Public Health Sciences pdf that is really good

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1. TABLE OF CONTENTS
1.Ethics
2.Communication
3.Delivering Care
4.Safety
5.Practice Questions
Public Health
SciencesAfraTafreeh.com

2. OUTLINE
1.Ethical Principles
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
E. Confidentiality
F. Accepting Gifts
2.Capacity & Consent
A. Decision Making Capacity
B. Informed Consent
C. Consent for minors
3.Directives & Decision Making
A. Advance Directives
B. Power of Attorney
C. Surrogate Decision Maker
Public Health
Sciences:
EthicsAfraTafreeh.com

3. Bootcamp.comPublic Health Sciences: Ethics
Ethical Principles
Autonomy:
●Respect patients as individuals and respect their choices
Beneficence:
●Act in the patient’s best interest; “do good”
Nonmaleficence:
●“Do no harm”
Justice:
●Treat everyone fairly; does not imply equally
●Example: Triaging patients
●Equity does not mean equality
Confidentiality:
●Respect patient privacy and autonomy
○Can disclose information to family and friends if patient is incapicated or emergent situation
○Exceptions for emergent situations and risk of harm
○Example: Critically ill patient requiring intubation
○Example: Patient reporting suicidal/homicidal ideation
○Some exceptions may be state-specific
Accepting Gifts:
●Must weigh benefits vs risks
●Must not influence physician-patient relationships
●Some facilities limit gifts by dollar amount
●Never accept cashAfraTafreeh.com

4. Bootcamp.comPublic Health Sciences: Ethics
Capacity & Consent
Decision Making Capacity:
●Patient is psychologically and legally capable of making healthcare decisions
●4 Components: Understanding, Appreciation, Reasoning, Expressing a choice
●Decisions made with capacity cannot later be revoked if patient loses capacity
●Intellectual disability and mental illness are not exclusions
○Example: Patient with Down syndrome
○Example: Patient diagnosed with depression
●Example: Patient wanting to leave the hospital against medical advice
●Different from Competency
Informed Consent:
●2 Step process
○Patient discusses important information about a procedure or treatment with a healthcare provider
○Patient makes their own decision about their care
●4 Components
○Capacity
○Disclosure: Disclosing important information, including benefits and risks
○Understanding: Patient has the ability to understand what is being discussed
○Voluntariness: Patient is agreeing voluntarily and is free from manipulation
●Exceptions: Patient waives right to consent, patient is legally incompetent, emergency situations
Consent for Minors:
●Minor → Person < 18 years old → Parental consent
●Exceptions
○Legally emancipated; Examples: Married, self-supporting, in the military
○Contraception, STIs, pregnancy
○Substance use
○Emergency treatment; Example: Blood transfusionAfraTafreeh.com

5. Bootcamp.comPublic Health Sciences: Ethics
Directives & Decision Making
Advance Directives:
●Instructions given by a patient for future medical decisions
○Examples: Do not resuscitate (DNR), Do not intubate (DNI), Comfort measures only (CMO)
●May be oral or written
○Oral: Statements patient made to family or loved ones
○Written: Document with specific interventions regarding potential treatments or illnesses
■Example: Living will
●Most states have a specific legal document
○Example: Medical Orders for Life Sustaining Treatment (MOLST)
●Patient may have Power of Attorney
Power of Attorney:
●Patient designates someone to make medical decisions if they do not want to or if they become incapacitated
●Can be revoked if patient has decision making capacity
●More flexible than a living will
Surrogate Decision Maker:
●Medical decision maker if patient loses decision-making capacity and does not have an advance directive
●Priority: Spouse → Adult children → Parents → Adult siblings → Other relatives
●Example: Patient on a ventilator → Spouse withdraws
Ventilator-Assisted Life Support:
●If possible, discussion should take place before ventilator support
●Subsequent decisions rely on surrogate decision maker, prognosis, and patient’s wishes
○Surrogate says patient would not want life support on ventilator → Withhold/Withdraw care
○If withhold/withdraw care → Involve palliative care, religious leaders, primary care physicianAfraTafreeh.com

6. OUTLINE
Public Health
Sciences:
Communication
1.Interviewing Patients
A. Interview Flow
B. Building Relationships with Patients
C. Delivering Bad News
2.Inclusive Interviewing
A. Gender- & Sexuality-Inclusive Interviewing
B. Culturally-Inclusive Interviewing
C. Patients with Disabilities
D. Using Interpreters
E. Motivational InterviewingAfraTafreeh.com

7. Bootcamp.comPublic Health Sciences: Communication
Interviewing Patients
Interview Flow:
●Introduction → Identify Concerns → Active Listening → Validation → Summarizing → Asking Questions
Building Relationships with Patients:
●Create a partnership
●Be empathetic
●Take responsibility
●Show respect
●Support them
Delivering Bad News:
●Prepare the environment
○Offer patient to bring support, eliminate distractions
●Determine patient’s understanding
●Obtain permission
○Example: Some patients want health information discussed with oldest child
●Explain in plain language
●Acknowledge emotions
●Discuss next steps: Treatment options, goals of careAfraTafreeh.com

8. Bootcamp.comPublic Health Sciences: Communication
Inclusive Interviewing
Gender- & Sexuality-Inclusive Interviewing:
●Avoid assumptions about gender and sexual preferences/behaviors
●Be considerate of pronouns
●Reassure confidentiality
●Do not discuss these things if they are not relevant to the current visit
Culturally-Inclusive Interviewing:
●Identify the problem
●Understand background information
●Identify cultural influences and barriers
●Come to collective solutions
●Example: In some cultures, females do not want to be touched by male physicians
Patients with Disabilities:
●Address patient first and other caregivers second
●Respect their independence
●Allow for extra time if needed
○Example: Patient with speech difficulty may want to write things down
●Do not cut corners during interview and exam
○Example: Thorough examination of a patient in a wheelchair
Using Interpreters:
●Must be professionally trained and certified
●Still address the patient directly
Motivational Interviewing:
●Counseling patients to motivate them to make changes
●Patient usually has a desire to change but is hesitant
●Examples: Obesity, exercise, smoking
●Specificity is keyAfraTafreeh.com

9. OUTLINE
Public Health
Sciences:
Delivering Care
1.Disease Prevention & Management
A. Levels of Disease Prevention
B. Palliative Care
C. Hospice Care
2. Healthcare Systems
A.Medical Insurance Plans
B. Medicare
C. Medicaid
3. Healthcare Payments
A.Payment ModelsAfraTafreeh.com

10. Public Health Sciences: Delivering Care Bootcamp.com
Disease Prevention & Management
Levels of Disease Prevention:
●Primary:Preventing disease before it occurs
○Examples:Diet modification, exercise, smoking cessation, immunizations
●Secondary: Screening for and managing pre-symptomatic disease
○Examples: Blood pressure screening, pap smear, mammograms, DEXA scans
●Tertiary:Treating symptomatic disease to prevent complications
○Examples: Lisinopril for hypertension, Bisphosphonates for osteoporosis
●Quaternary:Reducing harm by discontinuing unnecessary treatments
○Example:Stopping Lisinopril due to hyperkalemia, preventing polypharmacy for depression
●Example: Type 2 diabetes
○Primary prevention: Diet and exercise to prevent diabetes
○Secondary prevention: Glucose checks to screen for diabetes
○Tertiary prevention: Treating diabetes with sulfonylurea and trending hemoglobin A1c
○Quaternary prevention: Discontinuing sulfonylurea due to hypoglycemic events
●Some interventions may occur at multiple levels
Palliative Care:
●Improves the quality of life of patients by focusing on providing comfort and relieving pain/suffering
○Example: Patient on chronic opioids receiving medication for constipation
●Typically interdisciplinary
Hospice Care (End-of-Life Care):
●Palliative care for patients with a prognosis of < 6 months to live
●Patient and family have decided to stop curative or life-preserving treatment
●Can be provided in a hospital, skilled nursing facility or at home
●Provide maximum comfort while preserving dignityAfraTafreeh.com

11. Public Health Sciences: Delivering Care Bootcamp.com
Healthcare Systems
Medical Insurance Plans:
Medicare:Federal healthcare program for patients ≥ 65 years old OR < 65 with certain disabilities
●Part A-Hospital Admissions (including hospice)
●Part B-Medical Bills (diagnostic tests)
●Part C-Combination of A and B from private companies
●Part D-Prescription Drugs
Medicaid: Federal and state healthcare program for people with limited income and/or resources
●Both originated from the Social Security Act
Insurance Plan PCP Choice Specialist Care Notes
Health Maintenance
Organization (HMO)
Limited
(except emergencies)
Requires PCP referral Most affordable
Point of Service Can see providers
out of network
Requires PCP referral Higher copays and deductibles for out of
network services
Preferred Provider
Organization (PPO)
Can see providers
out of network
No referral required Higher copays and deductibles for all services
Exclusive Provider
Organization
Limited
(except emergencies)
No referral required Hybrid between HMO and PPO
Accountable Care
Organization
Providers voluntarily enrollSpecialists voluntary enrollPayments
through
Medicare

*Not an insurance planAfraTafreeh.com

12. Public Health Sciences: Delivering Care Bootcamp.com
Healthcare Payments
Payment Models:
●Bundled Payment: Healthcare organization receives a fixed amount that is divided amongst all providers/facilities
○Amount is fixed regardless of the total cost
●Capitation: Physician receives a fixed-amount per patient per unit time in advance
○Amount is fixed regardless of how much the patient uses their healthcare
○Primarily used by pure HMOs
●Fee-for-Service:Insurer and/or patient pays for each individual service
○Allows patient more flexibility to see the providers they want to see
○Health plan may pay provider directly or reimburse patient for paying
○Frequently used by PPOs
●Discounted Fee-for-Service:Insurer and/or patient pays for each individual service at a predetermined, discounted rate
○Health plan may pay provider directly or reimburse patient for paying
○Also used by PPOs
●Per Diem Reimbursement: Insurer pays for services based on the number of days the patient receives care
●Pay for Performance (P4P): Offers financial incentives for meeting certain performance measures
○Examples: Lowering blood pressure, smoking cessation counseling
○Also penalizes healthcare providers for poor outcomes and medical errors
○Overall goal is to improve the efficiency, quality, and value of healthcare
●Global Payment: Insurer and/or patient pays for all expenses of a single encounter with a single payment
○Health plan may pay provider directly or reimburse patient for paying
○Usually paid monthly per patient over 1 year
○Used for elective surgeriesAfraTafreeh.com

13. OUTLINE
Public Health
Sciences:
Safety
1.Quality Assurance
A. Safety by Design
B. Quality Improvement Process
C. Quality Measures
2.Medical Errors
A. Types of Medical Errors
B. Medical Error Analysis
C. BurnoutAfraTafreeh.com

14. Bootcamp.comPublic Health Sciences: Safety
Quality Assurance
Safety by Design:
●Working environments should be organized with an emphasis on safety
○If there are safety concerns, workers should be able to bring them up without fear of retaliation
●Core Principles
○Function by Form
■Examples: Safety syringes, different types of tubing, certain medications being in a Pyxis
○Standardization
■Examples: PPE, hospital codes, checklists for procedures, popup notifications for allergies
○Simplification
■Examples: Safety wristbands, consolidating records in an EMR, universal sharps container
○Some safety measures fall within multiple core principles
Quality Improvement Process:
●Define problem → Create solution → Test solution → Collect and analyze data → Implement or abandon
●Example: Hospital has had multiple missed patient deaths from aortic dissection
○Missed diagnosis → Faster imaging → Radiology changes → Usage data → Implement
Quality Measures:
●Analyzing the setup, execution, and effectiveness of an initiative or solution
●4 Key components: Structure, Process, Outcome, Global Impact
●Example: Creating a swab to diagnose COVID-19
○Structure: Packaging, swab, test tube, reagent, storage
○Process: Mass production and delivery system
○Outcome: Increased prevalence, earlier treatment
○Global Impact: Better data, decreased hospital visits, increased waste
●Analyzing quality measures is a fluid processAfraTafreeh.com

15. Bootcamp.comPublic Health Sciences: Safety
Medical Errors
Types of Medical Errors:
●Active Error: Worker makes an error in real time and causes immediate harm
○Examples: Patient receives the wrong medication, IV placed in artery instead of vein
●Latent Error: Worker makes an error that has the potential to cause harm
○An accident waiting to happen
○Examples: X-ray taken of incorrect limb, guard rails on stretcher are left down
○Could also be operations or processes unrelated to worker with potential to cause harm
■Examples: Hospital has different types of IV pumps or different concentrations of same medication
●Never Event: Error is easy to identify and easy to prevent, but is also very high risk
○Examples: Performing a procedure on the wrong patient, retained scalpel in patient from surgery
○Ideally, these errors should never occur
■Sentinel event: Never event does occur and cause death or serious/permanent harm
●Near Miss: Error is unexpected and does not cause harm but has the potential to cause harm
○Example: Pharmacist identifies a potentially serious medication interaction and cancels the order
○Example: Identifying that a patient has a DNR before performing CPR
●Some errors may be classified under multiple different types
●Errors can occur at every step of care, from patient identification to workup to discharge process
Medical Error Analysis:
●Root Cause Analysis: Retrospective; looking at previous failures to prevent recurrence
○Methods: Interviews, surveys, chart review, process maps
●Effects Analysis: Prospective; predicting failures and implementing processes to prevent them
○Methods: Modeling, simulation, AI, inductive reasoning
○Prioritizes potential failures by the probability they might occur
Burnout:
●Burnout: Prolonged, excessive stress leads to decreased efficacy and increased medical errors
●Fatigue: Lack of sleep/rest leads to cognitive impairment and increased medical errorsAfraTafreeh.com

16. ≣
Item 1 of 1
Question ID: 2001
Test Your Knowledge
Difficulty Rating: ✪ Bootcamp.com
Two patients present to the emergency department for evaluation at the same time. The first patient is a 25-year-old female requesting a refill of her anxiety medication. She
states that her primary care physician’s office is across town and she thought it would be easier to get her medication refilled here. The second patient is a 67-year-old male
grabbing his chest and complaining of difficulty breathing. The physician decides to see the 67-year-old patient first.
Which ethical principle is most likely displayed in this scenario?
⚪ A. Autonomy
⚪ B. Justice
⚪ C. Nonmaleficence
⚪ D. Beneficence
⚪ E. NegligenceAfraTafreeh.com

17. ≣
Item 1 of 1
Question ID: 2002
Test Your Knowledge
Difficulty Rating: ✪✪ Bootcamp.com
A 77-year-old male with a past medical history of coronary artery disease, hypertension, hyperlipidemia and diabetes mellitus presents to his primary care physician’s office for
a routine visit. The patient takes multiple medications for his conditions including aspirin, metformin, lisinopril, hydrochlorothiazide, and amlodipine. The patient tells his
physician that he recently went to the hospital due to severe swelling of his face and lips. The physician decides to discontinue lisinopril and instead start the patient on
losartan. The physician’s decision most likely represents which level of disease prevention?
⚪ A. Primary
⚪ B. Secondary
⚪ C. Tertiary
⚪ D. Quaternary
⚪ E. QuintenaryAfraTafreeh.com

18. ≣
Item 1 of 1
Question ID: 2003
Test Your Knowledge
Difficulty Rating: ✪✪✪ Bootcamp.com
A hospital system is under investigation following a recent adverse outcome. A 64-year-old-male with a past medical history of hypertension, coronary artery disease and
diabetes was scheduled to have an amputation of the first toe on his right foot. The surgeon who performed the procedure instead amputated three toes from the right foot.
Root cause analysis determines that this event was easily preventable because an outpatient general surgeon evaluated the patient and clearly documented the medical
necessity and type of procedure the patient would require. This event most appropriately represents which type of error?
⚪ A. Latent error
⚪ B. Active error
⚪ C. Negligence
⚪ D. Missed error
⚪ E. Sentinel eventAfraTafreeh.com

19. ≣
Item 1 of 1
Question ID: 2004
Test Your Knowledge
Difficulty Rating: ✪✪✪ Bootcamp.com
A middle-aged female patient presents to the emergency department for respiratory distress. The patient is intubated and transferred to the ICU. The patient remains in the ICU
for several weeks. During that time, the patient has multiple family members visit her including her mother, older brother, son, uncle, and younger sister. Several of the patient’s
family members express concerns over her prolonged intubation and are requesting she be disconnected from the ventilator. The patient’s mother, who is a critical care
physician at a neighboring hospital, is adamant that this would be inappropriate management.
Which of the following would be the most appropriate next step in the management of this patient?
⚪ A. Immediately proceed with discontinuation of the ventilator
⚪ B. Contact the ethics committee
⚪ C. Discuss the next steps in decision making with the patient’s mother
⚪ D. Discuss the next steps in decision making with the patient’s son
⚪ E. Allow the patient to remain on the ventilatorAfraTafreeh.com

20. ≣
Item 1 of 1
Question ID: 2005
Test Your Knowledge
Difficulty Rating: ✪ Bootcamp.com
You are the physician managing the medical ICU at a large community hospital. During an overnight shift you admit a 78-year-old male who suffered cardiac arrest due to
septic shock. The patient is intubated, sedated, and he is on multiple medications to support his blood pressure. The following day at a local grocery store, you run into a
colleague who is currently employed at another hospital. He mentions that his friend’s father was admitted to the ICU at your hospital. Your colleague is asking for an update so
he can “explain it in plain language” to his friend. What is the most appropriate response?
⚪ A. Provide your colleague with an update on the patient’s current status and plan
⚪ B. Tell your colleague that the patient is in critical condition only
⚪ C. Tell your colleague that you cannot discuss any information
⚪ D. Explain to your colleague that you are taking care of his friend’s father, however you cannot disclose further information
⚪ E. Advise your colleague to call the medical ICU directly for an updateAfraTafreeh.com

21. ≣
Item 1 of 1
Question ID: 2006
Test Your Knowledge
Difficulty Rating: ✪✪ Bootcamp.com
You are the physician working in a busy emergency department when a nurse calls you to see a patient they are concerned about. A 14-year-old female with no known past
medical history presents due to lethargy. Her mother states the patient has been very sleepy for the past several days, however she appears even more sleepy today. The
patient’s mother also mentions the patient is currently on her menstrual period and has been changing her pads every hour. Blood work is obtained and you find that the patient
has a critically low hemoglobin. You explain to the mother that you believe the patient requires a blood transfusion, however the mother refuses, citing that this is against their
religious beliefs. While in the room, the patient’s blood pressure begins to drop rapidly. What is the most appropriate next step in management?
⚪ A. Proceed with emergent blood transfusion
⚪ B. Urge the mother to reconsider her decision
⚪ C. Attempt to obtain consent from the patient’s father instead
⚪ D. Withhold blood transfusion as per the mother’s wishes
⚪ E. Consult the ethics committeeAfraTafreeh.com

22. ≣
Item 1 of 1
Question ID: 2007
Test Your Knowledge
Difficulty Rating: ✪ Bootcamp.com
A family medicine physician is working in his local community clinic. The clinic is extremely busy and there are many patients waiting to be seen. A 56-year-old female with a
past medical history of lupus and Hashimoto’s thyroiditis presents due to a rash on her scalp. The patient is noted to be wearing a headscarf. After having her vital signs
completed, the patient is brought back into a room to be evaluated by the physician. When the physician asks the patient to remove her headscarf, she becomes visibly
uncomfortable and states that the rash is not bothering her very much and that she would like to leave. What is the most appropriate response by the physician?
⚪ A. “Okay, I respect your decision to leave”
⚪ B. “Would you feel more comfortable if a female examines the rash?”
⚪ C. “What is making you so uncomfortable?”
⚪ D. “I need to evaluate the rash so that I can appropriately treat you”
⚪ E. “I understand that you are uncomfortable, however this is a normal part of a medical exam” AfraTafreeh.com

23. ≣
Item 1 of 1
Question ID: 2008
Test Your Knowledge
Difficulty Rating: ✪✪ Bootcamp.com
An 89-year-old male with a past medical history of COPD presents to the hospital with his sister due to shortness of breath. The patient reports he recently ran out of his
albuterol inhaler and has been unable to refill it. The patient has audible wheezing during the interview, however he is able to speak in complete sentences and provide a full
history. The provider inquires if the patient would want to be intubated if his symptoms worsen and the patient states he would not want to be intubated under any
circumstances. The patient’s sister mentions that the patient’s memory “is not what it used to be” and has a paper document showing that she is the patient’s power of attorney.
The patient’s sister says the patient would want to be intubated. What is the most appropriate management if the patient’s condition worsens?
⚪
A. Intubate the patient since the sister has a legal document indicating power of attorney
⚪ B. Intubate the patient because it would then be an emergent situation
⚪ C. Do not intubate the patient because that is his request
⚪ D. Do not intubate the patient because his code status is unknown AfraTafreeh.com