Ethical Challenges in Life-Saving Medical Interventions:

Balancing Religious Beliefs and Healthcare Ethics

Group Five

Abd-Manaaf Bakere, Christian Cruz, Emmanuel Ikealugo-Dennis, Rachel Freundlich York College PA Program
Biomedical Ethics
Professor McGarry
July 14, 2023

Life-saving medical procedures such as abortions, blood transfusions, and organ transplantations may be considered a “no-brainer” for some individuals, however, there are also several patients for whom the decision is not as simple, especially for those from a particular religious background. Every day, many providers come across conflicts between a religious belief and a medical intervention, and the healthcare principles of beneficence, nonmaleficence, and autonomy come into question. Cultural competence is indeed a crucial skill for healthcare providers, including physician assistants (PAs). It involves having the knowledge, beliefs, and ability to provide effective healthcare to patients from diverse cultural backgrounds. By being culturally competent, PAs can enhance healthcare outcomes and promote better communication and understanding between patients and the healthcare team. Throughout this essay, independent views and beliefs varying from different spiritualities are analyzed regarding several medical practices. In essence, we intend to shed light on the many different perspectives patients have when it pertains to their health care and religious views, with hopes that it will help providers navigate these ethical dilemmas to provide patient-centered care that best meets the patient’s needs while respecting their religious beliefs.

Blood transfusion is a common treatment for various health problems such as anemia, major blood loss from injury, child birth or post surgery and hemophilia among many other related conditions. This type of treatment is often used when patients are in critical or life threatening conditions. However, there are some people who find this type of treatment to be against their religion. Jehovah’s Witnesses typically refuse the transfusion of whole blood and other blood components. Jehovah’s Witnesses believe that if a member of their religion were to ‘wilfully and unrepentantly’ accept a blood transfusion, it would be considered as if they have left the faith (Conti et al., 2018). Religious beliefs like these tend to put great strain on healthcare

providers and their primary goal of treating and healing those who come before them. Though providers are here to help patients they must also be mindful of the cultural and spiritual needs and beliefs of those in their care.

With the development of modern medicine there have been many ethical dilemmas when a patient who is in need of a blood transfusion refuses treatment. Every competent patient has the right to refuse a blood transfusion or more so any type of medication, procedure or treatment. A patient’s right to the refusal of care is founded upon one of the basic ethical principles of medicine, autonomy. Autonomy in healthcare indicates that individuals in care have the right to make decisions about their medical care without their health care provider trying to influence the decision. Cases where minors are involved and Jehovah’s witness parents are left to make decisions on their child’s behalf have often led to chaos and legal actions. Healthcare providers must act with the ethical principle of beneficence which is to act with the responsibility to promote the health and wellbeing of patients through research and evidence based practice with an end goal of achieving positive patient outcomes. Healthcare providers are usually placed in a position where they must ask for ordinance from judicial authorities to make decisions like performing a blood transfusion for minors who belong to Jehovah’s Witness. These providers do this with guidance of a simple point that states, “nobody can be deprived of life by their own parents” (Conti et al., 2018).

While blood transfusions are at times the treatment required to treat a patient, in other cases, patients require more invasive medical intervention. In the case of a woman whose pregnancy is either unintended, the result of rape, or putting the mother’s life in danger, abortion may be necessary. Abortion is a very controversial issue for many people coming from many different walks of life. At times, it can be very divisive, and it becomes even more complex

considering it in the medical setting. Today, providers not only have to consider the scientific perspective but also must acknowledge the diverse and religious outlook since it can directly influence a patient’s decision in their level of care. Many dilemmas can arise from this conflict of sciences vs religion, and it is important that we still practice the principles of autonomy, beneficence, and nonmaleficence. A common example of this dilemma between these factors is whether a patient can decide to abort a pregnancy in the event of a life-threatening scenario, rape or incest, and any other factors that may reduce the quality of life of the mother or infant (Swihart et al. 2022). As a provider, it is important to be culturally aware of these perspectives in order to adequately provide the best care to the patient that meets their preferences.

Some religions are stricter than others when it comes to whether abortion is considered “justifiable”. The Catholic religion believes abortion is forbidden under any circumstance, however, some exceptions can be made (Stephens et al,. 2010). Knowing the patient’s creed can be very useful in the context of providing the patient information in the event of life-threatening pregnancy or the event of pregnancy due to rape or incest. In the event of pregnancy due to rape, incest, or financial struggles, the Catholic Church opposes the option of abortion and instead promotes positive support from organizations or families in similar circumstances (Stephens et al., 2010). However, it is interesting to note that a study conducted by the Pew Research Center in 2014, found that 48% of Catholics were in favor of legalizing abortion in all states as opposed to 47% opposing the legalization of abortion in all states (Pew Research Center, 2023). In the event of a life-threatening pregnancy, the mother is not morally required to continue the abortion if it is deemed that the procedure will inevitably terminate the fetus. Interestingly, it has been noted that some mothers have taken the risk in some circumstances.

From a Jewish perspective, abortion is a much more lenient option when compared to the Catholic religion. The mother’s “already-existing” life is prioritized over the fetus in a life- threatening pregnancy (Stephens et al., 2010). According to the same study conducted by the Pew Research Center, 83% of Jewish individuals were in favor of legalizing abortion in all states, which is a significant finding (Pew Research Center, 2023). Even in the case of financial constraints, an abortion may be morally justifiable if it is likely that the pregnancy may result in severe depression or suicide to the mother (Stephens et al., 2010). While the Jewish perspective has an open view when it comes to abortion in emergent scenarios, it is also worth noting that the religion strongly opposes the procedure for the matter of inconvenience (Seltzer et al., 2022). The issue then becomes whether certain situations can be interpreted as life-threatening or not. In some cases, many providers encourage collaborating with rabbis or experts for further assistance and insight when attempting to counsel a patient (Seltzer et al., 2022).

In more extreme cases, when organ donation is the only medically indicated treatment, this can arouse many ethical dilemmas, particularly amongst varying religious groups. The issue of defining death, particularly brain death, and cultural challenges surrounding organ donation in a diverse society like the United States are significant factors in the field of transplantation. Sociological and anthropological studies have highlighted the role of symbolic aspects in transplantation medicine, shedding light on the concept of “cultural resistance.” While transplantation itself is not a subject of organized disputes or social speeches questioning its validity, there may not be as clear a consensus on organ donation as some experts suggest. Despite the public consensus and favorable positions of major religions toward organ donation, the persistent shortage of organs suggests social resistance or a lack of complete integration of organ donation into societal norms. The concept of the “compatibility culture” of transplantation,

according to doctor and philosopher Anne-Marie Moulin, has been overlooked and represents a major obstacle to its development.

Transplantation challenges traditional conceptions of self, bodily integrity, and death by presenting a mechanistic view of the body as repairable, with organs serving as replaceable parts. While Western medical ideology may perceive organs as mere biological entities, the lived experiences of patients, living donors, and their relatives often assign a deeper significance to the organs. Transplant patients may question their identity and draw connections between the characteristics of the donor and their newfound vigor, interests, or tastes, as if the transplanted organ carries the imprint of the donor’s personality. In the case of deceased donors, recipients may struggle with integrating the new organ into their body schema, temporarily impacting their sense of identity. These difficulties go beyond the individual patient and relate to the unfamiliarity of the situation itself. Organ transplantation is not a neutral process but an experience that resonates with the recipient’s identity and creates complex social relationships, real or imagined, between donors or their relatives and the transplant recipients.

The symbolic value of the body is also evident in the phenomenon of the “tyranny of the gift,” where recipients perceive the gift as a psychological and moral weight, resulting in a sense of indebtedness that cannot be repaid. Similarly, relatives who authorize organ removal may find solace in the belief that part of the deceased “survives” through the transplanted organs. On the other hand, the association of the person with their organs can lead to resistance towards organ donation, as it may be seen as fragmenting the integrity of the deceased’s body. The persistent symbolism attached to organs reveals a disconnect between the medical perspective and the intimate beliefs of people involved. Despite healthcare providers’ efforts to present a purely biological and functional view of the graft, it is often perceived as emotionally and symbolically

significant. This cultural difference in perspective of the medical world and some patients can lead to moral distress of clinicians. By adopting, recognizing and promoting values of diversity through cultural competence and awareness, clinicians and PAs can simultaneously decrease their moral distress and the resistance towards organ donation within certain cultures.

Organ donation is also often complicated by the lack of clarity amongst religions regarding what is considered to be irreversible death. Oftentimes, brain dead patients in a hospital would be candidates for organ donation. However, certain religions do not recognize brain death as irreversible, and would therefore not allow the patient’s organs to be removed for donation. For example, Islam believes that death is separation from body and soul defined in the Quran as the disintegration of the body. From this definition, brain death is not simply understood. In one study, an estimated 37% of Muslims supported the idea that brain death is irreversible, while 63% contended it (Alhawari, et al., 2019) Many Islamic ethical and medical scholars have written on this topic. While there is not one consensus, one significant approach states that a patient can be pronounced dead if three clinicians confirm that the patient is brain dead and there is no chance for recovery (Sajjad, et al., 2020). Because the donation of a vital organ from a living donor is forbidden in Islam, it is imperative that brain death be defined according to Muslim law (Padela, Auda, 2020).

Judaism similarly prohibits the donation of vital organs from a living donor. Therefore, brain death must be defined according to Jewish law. In the study referred to above, it was found that 71% of Jews reported that they believed in the certainty of brain death (Alhawari, et al., 2019). However, many religious Jews object to treating brain death as the complete cessation of life (Gabbay, Fins, 2019). Since brain death is not explicitly described in the Bible, the interpretation and therefore application of the text to modern medicine is in the hands of the Rabbis, Jewish

spiritual leaders. Therefore, the acknowledgement of brain death and its certainty as well as members of a family permitting organ donation from a brain dead patient will depend upon the guidance of one’s personal Rabbi. Fundamental to Judaism is the belief that preserving a life is of utmost importance and all efforts must be exerted in doing so (Steinberg, 2015). Organ donation is forbidden if it will hasten a person’s life in any manner. Therefore, the patient must be confirmed deceased before organs may be harvested.

The integration of medicine and religion present ethical dilemmas, particularly in cases which involve life-saving medical interventions. To navigate these complex decisions, the patient’s beliefs and religious associations must be identified and respected in order to maintain patient autonomy. However, a clinician may feel that this conflicts with their responsibility to act with beneficence and provide healthcare. To mitigate this challenge, involving religious and spiritual leaders can bridge gaps in understanding between parties involved (Weiner, Sheer, 2020). Engaging Rabbis, Sheikhs, and Priests provides patients with both spiritual and medical advocates to allow for the fusing of religion and modern day medicine to optimize patient’s care. Lastly and most importantly, training hospital staff to be culturally competent and aware is essential in building therapeutic provider-patient relationships. PAs should strive to collaborate respectfully with individuals from diverse backgrounds, seeking their input and involving them in decision-making processes. This can enable PAs to lead their team in reducing the strain of cultural and religious conflicts in healthcare.

Works Cited

Conti, A., Capasso, E., Casella, C., Fedeli, P., Salzano, F. A., Policino, F., Terracciano, L., & Delbon, P. (2018). Blood Transfusion in Children: The Refusal of Jehovah’s Witness Parents’. Open medicine (Warsaw, Poland), 13, 101–104. https://doi.org/10.1515/med-2018-0016

Gordon, E. J., Romo, E., Amórtegui, D., Rodas, A., Anderson, N., Uriarte, J., McNatt, G., Caicedo, J. C., Ladner, D. P., & Shumate, M. (2020). Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study. Health expectations : an international journal of public participation in health care and health policy, 23(6), 1450–1465. https://doi.org/10.1111/hex.13124

Alhawari, Y., Verhoff, M. A., Ackermann, H., & Parzeller, M. (2019). Religious

denomination influencing attitudes towards brain death, organ transplantation and

autopsy—a survey among people of different religions. International Journal of

Legal Medicine, 134(3), 1203–1212. https://doi.org/10.1007/s00414-019-02130-0

Gabbay, E., & Fins, J. J. (2019). Go in Peace: Brain Death, Reasonable

Accommodation and Jewish Mourning Rituals. Journal of Religion and Health,

58(5), 1672–1686. https://doi.org/10.1007/s10943-019-00874-y

Kassim, P. N., & Alias, F. (2015). Religious, Ethical and Legal Considerations in

End-of-Life Issues: Fundamental Requisites for Medical Decision Making.

Journal of Religion and Health, 55(1), 119–134. https://doi.org/10.1007/s10943-

014-9995-z

Liu, J. (2013, November 21). Religious groups’ views on end-of-life issues. Pew

Research Center. https://www.pewresearch.org/religion/2013/11/21/religious-

groups-views-on-end-of-life-issues/

N. Scheper-Hughes, “The Tyranny of the Gift: Sacrificial Violence in LivingDonor Transplants”
Published by American Journal of Transplantation. @ https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-6143.2006.01679.x. Accessed July 12, 2023

Padela, A. I., & Auda, J. (2020). The Moral Status of Organ Donation and Transplantation Within Islamic Law. Transplantation Direct, 6(3), e536. https://doi.org/10.1097/txd.0000000000000980

Pew Research Center. (2022). Religious Landscape Study. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/religion/religious- landscape-study/views-about-abortion/

Seltzer, S. (2022, 21). Jewish law and abortion. Lilith, 46, 5. Retrieved from http://york.ezproxy.cuny.edu/login?url=https://www.proquest.com/magazines/jew ish-law-abortion/docview/2631909626/se-2.

Stephens, M., Jordens, C. F. C., Kerridge, I. H., & Ankeny, R. A. (2010). Religious Perspectives on Abortion and a Secular Response. Journal of Religion and Health, 49(4), 513–535. https://doi.org/10.1007/s10943-009-9273-7

Swihart, D. L., & Martin, R. L. (2022, November 14). Cultural Religious Competence In Clinical Practice. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493216/

Zouaghi, S. (2023). Receiving an organ: The ambivalence of the debt and the question of giving back. Recherche et Applications En Marketing (English Edition), 38(2), 57–79. https://doi.org/10.1177/20515707231161217

This case depicts a distressing interaction between an attending physician, his dermatologic residents, and a Haitian woman who has limited English proficiency and is suffering from an immunologic skin condition. The attending physician, in an attempt to teach his students, briefly explained in English to both the patient and residents what they would be examining. However, without obtaining explicit consent from the patient, potentially due to her English limitation, he abruptly pulled down her hospital gown, exposing her breasts. The patient’s discomfort was evident as her eyes widened and her arms remained paralyzed at her sides. This essay aims to examine the ethical dilemma surrounding this case, focusing on the violation of the patient’s right to be fully informed and give consent against the beneficence of treating her condition.

Interactions between healthcare professionals and patients from different cultures are increasingly common in our diverse society. Communication plays a vital role in patient care, and linguistic diversity can create barriers that impact the quality and accessibility of healthcare, as well as overall health outcomes. In this case, the physician failed to ensure that the patient understood the procedure being performed. This failure compromises the principles of autonomy, which are core values in the physician assistant profession. The pursuit of beneficence, in this case treating her skin condition and teaching the future clinicians, should not override the importance of respecting patients’ autonomy. It is essential to recognize that communication with foreign language or Limited English proficient patients requires different approaches. The most effective means of communication in this case is through the use of professional interpreters.

This scenario underscores the significance of utilizing networks of professional interpreters who are specifically trained in medical interpreting and adhere to principles of confidentiality, professional objectivity, and neutrality. The use of such interpreters ensures that the quality of communication between healthcare providers and patients who have limited English proficiency or struggle with the language is on par with those who are fluent. In the case described, the presence of an interpreter would have alleviated the patient’s emotional distress. Moreover, it would have guaranteed adherence to medical ethics principles, including autonomy, by facilitating the transmission of accurate information, obtaining informed consent, and ensuring respect for confidentiality and medical privacy. In addition, the therapeutic efficacy of the encounter would have been enhanced, and sufficient time would have been allocated for the teaching session.

However, it is important to acknowledge that professional interpreters are not always readily available, and there may be delays in accessing their services. In this case, if the attending had at least requested one, it possible that he could not find an interpreter, instead of ignored this patient’s right. In such cases, qualified bilingual staff who possess medical knowledge and can clarify crucial points for patient care can be utilized. However, the availability of such staff outside of working hours is limited, and their contribution to this task is often not financially compensated. Another option in certain situations is to engage a telephone interpreter.

To deliver quality care, it is essential for patients to understand their healthcare providers and to be understood by them. Core values of the PA Practice highlight the importance of providing information that is understandable to competent patients. Without effective communication, a solid bond of trust cannot be established, and most importantly, patients cannot provide their preferences, nor consent to care in a free and informed manner. Recognizing that a language barrier can hinder the therapeutic relationship, the PA Practice core values expect all Physician Assistants to exert every effort and demonstrate a genuine desire to communicate with their patients in the

appropriate language. Lastly, it is crucial to remember that patients are our partners in care, and as healthcare professionals, we should treat them with the utmost respect and dignity.

Reference

Gaurab Basu, MD, MPH, Vonessa Phillips Costa, and Priyank Jain, MD. “Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency”.
AMA J Ethics. 2017;19(3):245-252. doi: 10.1001/journalofethics.2017.19.3.ecas2-1703.

Jonsen, A., Siegler, M., & Winslade, W. (2015). Clinical ethics: A practical approach to ethical decisions in clinical medicine. (8th edition).

Guidelines for Ethical Conduct for the PA Profession, AAPA, reaffirmed 2013

For the final semester of Clinical Correlations, my instructor was Professor Gary Maida.

Levels of Achievement Criteria	Proficient	Developing	Minimum Performance	Unsatisfactory
Content & Focus Weight 30.00%	95 % Clearly understands content, focused upon most relevant information. And uses best sources of evidence	85 % Familiar with content, may not be appropriately focused or does not use best sources of evidence	70 % Has some familiarity with content, but lacks focus on most important elements. Sources are tangentially relevant, but not on target.	0% Unfamiliar with content required for participation.
Logic and Flow Weight 30.00%	100 % Able to present an argument or topic in a logical and organized fashion.	95 % Presents an argument or topic in a thorough way, but needs better logic or organization	70 % Presents some aspects of topic well, but lacks logic or organization in other aspects	0% Disorganized presentation, not supporting point of view
Analysis Weight 30.00%	95 % Identifies relationships and components to clearly support opinions or ideas	85 % Identifies relationships and components, but lacks clarity in supporting opinions or ideas	70 % Identifies some relationships and components, but lacks some important connections.	0% Does not identify components or relationships
Communication/ Collaboration Weight 30.00%	100 % Demonstrates good listening and reflecting skills and contributes appropriately. Able to present clearly and effectively	85 % Listening or reflecting skills are good and contributes appropriately. Presents clearly, but could improve speaking style	70 % Listening or reflecting skills are minimal and contributes only minimally Presents information that is correct, but needs to work on clarity and speaking style	0% Does not contribute appropriately or lacks listening and

Throughout these sessions, I’ve witnessed significant growth in my confidence regarding decision- making and critical thinking. I’ve refined my ability to connect various class materials, especially by initially providing a top differential diagnosis and then adjusting it with gathered patient information. This method has played a pivotal role in my overall development.

Regarding Content & Focus, I have evaluated myself at 95%. I’ve deepened my familiarity with topics and maintained a sharper focus during discussions. While successfully considering and narrowing down differential diagnoses with evolving patient information, I recognize the need for further improvement in this skill. The simulation exercises, where we interpreted patient results and labs, offered invaluable real-life scenario insights, effectively preparing me for rotations.

In terms of Logic/Flow and Analysis, I’ve rated myself at 95%. I’m learning that presenting symptoms might not always directly relate to the final diagnosis. For instance, the case of the 5- year-old boy presenting with a red, puffy eye and later developing fever, lethargy, and knee pain, ultimately diagnosed with leukemia, emphasized this point vividly.

Our team dynamics have been positive, fostering reliance on each other as we gathered patient information. Presenting cases to the group has been a great learning experience, requiring in-depth research and guiding discussions on the subject and differential diagnoses. I’ve come to appreciate how seemingly unrelated questions can significantly impact the diagnostic process.

Reflecting on these sessions, it’s evident that this approach has been invaluable for my growth, enhancing not only my medical knowledge but also my collaborative and analytical skills essential for effective medical practice.

A surprising and demanding element in my experience was the regular rotation of instructors during the clinical correlations courses. I perceive this as immensely beneficial, exposing us, as students, to diverse educators with unique expectations for in-class presentations, participation, and our knowledge base. I believe this aspect closely parallels what we will face in the clinical year, and for that, I am truly appreciative. The tools I found most advantageous in the clinical correlations class were UpToDate, Pubmed, CMDT, NEJM, and Cochrane Reviews.

Public Health Intervention

Policy Brief Analysis

To: Bob Cook-Deegan

From: Abd-Manaaf Bakere
Date: July 18, 2023
Re: Policies to Implement to Increase access to dental care

Problem Statement: What type of policy should be implemented to increase access to dental care?

Background:
Maintaining good dental hygiene is crucial as we rely on our mouths for various daily activities throughout our lives. From breathing and speaking to consuming food and beverages, our oral health significantly impacts our overall well-being. This is particularly true for the elderly population, where neglecting proper dental care can lead to an increased risk of gum pain and gum disease, resulting in difficulties with eating, dry mouth affecting speech, and compromised eating habits. Furthermore, poor dental health among the elderly can have cosmetic implications, affecting self-esteem. Research has also established a correlation between periodontal disease and other health complications such as heart issues, strokes, diabetes-related complications, and respiratory problems^1. According to a recent report by the CDC, approximately 47.2% of adults aged 30 years and older have some form of periodontal disease, with the prevalence increasing with age, affecting 70.1% of adults aged 65 years and older^2.

The oral health of Americans has shown improvement over time, but significant challenges. remain, particularly for low-income families. Limited access to oral health care perpetuates a cycle of poverty and compromised overall health. Children from low-income families are more likely to suffer from tooth decay and less likely to visit the dentist, leading to untreated decay affecting more than 9.6 million kids^3. The consequences of untreated tooth decay extend beyond pain and anxiety, as it can cause malnourishment and make children vulnerable to bullying. Moreover, dental issues contribute to missed school hours, with 34 million hours lost annually^3.

Landscape:

Dental insurance coverage remains a significant concern in the United States, with one in three Americans lacking dental insurance. The primary deterrent for adults in seeking dental care is the high cost associated with it^4. For individuals without insurance, routine dental cleanings can cost nearly $200, while extensive treatments like braces can quickly accumulate into thousands of dollars. It is important to note that health insurance and dental insurance are separate in the US, and public insurance programs such as Medicaid and Medicare either provide limited coverage or do not cover dental care at all. Public officials have a crucial role in considering the inclusion of dental care within Medicaid and Medicare. Expensive private dental insurance policies typically offer coverage in three categories: preventive care (such as regular exams, cleanings, and X-rays) with 100% coverage, basic services (including fillings and simple extractions) with 80% coverage, and major services (such as root canals, bridges, crowns, dentures, and implants) with 50% coverage.

The American Dental Association highlights several reasons why individuals are not able to access necessary dental care. The primary reason, affecting 11.4% of people, is the inability to afford the costs associated with dental treatment. Additionally, 3.0% of individuals face the obstacle of insurance plans that do not cover necessary procedures, while 1.2% simply choose not to allocate funds towards dental care. Fear or dislike of dentists is another common deterrent^4. Although less prevalent at less than 1%, other factors such as being too busy, unable to take time off work, expecting the issue to resolve on its own, inconvenient office hours, distant dental offices, or receiving contrary recommendations from other dentists also contribute to the problem^4. It is evident from these challenges that a collaborative effort involving community leaders, government officials, public health professionals, healthcare providers, and social service providers is necessary to address these issues. These stakeholders should focus on improving oral health care financing, strengthening the oral health workforce, and removing barriers to accessing dental services.

Policy Options

1: A federal policy mandate requiring Medicaid and Medicare to include coverage of dental services is crucial. It is particularly important to add a dental benefit to Medicare Part B^5. Currently, almost half of the Medicare population, which amounts to 24 million beneficiaries, lack any dental coverage whatsoever^5. Additionally, dental services are currently optional under Medicaid^1. By mandating dental coverage within these programs, millions of individuals, especially vulnerable populations, will have improved access to essential oral healthcare. This step would address a significant gap in healthcare coverage and contribute to overall improved oral health outcomes for Medicare and Medicaid beneficiaries.

Advantages: While enrollment in Medicare Part B is voluntary, the vast majority of beneficiaries who are entitled to Part A are also enrolled in Part B. Medicaid on the other hand, is the most common form of public insurance, covering more than 86 million people each year. This policy would establish appropriate standards of preventive and restorative oral health care to which everyone living in US to have reasonable access. Including dental services in Medicaid and Medicare promotes the integration of oral health care with primary and overall healthcare. This integration can lead to better coordination of care, improved communication among healthcare providers, and a more holistic approach to patients’ well-being.

Disadvantages: Including dental services in Medicaid and Medicare coverage would require additional funding from the federal government. The cost of providing comprehensive dental care to a large population could strain the budget and potentially lead to increased taxes or reduced funding for other healthcare areas^5. Furthermore, the inclusion of dental services under Medicaid and Medicare coverage might result in increased demand for dental care, potentially leading to overutilization of services. Without appropriate utilization management, this could strain the healthcare system, increase costs, and delay care for those in need. Furthermore, it is worth noting that some healthcare institutions still do not accept Medicaid insurance, posing a barrier to access for those covered by these programs.

2: Policy that increase the numbers of oral health professionals who can deliver high standards of oral healthcare^6. Need to increase federal and state funding to dental schools and oral health professional training programs. To increase access to oral health care, states can play a vital role by authorizing both traditional and non-traditional providers to deliver dental services. Traditional providers such as dentists, dental hygienists, and dental assistants can continue to offer their

expertise. Additionally, non-traditional providers like primary care physicians, pharmacists, community health workers, and social workers can be trained and empowered to contribute to a robust and comprehensive oral health care system^6.
Advantages: This collaborative approach would leverage the skills and resources of various healthcare professionals, enabling them to work together in addressing the oral health needs of underserved populations, especially low-income families.

Disadvantages: It will potentially increase healthcare expenditures, which are already high. The absence of universal health insurance can indeed present challenges to collaborative efforts. Increasing the overall numbers of oral health professionals may not address the issue of maldistribution. Certain regions, particularly rural and underserved areas, may still face shortages even with an overall increase in professionals. Encouraging professionals to practice in these underserved areas may require additional incentives and support.

3: State policy to expand the scope of services allowed for oral health providers^6. States policy can enable them to perform a broader range of procedures, increasing their capacity to meet the needs of patients. States have the power to enhance access to dental care by implementing workforce-related legislation, regulations, and procedures. These measures can be effective in improving the availability of oral health services for underserved populations.

Advantages: Relaxing supervision requirements can allow dental hygienists and other non-dentist providers to work more independently, extending their reach to areas with limited access to dental care. Expanding teledentistry services can leverage technology to connect patients with oral health providers remotely, particularly in rural or underserved areas. Granting more providers, the authority to write prescriptions can streamline the process of obtaining necessary medications for dental treatments. Encouraging authorized dental providers to practice at federally qualified health centers can further improve access, as these centers often serve low-income individuals and communities with limited resources.

Disadvantages: Different oral health providers may have varying levels of training and education. Expanding their scope of practice without adequate standardization and oversight can result in inconsistent quality of care across providers. Expansion often requires changes in regulatory frameworks, licensure requirements, and professional scopes of practice^6. These changes can be complex and time-consuming, requiring careful consideration of potential risks, consensus- building among stakeholders, and adjustments to legal and regulatory systems.

4: State policy that aims to educate patients and the general public about the importance of oral hygiene, preventive measures, and regular dental care^1. This will need an integration into school curriculum and public awareness campaigns.
Advantages: Incorporate oral health education into school curricula at various levels, starting from primary education. This ensures that children receive early education on proper oral hygiene practices and understand the importance of maintaining oral health. Encourage healthcare providers, including primary care physicians and pediatricians, to incorporate oral health education into their practice. Provide training and resources to ensure they can effectively communicate oral health information to patients and emphasize the importance of regular dental visits. Disadvantages: Education alone may not guarantee behavior change. Despite receiving information about oral hygiene and preventive measures, individuals may not always translate that knowledge into consistent practices. Some individuals may struggle to adopt new habits or prioritize oral health due to various factors, including competing priorities, cultural beliefs, or lack

of resources. Language and literacy levels, cultural beliefs, practices, and attitudes, can influence the effectiveness of educational programs. If materials are not provided in multiple languages or presented in a way that is easily understood by diverse populations, some individuals may not fully comprehend or engage with the educational content.

Policy Recommendation

Including dental services in Medicaid and Medicare coverage ensures that a larger population, particularly low-income individuals, and seniors, has access to essential oral health care^5. This can help address existing disparities in dental care access and reduce barriers to treatment for vulnerable populations. By providing coverage for dental services, the federal policy mandate can contribute to improved overall health outcomes. Timely prevention, diagnosis, and treatment of oral health issues can help prevent or manage systemic conditions such as cardiovascular disease, diabetes, and respiratory infections. Early detection and treatment of oral health issues can prevent the progression of diseases, reduce emergency room visits related to dental problems, and minimize the need for expensive interventions. Lastly Extending dental coverage to Medicaid and Medicare aligns with principles of equity and social justice, ensuring that individuals have equal access to necessary healthcare services, regardless of their income or age.

References

1.Center for Health Care Strategies. “Medicaid adult dental benefits: an overview.” Fact Sheet. January 2018. Available from: https://www.chcs.org/media/Adult-Oral-Health-Fact- Sheet_011618.pdf. Accessed July 17, 2023.

2.Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion. “Basics of Oral Health.” Last Reviewed: January 4, 2023. Available from: https://www.cdc.gov/oralhealth/basics/index.html

3. National Center for Health Statistics. “Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016” Published by CDC on July 25, 2018. https://www.cdc.gov/nchs/products/databriefs/db307.htm

4.Niodita Gupta, Marko Vujicic. “Main Barriers to Getting Needed Dental Care All Relate to Affordability.” Published by The Health Policy Institute, American Dental Association. Available from: https://www.ada.org/-/media/project/ada-organization/ada/ada- org/files/resources/research/hpi/hpibrief_0419_1.pdf

5.Meredith Freed, Lisa Potetz, Gretchen Jacobson, and Tricia Neuman. “Policy Options for Improving Dental Coverage for People on Medicare.” Published By KFF on Sep 18, 2019. Available from: https://www.kff.org/medicare/issue-brief/policy-options-for-improving-dental- coverage-for-people-on-medicare/

6.US Department of Health and Human Services. “Using Law and Policy to Promote the Use of Oral Health Services in the United States.” Published by Office of Disease Prevention and Health Promotion (OSHA). Available from: https://health.gov/our-work/national-health- initiatives/healthy-people/healthy-people-2020/healthy-people-2020-law-and-health-policy/oral- health

Ethical Argument Essay
This case depicts a distressing interaction between an attending physician, his dermatologic residents, and a Haitian woman who has limited English proficiency and is suffering from an immunologic skin condition. The attending physician, in an attempt to teach his students, briefly explained in English to both the patient and residents what they would be examining. However, without obtaining explicit consent from the patient, potentially due to her English limitation, he abruptly pulled down her hospital gown, exposing her breasts. The patient’s discomfort was evident as her eyes widened and her arms remained paralyzed at her sides. This essay aims to examine the ethical dilemma surrounding this case, focusing on the violation of the patient’s right to be fully informed and give consent against the beneficence of treating her condition.

Interactions between healthcare professionals and patients from different cultures are increasingly common in our diverse society. Communication plays a vital role in patient care, and linguistic diversity can create barriers that impact the quality and accessibility of healthcare, as well as overall health outcomes. In this case, the physician failed to ensure that the patient understood the procedure being performed. This failure compromises the principles of autonomy, which are core values in the physician assistant profession. The pursuit of beneficence, in this case treating her skin condition and teaching the future clinicians, should not override the importance of respecting patients’ autonomy. It is essential to recognize that communication with foreign language or Limited English proficient patients requires different approaches. The most effective means of communication in this case is through the use of professional interpreters.

This scenario underscores the significance of utilizing networks of professional interpreters who are specifically trained in medical interpreting and adhere to principles of confidentiality, professional objectivity, and neutrality. The use of such interpreters ensures that the quality of communication between healthcare providers and patients who have limited English proficiency or struggle with the language is on par with those who are fluent. In the case described, the presence of an interpreter would have alleviated the patient’s emotional distress. Moreover, it would have guaranteed adherence to medical ethics principles, including autonomy, by facilitating the transmission of accurate information, obtaining informed consent, and ensuring respect for confidentiality and medical privacy. In addition, the therapeutic efficacy of the encounter would have been enhanced, and sufficient time would have been allocated for the teaching session.

However, it is important to acknowledge that professional interpreters are not always readily available, and there may be delays in accessing their services. In this case, if the attending had at least requested one, it possible that he could not find an interpreter, instead of ignored this patient’s right. In such cases, qualified bilingual staff who possess medical knowledge and can clarify crucial points for patient care can be utilized. However, the availability of such staff outside of working hours is limited, and their contribution to this task is often not financially compensated. Another option in certain situations is to engage a telephone interpreter.

To deliver quality care, it is essential for patients to understand their healthcare providers and to be understood by them. Core values of the PA Practice highlight the importance of providing information that is understandable to competent patients. Without effective communication, a solid bond of trust cannot be established, and most importantly, patients cannot provide their preferences, nor consent to care in a free and informed manner. Recognizing that a language barrier can hinder the therapeutic relationship, the PA Practice core values expect all Physician Assistants to exert every effort and demonstrate a genuine desire to communicate with their patients in the

appropriate language. Lastly, it is crucial to remember that patients are our partners in care, and as healthcare professionals, we should treat them with the utmost respect and dignity.

Reference

Gaurab Basu, MD, MPH, Vonessa Phillips Costa, and Priyank Jain, MD. “Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency”.
AMA J Ethics. 2017;19(3):245-252. doi: 10.1001/journalofethics.2017.19.3.ecas2-1703.

Jonsen, A., Siegler, M., & Winslade, W. (2015). Clinical ethics: A practical approach to ethical decisions in clinical medicine. (8th edition).

Guidelines for Ethical Conduct for the PA Profession, AAPA, reaffirmed 2013

Course Project

Ethical Challenges in Life-Saving Medical Interventions:

Balancing Religious Beliefs and Healthcare Ethics

Group Five

Abd-Manaaf Bakere, Christian Cruz, Emmanuel Ikealugo-Dennis, Rachel Freundlich York College PA Program
Biomedical Ethics
Professor McGarry
July 14, 2023

Life-saving medical procedures such as abortions, blood transfusions, and organ transplantations may be considered a “no-brainer” for some individuals, however, there are also several patients for whom the decision is not as simple, especially for those from a particular religious background. Every day, many providers come across conflicts between a religious belief and a medical intervention, and the healthcare principles of beneficence, nonmaleficence, and autonomy come into question. Cultural competence is indeed a crucial skill for healthcare providers, including physician assistants (PAs). It involves having the knowledge, beliefs, and ability to provide effective healthcare to patients from diverse cultural backgrounds. By being culturally competent, PAs can enhance healthcare outcomes and promote better communication and understanding between patients and the healthcare team. Throughout this essay, independent views and beliefs varying from different spiritualities are analyzed regarding several medical practices. In essence, we intend to shed light on the many different perspectives patients have when it pertains to their health care and religious views, with hopes that it will help providers navigate these ethical dilemmas to provide patient-centered care that best meets the patient’s needs while respecting their religious beliefs.

Blood transfusion is a common treatment for various health problems such as anemia, major blood loss from injury, child birth or post surgery and hemophilia among many other related conditions. This type of treatment is often used when patients are in critical or life threatening conditions. However, there are some people who find this type of treatment to be against their religion. Jehovah’s Witnesses typically refuse the transfusion of whole blood and other blood components. Jehovah’s Witnesses believe that if a member of their religion were to ‘wilfully and unrepentantly’ accept a blood transfusion, it would be considered as if they have left the faith (Conti et al., 2018). Religious beliefs like these tend to put great strain on healthcare

providers and their primary goal of treating and healing those who come before them. Though providers are here to help patients they must also be mindful of the cultural and spiritual needs and beliefs of those in their care.

With the development of modern medicine there have been many ethical dilemmas when a patient who is in need of a blood transfusion refuses treatment. Every competent patient has the right to refuse a blood transfusion or more so any type of medication, procedure or treatment. A patient’s right to the refusal of care is founded upon one of the basic ethical principles of medicine, autonomy. Autonomy in healthcare indicates that individuals in care have the right to make decisions about their medical care without their health care provider trying to influence the decision. Cases where minors are involved and Jehovah’s witness parents are left to make decisions on their child’s behalf have often led to chaos and legal actions. Healthcare providers must act with the ethical principle of beneficence which is to act with the responsibility to promote the health and wellbeing of patients through research and evidence based practice with an end goal of achieving positive patient outcomes. Healthcare providers are usually placed in a position where they must ask for ordinance from judicial authorities to make decisions like performing a blood transfusion for minors who belong to Jehovah’s Witness. These providers do this with guidance of a simple point that states, “nobody can be deprived of life by their own parents” (Conti et al., 2018).

While blood transfusions are at times the treatment required to treat a patient, in other cases, patients require more invasive medical intervention. In the case of a woman whose pregnancy is either unintended, the result of rape, or putting the mother’s life in danger, abortion may be necessary. Abortion is a very controversial issue for many people coming from many different walks of life. At times, it can be very divisive, and it becomes even more complex

considering it in the medical setting. Today, providers not only have to consider the scientific perspective but also must acknowledge the diverse and religious outlook since it can directly influence a patient’s decision in their level of care. Many dilemmas can arise from this conflict of sciences vs religion, and it is important that we still practice the principles of autonomy, beneficence, and nonmaleficence. A common example of this dilemma between these factors is whether a patient can decide to abort a pregnancy in the event of a life-threatening scenario, rape or incest, and any other factors that may reduce the quality of life of the mother or infant (Swihart et al. 2022). As a provider, it is important to be culturally aware of these perspectives in order to adequately provide the best care to the patient that meets their preferences.

Some religions are stricter than others when it comes to whether abortion is considered “justifiable”. The Catholic religion believes abortion is forbidden under any circumstance, however, some exceptions can be made (Stephens et al,. 2010). Knowing the patient’s creed can be very useful in the context of providing the patient information in the event of life-threatening pregnancy or the event of pregnancy due to rape or incest. In the event of pregnancy due to rape, incest, or financial struggles, the Catholic Church opposes the option of abortion and instead promotes positive support from organizations or families in similar circumstances (Stephens et al., 2010). However, it is interesting to note that a study conducted by the Pew Research Center in 2014, found that 48% of Catholics were in favor of legalizing abortion in all states as opposed to 47% opposing the legalization of abortion in all states (Pew Research Center, 2023). In the event of a life-threatening pregnancy, the mother is not morally required to continue the abortion if it is deemed that the procedure will inevitably terminate the fetus. Interestingly, it has been noted that some mothers have taken the risk in some circumstances.

From a Jewish perspective, abortion is a much more lenient option when compared to the Catholic religion. The mother’s “already-existing” life is prioritized over the fetus in a life- threatening pregnancy (Stephens et al., 2010). According to the same study conducted by the Pew Research Center, 83% of Jewish individuals were in favor of legalizing abortion in all states, which is a significant finding (Pew Research Center, 2023). Even in the case of financial constraints, an abortion may be morally justifiable if it is likely that the pregnancy may result in severe depression or suicide to the mother (Stephens et al., 2010). While the Jewish perspective has an open view when it comes to abortion in emergent scenarios, it is also worth noting that the religion strongly opposes the procedure for the matter of inconvenience (Seltzer et al., 2022). The issue then becomes whether certain situations can be interpreted as life-threatening or not. In some cases, many providers encourage collaborating with rabbis or experts for further assistance and insight when attempting to counsel a patient (Seltzer et al., 2022).

In more extreme cases, when organ donation is the only medically indicated treatment, this can arouse many ethical dilemmas, particularly amongst varying religious groups. The issue of defining death, particularly brain death, and cultural challenges surrounding organ donation in a diverse society like the United States are significant factors in the field of transplantation. Sociological and anthropological studies have highlighted the role of symbolic aspects in transplantation medicine, shedding light on the concept of “cultural resistance.” While transplantation itself is not a subject of organized disputes or social speeches questioning its validity, there may not be as clear a consensus on organ donation as some experts suggest. Despite the public consensus and favorable positions of major religions toward organ donation, the persistent shortage of organs suggests social resistance or a lack of complete integration of organ donation into societal norms. The concept of the “compatibility culture” of transplantation,

according to doctor and philosopher Anne-Marie Moulin, has been overlooked and represents a major obstacle to its development.

Transplantation challenges traditional conceptions of self, bodily integrity, and death by presenting a mechanistic view of the body as repairable, with organs serving as replaceable parts. While Western medical ideology may perceive organs as mere biological entities, the lived experiences of patients, living donors, and their relatives often assign a deeper significance to the organs. Transplant patients may question their identity and draw connections between the characteristics of the donor and their newfound vigor, interests, or tastes, as if the transplanted organ carries the imprint of the donor’s personality. In the case of deceased donors, recipients may struggle with integrating the new organ into their body schema, temporarily impacting their sense of identity. These difficulties go beyond the individual patient and relate to the unfamiliarity of the situation itself. Organ transplantation is not a neutral process but an experience that resonates with the recipient’s identity and creates complex social relationships, real or imagined, between donors or their relatives and the transplant recipients.

The symbolic value of the body is also evident in the phenomenon of the “tyranny of the gift,” where recipients perceive the gift as a psychological and moral weight, resulting in a sense of indebtedness that cannot be repaid. Similarly, relatives who authorize organ removal may find solace in the belief that part of the deceased “survives” through the transplanted organs. On the other hand, the association of the person with their organs can lead to resistance towards organ donation, as it may be seen as fragmenting the integrity of the deceased’s body. The persistent symbolism attached to organs reveals a disconnect between the medical perspective and the intimate beliefs of people involved. Despite healthcare providers’ efforts to present a purely biological and functional view of the graft, it is often perceived as emotionally and symbolically

significant. This cultural difference in perspective of the medical world and some patients can lead to moral distress of clinicians. By adopting, recognizing and promoting values of diversity through cultural competence and awareness, clinicians and PAs can simultaneously decrease their moral distress and the resistance towards organ donation within certain cultures.

Organ donation is also often complicated by the lack of clarity amongst religions regarding what is considered to be irreversible death. Oftentimes, brain dead patients in a hospital would be candidates for organ donation. However, certain religions do not recognize brain death as irreversible, and would therefore not allow the patient’s organs to be removed for donation. For example, Islam believes that death is separation from body and soul defined in the Quran as the disintegration of the body. From this definition, brain death is not simply understood. In one study, an estimated 37% of Muslims supported the idea that brain death is irreversible, while 63% contended it (Alhawari, et al., 2019) Many Islamic ethical and medical scholars have written on this topic. While there is not one consensus, one significant approach states that a patient can be pronounced dead if three clinicians confirm that the patient is brain dead and there is no chance for recovery (Sajjad, et al., 2020). Because the donation of a vital organ from a living donor is forbidden in Islam, it is imperative that brain death be defined according to Muslim law (Padela, Auda, 2020).

Judaism similarly prohibits the donation of vital organs from a living donor. Therefore, brain death must be defined according to Jewish law. In the study referred to above, it was found that 71% of Jews reported that they believed in the certainty of brain death (Alhawari, et al., 2019). However, many religious Jews object to treating brain death as the complete cessation of life (Gabbay, Fins, 2019). Since brain death is not explicitly described in the Bible, the interpretation and therefore application of the text to modern medicine is in the hands of the Rabbis, Jewish

spiritual leaders. Therefore, the acknowledgement of brain death and its certainty as well as members of a family permitting organ donation from a brain dead patient will depend upon the guidance of one’s personal Rabbi. Fundamental to Judaism is the belief that preserving a life is of utmost importance and all efforts must be exerted in doing so (Steinberg, 2015). Organ donation is forbidden if it will hasten a person’s life in any manner. Therefore, the patient must be confirmed deceased before organs may be harvested.

The integration of medicine and religion present ethical dilemmas, particularly in cases which involve life-saving medical interventions. To navigate these complex decisions, the patient’s beliefs and religious associations must be identified and respected in order to maintain patient autonomy. However, a clinician may feel that this conflicts with their responsibility to act with beneficence and provide healthcare. To mitigate this challenge, involving religious and spiritual leaders can bridge gaps in understanding between parties involved (Weiner, Sheer, 2020). Engaging Rabbis, Sheikhs, and Priests provides patients with both spiritual and medical advocates to allow for the fusing of religion and modern day medicine to optimize patient’s care. Lastly and most importantly, training hospital staff to be culturally competent and aware is essential in building therapeutic provider-patient relationships. PAs should strive to collaborate respectfully with individuals from diverse backgrounds, seeking their input and involving them in decision-making processes. This can enable PAs to lead their team in reducing the strain of cultural and religious conflicts in healthcare.

Works Cited

Conti, A., Capasso, E., Casella, C., Fedeli, P., Salzano, F. A., Policino, F., Terracciano, L., & Delbon, P. (2018). Blood Transfusion in Children: The Refusal of Jehovah’s Witness Parents’. Open medicine (Warsaw, Poland), 13, 101–104. https://doi.org/10.1515/med-2018-0016

Gordon, E. J., Romo, E., Amórtegui, D., Rodas, A., Anderson, N., Uriarte, J., McNatt, G., Caicedo, J. C., Ladner, D. P., & Shumate, M. (2020). Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study. Health expectations : an international journal of public participation in health care and health policy, 23(6), 1450–1465. https://doi.org/10.1111/hex.13124

Alhawari, Y., Verhoff, M. A., Ackermann, H., & Parzeller, M. (2019). Religious

denomination influencing attitudes towards brain death, organ transplantation and

autopsy—a survey among people of different religions. International Journal of

Legal Medicine, 134(3), 1203–1212. https://doi.org/10.1007/s00414-019-02130-0

Gabbay, E., & Fins, J. J. (2019). Go in Peace: Brain Death, Reasonable

Accommodation and Jewish Mourning Rituals. Journal of Religion and Health,

58(5), 1672–1686. https://doi.org/10.1007/s10943-019-00874-y

Kassim, P. N., & Alias, F. (2015). Religious, Ethical and Legal Considerations in

End-of-Life Issues: Fundamental Requisites for Medical Decision Making.

Journal of Religion and Health, 55(1), 119–134. https://doi.org/10.1007/s10943-

014-9995-z

Liu, J. (2013, November 21). Religious groups’ views on end-of-life issues. Pew

Research Center. https://www.pewresearch.org/religion/2013/11/21/religious-

groups-views-on-end-of-life-issues/

N. Scheper-Hughes, “The Tyranny of the Gift: Sacrificial Violence in LivingDonor Transplants”
Published by American Journal of Transplantation. @ https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-6143.2006.01679.x. Accessed July 12, 2023

Padela, A. I., & Auda, J. (2020). The Moral Status of Organ Donation and Transplantation Within Islamic Law. Transplantation Direct, 6(3), e536. https://doi.org/10.1097/txd.0000000000000980

Reflection on PD Lab H&P-1 and H&P-3.

1.What differences do you note between the two H&Ps?

In my first H&P, I stopped at recording the vital signs, while in my third H&P, I was able to conduct a more comprehensive physical examination, including the skin, head, nose, eyes, mouth, ears, throat, heart, and lungs. The patients in the first and third H&Ps were of different genders (male and female), leading to variations in the history questions and physical exam procedures. As expected, the physical exam findings differed between the two patients, reflecting their specific symptoms and medical conditions. These differences underscore the importance of personalized and thorough healthcare assessments and treatment plans tailored to each individual’s unique presentation.

2.In what ways has your history-taking improved?  Are you eliciting all the important information?

The history-taking in the third History and Physical Exam appears to be more detailed and comprehensive compared to the first one. The third H&P provides a more specific and focused chief complaint, which is “shortness of breath for two weeks.” This concise and precise description helps in understanding the primary reason for the patient’s visit. The third H&P provides more comprehensive social history details, including the patient’s occupation, living situation, and dietary habits. These aspects can significantly impact the patient’s health and well-being.

3.In what ways has writing an HPI improved?

The HPI in the third H&P is more focused, specific, and concise. It clearly presents the patient’s main complaint of shortness of breath for two weeks, along with relevant details about the onset, duration, and provoking factors. This improved clarity helps the healthcare provider quickly understand the patient’s primary concern. The HPI in the third H&P is presented in a chronological order, providing a clear timeline of the patient’s symptoms and medical history. This organization helps in identifying any potential patterns or triggers related to the shortness of breath.

4.What is your self-assessment of your current skill in performing a physical exam? Which areas do you feel strongest about/weakest about?

It appears that I have a good understanding of conducting a physical examination and documenting relevant findings. My physical exam documentation includes key components of the examination, such as general appearance, vital signs, skin, hair, nails, head, eyes, ears, nose, mouth, neck, chest, heart, and lungs. Additionally, I mentioned specific observations for each body system, which indicates a thorough approach to the physical examination process. My documentation also includes important information about the patient’s medical history, past surgical history, medications, allergies, family history, social history, and review of systems.

5.Of course we expect you to get stronger in all areas, but which of the specific areas will you target as needing particular focus in future patient visits when you start the clinical year?

In both cases, the social history is relatively brief, and there may be opportunities to gather more detailed information about the patients’ lifestyle, habits, living situation, and support systems. A more in-depth social history can provide valuable insights into the patient’s overall health and help identify potential risk factors or factors contributing to their current medical conditions. Given the presence of dyspnea and respiratory symptoms in the third patient, a thorough respiratory evaluation, including a detailed lung examination, may be necessary. Both patients have a history of hypertension and other cardiovascular risk factors. It would be essential to continue monitoring and managing patients with blood pressure and evaluating their cardiovascular health during future visits. In the third H&P, my patient has a history of schizophrenia. Therefore, getting better at conduction Mental Health Assessment will be essential in monitoring and managing mental health status and medication regimen.