapter 24 ep. 327) is the begming of your Ethics Case Studies, using Case Study #1 as a guide select one ofthe case studies (24) and present your response to the case in the discussion forum

i need minimum 300 words and workcite

thank you

Answer 1

To maintain patient faithfulness, a radiologic technologist must follow a series of steps.

A radiologic technologist can often be confronted by situations that will test their abilities in dealing with sensitive patient care information. It is their duty to respect the patients confidences.

Recommendations of the American College of Physicians

1. Time is an important element of high quality clinical care, and a necessary condition for the development of the patient-physician relationship and trust between patient and physician. Therefore, efforts to improve how care is delivered must focus on preserving the patient-physician relationship, with an emphasis on fostering trust, maintaining fidelity, demonstrating patient advocacy, exhibiting respect for the patient as a person, and carrying out the individual and collective ethical obligations of physicians.

2. Effective communication, especially active listening by the physician, and the provision of information and recommendations to facilitate informed decision making and patient education, are critical to the patient-physician relationship and to respect for patient rights. Health care systems, payers, government agencies and others should recognize that these activities require time and be supportive of them.

3. Health plans, institutions, and others should support the patient advocacy duty and resource stewardship role of the physician, and minimize barriers to appropriate care, by recognizing the value of time spent by the physician in his or her role as patient advocate in an increasingly complex health care system.

4. Physicians should spend adequate time with patients based on patient need and uphold their ethical obligations in doing so. It should be recognized, however, that measures of “adequate” time for the medical encounter involve dimensions of caring and trust that are not so easily quantifiable, and that it is not just the actual time a patient spends with the physician that affects outcomes, but how the time is used. Research that examines how time is used and that distinguishes between time spent with patients (actual care) versus time spent on patient care (tasks associated with care) should be encouraged.

Does “time” have ethical significance? Many physicians and health care leaders talk about time in clinical practice. For instance, a Medline search of the medical subject heading “time management” returns over 1,500 citations. Most of this literature concentrates on the practical dimensions of time—how best to schedule operating room time or to schedule clinic appointments. Short of articles in which clinicians complain about “not having enough time,” however, there is little in the literature concerning the ethical significance of time. A Medline search of the combination, “time management” and “medical ethics,” for example, reveals no citations.

We assert that time has ethical significance, with specific implications for the patient-physician relationship, for respect of patient autonomy, for promotion of well being, for maintenance of fidelity, and for preserving justice. In the paragraphs that follow, we will offer both conceptual and empirical defense of these claims. Once having established the ethical significance of “time,” we will then argue that these connections entail important ethical obligations with regard to time for both physicians and health care systems. These ethical obligations can and should guide how physicians and health systems think about and manage time. In the last portion of this paper, we will outline some specific practical strategies to address perceptions and ethical concerns about the “adequacy” of time.

TIME AND THE PATIENT-PHYSICIAN RELATIONSHIP

The ethical significance of adequate time begins with the observation that time is a necessary precondition for communication needed to promote a strong patient-physician relationship. The connection between “adequate time” and the patient-physician relationship operates through several mechanisms, including: time spent in building a therapeutic relationship and fostering rapport, time spent in acknowledging and demonstrating empathy for patients' psychosocial concerns, time spent eliciting patients' concerns and negotiating an agenda for the visit, and time spent in counseling and wellness activities or in motivating behavior change. The value of building the therapeutic relationship cannot be overemphasized, as there is growing data on the impact of these relationship-building activities and patient satisfaction, trust, and outcomes of medical care.^19–21

The patient-physician relationship continues to be a central concern in medicine and bioethics, and there are numerous models of the “idealized” relationship in the literature. Whatever their differences, all these models share the sentiment that building a therapeutic relationship has intrinsic ethical value. While we have long acknowledged this intrinsic ethical value, we also have growing empirical evidence that the patient-physician relationship has instrumental value, enhancing patient satisfaction, improving adherence to treatment regimens, and fostering better health outcomes.

Many strategies for effective patient-physician interactions recognize the importance of time, particularly having adequate time to engage in those activities that foster a strong relationship. For example, techniques of patient-centered interviewing emphasize the importance of judicious use of time, in order that the business of the medical interview is accomplished while creating a supportive and caring climate. Examples suggested by several authors include taking the time to let the conversation evolve and resisting the temptation to interrupt prematurely.  These and other patient-centered communication strategies have been shown in increase patient satisfaction and trust in primary care office visits. These same studies have established a link between patient-centered communication, trust, and time. In one study, each additional minute of the office visit increased patient trust as measured by the 8-item trust subscale of the Primary Care Assessment Scale (PCAS), a valid and reliable measure of trust.

In terms of adverse effects of time pressure, the physician working under the perception of inadequate time may exhibit signs of stress or annoyance that, while not directed at the patient, can nonetheless be perceived so. Patients may question whether the physician really cares if the physician seems annoyed, rushed, or inattentive. These same feelings in the physician may over time lead to burnout, a clinical syndrome that is underrecognized in clinical practice.

Another important dimension of the relationship between perceived adequacy of time and the patient-physician relationship is trust. Although the perception of adequate time has not been specifically examined as a predictor of patient trust, several other associations suggest that such a relationship could is likely to exist. For example, there is data showing that fee-for-service visits are slightly longer that with other forms of insurance, and that as a result trust in the physician is higher under fee-for-service indemnity health insurance. Similarly, patient's assessments that their physician had excellent communication skills and was attentive to interpersonal treatment were both highly correlated to trust in one study.³⁵ It is certainly plausible that having the kinds of interactions associated with increased trust will be more feasible when time is perceived to be adequate.

Medicare beneficiaries suggests that "faithful patients" — as the researchers term them — who remain with their physicians in a long-term relationship tend to generate lower costs, better compliance, and better outcomes than patients who do not. Their data do not show faithful patients as any more conscientious about taking preventive care measures.

They hypothesized that longer relationships between patients and physicians would be associated with the following:

— greater use of preventive care services such as mammograms and flu shots;

— more healthy behavior; less obesity, efforts at smoking cessation;

— more efficient use of health care services (fewer doctor visits and hospitalizations) and a decrease in "inappropriate" service use (less use of hospital emergency departments);

— decreased costs of care (lower annual Medicare Part A and Part B reimbursement).

Their data did not support the first hypothesis, but they did support the last three.

Here are specifics of their findings about patients who switch physicians vs. patients who don’t:

We all want doctors who will:

• Respect people, healthy or ill, regardless of who they are

• Support patients and their loved ones when and where they are needed

• Promote health as well as treat disease

• Embrace the power of information and communication technologies to support people with the best available information, while respecting their individual values and preferences

• Always ask courteous questions, let people talk, and listen to them carefully

• Give unbiased advice, let people participate actively in all decisions related to their health and health care, assess each situation carefully, and help whatever the situation

• Use evidence as a tool, not as a determinant of practice; humbly accept death as an important part of life; and help people make the best possible arrangements when death is close

• Work cooperatively with other members of the healthcare team

• Be proactive advocates for their patients, mentors for other health professionals, and ready to learn from others, regardless of their age, role, or status

Finally, we want doctors to have a balanced life and to care for themselves and their families as well as for others. In sum, we want doctors to be happy and healthy, caring and competent, and good travel companions for people through the journey we call life.

Unfortunately, we do not have a magic lamp, and there is no genie. We must use our own skills and endeavours to make the good doctors we want and need. It is an awesome responsibility.