ABA Professionalism, Ethics & Patient Safety 3 — Questions and Answers
Question 1: An anesthesiologist discovers intraoperatively that the informed consent form was signed by the patient's adult son without documented power of attorney. The patient is now under general anesthesia for a non-emergent procedure. What is the best course of action?
- Complete the procedure since anesthesia has already been induced
- Abort the procedure immediately and wake the patient
- Complete only life-saving portions, then wake the patient and obtain proper consent (Correct answer)
- Proceed and address the consent issue postoperatively via documentation
Correct answer: Complete only life-saving portions, then wake the patient and obtain proper consent
Without valid consent for a non-emergent procedure, the anesthesiologist should not proceed beyond what is necessary for the patient's immediate safety.
Question 2: The Universal Protocol for preventing wrong-site, wrong-procedure, and wrong-patient errors requires which three core components?
- Preoperative verification, site marking, and time-out (Correct answer)
- Surgeon sign-off, nursing count, and anesthesia check
- Consent review, imaging confirmation, and postoperative debriefing
- Patient identification, allergy check, and equipment inspection
Correct answer: Preoperative verification, site marking, and time-out
The Joint Commission's Universal Protocol mandates a preoperative verification process, surgical site marking, and a pre-incision time-out.
Question 3: A pharmaceutical company offers an anesthesiologist an all-expenses-paid trip to a conference where only their products are discussed. According to AMA and ASA ethics guidelines, this arrangement is best characterized as:
- Acceptable continuing medical education
- An inappropriate gift that could create a conflict of interest (Correct answer)
- Permissible if the physician discloses the sponsorship to patients
- Standard industry practice with no ethical implications
Correct answer: An inappropriate gift that could create a conflict of interest
Industry-sponsored travel that promotes specific products creates conflicts of interest inconsistent with physician professionalism standards.
Question 4: A patient with a DNR order requires an appendectomy. Which approach to the DNR in the perioperative period is most consistent with ASA guidelines?
- Automatically suspend the DNR for all surgical cases
- Discuss the DNR with the patient and tailor resuscitation goals to their perioperative wishes (Correct answer)
- Honor the DNR strictly and provide no resuscitative interventions intraoperatively
- Defer entirely to the surgeon's preference regarding the DNR
Correct answer: Discuss the DNR with the patient and tailor resuscitation goals to their perioperative wishes
ASA policy recommends 'required reconsideration' of DNR orders perioperatively through shared decision-making rather than automatic suspension or automatic honoring.
Question 5: Which behavior most strongly reflects the professional value of 'accountability' for an anesthesiologist?
- Delegating error documentation to the resident on service
- Acknowledging mistakes, reporting them, and participating in corrective action (Correct answer)
- Avoiding documentation of near-misses to reduce medicolegal exposure
- Consulting legal counsel before disclosing any adverse event to the patient
Correct answer: Acknowledging mistakes, reporting them, and participating in corrective action
Accountability requires that physicians personally own their errors, report them transparently, and actively engage in improvement efforts.
Question 6: A second-year anesthesiology resident feels pressured by a senior attending to perform an awake fiberoptic intubation on a mildly combative patient without adequate consent. The resident's primary obligation is to:
- Comply with the attending's directive to maintain the hierarchy
- Advocate for the patient's rights and raise concern through appropriate channels (Correct answer)
- Perform the procedure quickly to minimize patient distress
- Document the attending's request and proceed without intervention
Correct answer: Advocate for the patient's rights and raise concern through appropriate channels
Residents have an independent ethical obligation to protect patient rights even when facing hierarchical pressure.
Question 7: Which of the following is a primary goal of the Anesthesia Patient Safety Foundation (APSF)?
- Credentialing anesthesiologists for subspecialty practice
- Eliminating patient injury and death associated with anesthesia (Correct answer)
- Publishing the ASA's scope-of-practice statements
- Setting reimbursement rates for anesthesia services
Correct answer: Eliminating patient injury and death associated with anesthesia
The APSF's mission is that no patient should be harmed by the effects of anesthesia, focusing on safety research, education, and communication.
ABA Professionalism, Ethics & Patient Safety 3
An anesthesiologist discovers intraoperatively that the informed consent form was signed by the patient's adult son without documented power of attorney.
The patient is now under general anesthesia for a non-emergent procedure.
What is the best course of action?