Pediatricians may receive three credit hours in Category I for the Physician's Recognition Award of the American Medica] Association by reading the material in this issue and successfully answering the questions in the quiz below. To obtain credits, follow these instructions.
1. Read each of the articles carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding.
2. The following questions have been designed to provide a useful link between the articles in the issue and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME Registration Form at the end of the quiz. Retain a copy of your answers so that they can be compared with the correct answers that will be sent to you later.
3. Type or print your full name and address and your Social Security number in the spaces provided on the CME Registration Form.
4. Send the completed form, with your check or money order for $ 1 8 made out to PEDIATRIC ANNALS CME CENTER. 6900 Grove Road, Thorofare, NJ 08086.
5. Your answers will be graded, and you will be advised that you have passed [or failed). An answer sheet containing all correct answers will be mailed to you. Review the parts of the articles dealing with any questions you have missed, and read the supplemental material on this aspect of the subject listed in the references in this issue.
6. Be sure to mall the form on or before the deadline listed on the CME Registration Form so that credit can be awarded. (After that date, the quiz will close, and correct answers will appear in the magazine.) Unanswered questions will be considered incorrect and so scored. A minimum score of 70 must be obtained in order for credits to be awarded.
As an organization accredited for continuing medical education, the Lenox Hill Hospital of New York designates this continuing medical education activity as meeting the criteria for three credit hours in Category I for Educational Materials for the Physician's Recognition Award of the American Medical Association, provided it has been completed according to instructions.
Decision Making and Ethics
1. Commonly identified terms in discussions on medical ethics Include all of the following except.
2. It is not helpful to think of beneficence as a rule primarily because:
A. All rules have exceptions.
B. Being a caring physician often means bending the rules.
C. Rules apply to games but not to the practice of medicine.
D. Beneficence is more than a rule; it is a matter of execution and doing good for others.
3. The "Baby Doe" regulations:
A. Require full medical treatment of all infants no matter what their condition.
B. Require full medical treatment of all infants unless they are comatose.
C. Allow withholding treatment that would only prolong dying.
D. Allow withholding treatment if both parents agree.
4. Physicians know they are ethical when:
A. They follow moral, honorable rules.
B. They act for the good of patients within the guidelines of autonomy and justice.
C. They are inherently good people.
O. They have not been subjects of malpractice complaints.
5. All of the following statements are true except:
A. Justice consists of principles for the social distribution of medical care.
B. Beneficence expresses a physician's role in doing good for patients, as the physician sees that good.
C. Pity is Aristotle's name for the emotion one feels for another person's pain or suffering.
D. "Baby Doe" regulations are specific in telling physicians just what to do and when, and what not to do.
6. All of the following are true of a virtue theory of ethics except:
A. It was originally developed by Greek philosophers.
B. It has a positive view of the role of feelings in ethics.
C. Virtues are thought of as a middle ground between extremes of behavior.
D. It easily accommodates parental desires.
7. The main problem with the current reimbursement system for physicians fn our country is that payment for tests and procedures is far better than payment for cognitive thinking, time, and skill.
8. Carefully considered paternalistic behavior Includes the necessity of practicing with:
A. Victorian investment of authority in a father figure.
B. Genuine respect for a patient's right to self-determination.
C. Priestly attitudes in one's declarations as a physician.
D. A sense of the inviolability of medical judgment.
9. Autonomy and paternalism can be complementary values unless a constructive tension between them is weakened by:
A. The degree to which the patient is impaired by illness.
B. The perception of the patient derived from a physician's mature appraisal of attitudes, values, morals.
C. Respect for patient autonomy.
D. Unyielding certainty as to the appropriate approach to the solution of a problem.
10. A workable definition, based on Kleinig's writings, suggests that paternalism is:
A. The care or control of subordinates in a fatherly manner.
B. The quality or state of showing benevolence.
C. A rationale for acting in a manner toward another person to secure that person's good.
D. A coercion of one person's liberty of action by another person based on reasons referring to the welfare of the person being coerced.
11. Paternalistic behavior that includes informing, discussing consequences, and guiding decision making firmly is not inappropriate for a physician in his daily practice:
12. Criminal investigation of suspected child maltreatment:
A. Inevitably leads to a courtroom trial.
B. Can be used as an incentive to effectively get a perpetrator or family to seek treatment.
C. Carries a mandatory jail sentence.
D. Requires that a physician be prepared to directly accuse a specific perpetrator.
13. For children, participation in legal proceedings:
A. Is a uniformly harrowing experience.
B. Can be relied on to vindicate the child's claim that abuse took place.
C. Can be therapeutic if proper preparation and support are provided.
D. Presents little stress since courtroom dramas are frequently seen on television.
14. When a physician makes a report of suspected maltreatment, it is virtually certain that the alleged perpetrator will have to stand trial in a criminal court.
15. The legal threshold for making a report of suspected maltreatment:
A. Is not clearly defined in the law.
B. Can be summed up as, "if you think about it, you must report."
C. Is crossed when abuse is a likely explanation for a child's condition.
D. Can be modified if reporting might be seen as having some negative side effects.
16. For a pediatrician, working with a defense attorney in a criminal case regarding suspected child abuse:
A. Is permissible so long as no fee is charged for the consultation or testimony.
B. Requires that information be suppressed if it would not tend to support the defendant's innocence.
C. Is likely to ruin the pediatrician's reputation as an advocate for children.
D. Offers an opportunity to understand the adversarial nature of a criminal trial.
17. Recognized causes of conflict between parents and physicians include all of the following except.
A. Different emotions.
B. Different values.
C. Different relationships.
D. Different facts.
18. In the clinical setting, the basic element in management of conflict is:
A. Having an effective and experienced attorney.
B. Good and compassionate communication.
C. Learning effective techniques for negotiation.
D. Being sure that the nurses and all others involved in the patient's care are on your side.
19. Conflict resolution may often be facilitated by obtaining opinions from all of the following except.
A. A clinical ethicist, or an established ethics committee.
B. The hospital attorney.
C. Another physician in your specialty.
D. The family's attorney.
20. When a conflict in the management of a patient's care cannot be resolved, the physician's options include all of the following except:
A. Having the hospital attorney write a certified letter to the parents outlining your position.
B. Transfer of the child's care to another physician.
C. Going to court to ask a judge to make the health care decision.
D. Telling the parents your plans and the specific timing of those plans.
Answers to the February Quiz Diagnostic Imaging