Chapter 15 of 156% of exam

Professional Practice

Professional practice is its own 6% category on the blueprint, covering legal and ethical issues, informatics, communication, the PA role, professional development, public health and risk management. Items here use federal rules and professional ethics codes rather than state law.

Consent, refusal and capacity

Consent requires capacity, adequate disclosure and voluntariness. Exceptions are narrow and centered on emergencies. Capable adults may refuse care even when the clinician disagrees.

Informed refusal

A capable patient may refuse care; refusal alone is not evidence of incapacity.

Merck Manual Professional Edition, Informed Consent

Emergency exception

Consent is presumed for emergency care when the patient cannot consent and no surrogate is available.

Merck Manual Professional Edition, Informed Consent

Advance directives

Living wills and health care powers of attorney guide care when capacity is lost.

Merck Manual Professional Edition, Advance Directives

Federal rules

HIPAA and EMTALA appear on the blueprint as legal and medicolegal issues. Both are federal rules that apply regardless of state. State-specific law varies and is not covered here.

Minimum necessary

Does not apply to disclosures to or requests by a provider for treatment.

45 CFR 164.502(b)(2)(i)

EMTALA screening

A participating hospital ED must screen anyone who comes, regardless of ability to pay, without delay for insurance questions.

42 CFR 489.24

Treatment disclosures

Covered entities may use and disclose PHI for treatment without authorization.

45 CFR 164.506

Ethics, safety and evidence

Professional duties extend to colleagues, communication and the critical appraisal of evidence. Ethics codes set boundaries that do not depend on who initiates a relationship. Simple calculations such as NNT turn trial results into clinical meaning.

Impaired colleagues

PAs must identify and assist impaired colleagues to protect patients.

AAPA Guidelines for Ethical Conduct for the PA Profession

Sexual relationships

Sexual involvement with patients is unethical.

AAPA Guidelines for Ethical Conduct for the PA Profession

Teach-back

Ask patients to explain in their own words; it tests the explanation, not the patient.

AHRQ Health Literacy Universal Precautions Toolkit, 3rd ed., Tool 5

NNT

Number needed to treat equals 1 divided by the absolute risk reduction.

CDC Principles of Epidemiology

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