Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Competence. Show all posts
Showing posts with label Competence. Show all posts

Friday, February 2, 2024

Young people turning to AI therapist bots

Joe Tidy
BBC.com
Originally posted 4 Jan 24

Here is an excerpt:

Sam has been so surprised by the success of the bot that he is working on a post-graduate research project about the emerging trend of AI therapy and why it appeals to young people. Character.ai is dominated by users aged 16 to 30.

"So many people who've messaged me say they access it when their thoughts get hard, like at 2am when they can't really talk to any friends or a real therapist,"
Sam also guesses that the text format is one with which young people are most comfortable.
"Talking by text is potentially less daunting than picking up the phone or having a face-to-face conversation," he theorises.

Theresa Plewman is a professional psychotherapist and has tried out Psychologist. She says she is not surprised this type of therapy is popular with younger generations, but questions its effectiveness.

"The bot has a lot to say and quickly makes assumptions, like giving me advice about depression when I said I was feeling sad. That's not how a human would respond," she said.

Theresa says the bot fails to gather all the information a human would and is not a competent therapist. But she says its immediate and spontaneous nature might be useful to people who need help.
She says the number of people using the bot is worrying and could point to high levels of mental ill health and a lack of public resources.


Here are some important points-

Reasons for appeal:
  • Cost: Traditional therapy's expense and limited availability drive some towards bots, seen as cheaper and readily accessible.
  • Stigma: Stigma associated with mental health might make bots a less intimidating first step compared to human therapists.
  • Technology familiarity: Young people, comfortable with technology, find text-based interaction with bots familiar and less daunting than face-to-face sessions.
Concerns and considerations:
  • Bias: Bots trained on potentially biased data might offer inaccurate or harmful advice, reinforcing existing prejudices.
  • Qualifications: Lack of professional mental health credentials and oversight raises concerns about the quality of support provided.
  • Limitations: Bots aren't replacements for human therapists. Complex issues or severe cases require professional intervention.

Friday, December 15, 2023

Clinical documentation of patient identities in the electronic health record: Ethical principles to consider

Decker, S. E., et al. (2023). 
Psychological Services.
Advance online publication.

Abstract

The American Psychological Association’s multicultural guidelines encourage psychologists to use language sensitive to the lived experiences of the individuals they serve. In organized care settings, psychologists have important decisions to make about the language they use in the electronic health record (EHR), which may be accessible to both the patient and other health care providers. Language about patient identities (including but not limited to race, ethnicity, gender, and sexual orientation) is especially important, but little guidance exists for psychologists on how and when to document these identities in the EHR. Moreover, organizational mandates, patient preferences, fluid identities, and shifting language may suggest different documentation approaches, posing ethical dilemmas for psychologists to navigate. In this article, we review the purposes of documentation in organized care settings, review how each of the five American Psychological Association Code of Ethics’ General Principles relates to identity language in EHR documentation, and propose a set of questions for psychologists to ask themselves and their patients when making choices about documenting identity variables in the EHR.

Impact Statement

Psychologists in organized care settings may face ethical dilemmas about what language to use when documenting patient identities (race, ethnicity, gender, sexual orientation, and so on) in the electronic health record. This article provides a framework for considering how to navigate these decisions based on the American Psychological Association Code of Ethics’ five General Principles. To guide psychologists in decision making, questions to ask self and patient are included, as well as suggestions for further study.

Here is my summary:

The authors emphasize the lack of clear guidelines for psychologists on how and when to document these identity variables in EHRs. They acknowledge the complexities arising from organizational mandates, patient preferences, fluid identities, and evolving language, which can lead to ethical dilemmas for psychologists.

To address these challenges, the article proposes a framework based on the five General Principles of the American Psychological Association (APA) Code of Ethics:
  1. Fidelity and Responsibility: Psychologists must prioritize patient welfare and act in their best interests. This includes respecting their privacy and self-determination when documenting identity variables.
  2. Competence: Psychologists should possess the necessary knowledge and skills to accurately and sensitively document patient identities. This may involve ongoing training and staying abreast of evolving language and cultural norms.
  3. Integrity: Psychologists must maintain ethical standards and avoid misrepresenting or misusing patient identity information. This includes being transparent about the purposes of documentation and seeking patient consent when appropriate.
  4. Respect for Human Rights and Dignity: Psychologists must respect the inherent dignity and worth of all individuals, regardless of their identity. This includes avoiding discriminatory or stigmatizing language in EHR documentation.
  5. Social Justice and Public Interest: Psychologists should contribute to the promotion of social justice and the elimination of discrimination. This includes being mindful of how identity documentation can impact patients' access to care and their overall well-being.
To aid psychologists in making informed decisions about identity documentation, the authors propose a set of questions to consider:
  1. What is the purpose of documenting this identity variable?
  2. Is this information necessary for providing appropriate care or fulfilling legal/regulatory requirements?
  3. How will this information be used?
  4. What are the potential risks and benefits of documenting this information?
  5. What are the patient's preferences regarding the documentation of their identity?
By carefully considering these questions, psychologists can make ethically sound decisions that protect patient privacy and promote their well-being.

Saturday, October 22, 2022

Sexuality Training in Counseling Psychology: A Mixed-Methods Study of Student Perspectives

Abbott, D. M., Vargas, J. E., & Santiago, H. J. (2022).
Journal of Counseling Psychology. 
Advance online publication.

Abstract

Counseling psychologists are a cogent fit to lead the movement toward a sex-positive professional psychology (Burnes et al., 2017a). Though centralizing training in human sexuality (HS; Mollen & Abbott, 2021) and sexual and reproductive health (Grzanka & Frantell, 2017) is congruent with counseling psychologists’ values, training programs rarely require or integrate comprehensive sexuality training for their students (Mollen et al., 2020). We employed a critical mixed-methods design in the interest of centering the missing voices of doctoral-level graduate students in counseling psychology in the discussion of the importance of human sexuality competence for counseling psychologists. Using focus groups to ascertain students’ perspectives on their human sexuality training (HST) in counseling psychology, responses yielded five themes: (a) HST is integral to counseling psychology training, (b) few opportunities to gain human sexuality competence, (c) inconsistent training and self-directed learning, (d) varying levels of human sexuality comfort and competence, and (e) desire for integration of HST. Survey responses suggested students were trained on the vast majority of human sexuality topics at low levels, consistent with prior studies surveying training directors in counseling psychology and at internship training sites (Abbott et al., 2021; Mollen et al., 2020). Taken together, results suggested students see HST as aligned with the social justice emphasis in counseling psychology but found their current training was inconsistent, incidental rather than intentional, and lacked depth. Recommendations, contextualized within counseling psychology values, are offered to increase opportunities for and strengthen HST in counseling psychology training programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Impact Statement

The present study suggests that counseling psychology graduate students perceive human sexuality training (HST) as valuable to their professional development and congruent with counseling psychology values. Findings support the integration of consistent, comprehensive, sex-positive HST in doctoral counseling psychology training programs. 

Conclusion

Comprehensive training in human sexuality represents a notable omission from counseling psychology training, particularly in light of the discipline’s values including emphases on diversity, social justice, and contextual, holistic perspectives. In the present study, the first to explore counseling psychology student perceptions of sexuality training, participants outlined the importance of HST to counseling psychology training, specifically, and providing psychotherapeutic services, broadly, outlined the current nature of their training, or lack thereof, and conveyed their desire for HST including recommendations for how programs may successfully implement HST in ways that benefitted students and the public they serve. Therefore, we call on faculty in counseling psychology training programs to reevaluate their commitment to developing sexuality competence among their students, invest in their own sexuality training as needed, and invoke creative strategies to make HST accessible and comprehensive in their programs.

Saturday, October 15, 2022

Boundary Issues of Concern

Charles Dike
Psychiatric News
Originally posted 25 AUG 22

Here is an excerpt:

There are, of course, less prominent but equally serious boundary violations other than sexual relations with patients or a patients’ relatives. The case of Dr. Jerome Oremland, a prominent California psychiatrist, is one example. According to a report by KQED on October 3, 2016, John Pierce, a patient, alleged that his psychiatrist, Dr. Oremland, induced Mr. Pierce to give him at least 12 works of highly valued art. The psychiatrist argued that the patient had consented to their business dealings and that the art he had received from the patient was given willingly as payment for psychiatric treatment. The patient further alleged that Dr. Oremland used many of their sessions to solicit art, propose financial schemes (including investments), and discuss other subjects unrelated to treatment. Furthermore, the patient allegedly made repairs in Dr. Oremland’s home, offices, and rental units; helped clear out the home of Dr. Oremland’s deceased brother; and cleaned his pool. Mr. Pierce began therapy with Dr. Oremland in 1984 but brought a lawsuit against him in 2015. The court trial began shortly after Dr. Oremland’s death in 2016, and Dr. Oremland’s estate eventually settled with Mr. Pierce. In addition to being a private practitioner, Dr. Oremland had been chief of psychiatry at the Children’s Hospital in San Francisco and a clinical professor of psychiatry at UCSF. He also wrote books on the intersection of art and psychology.

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There are less dramatic but still problematic boundary crossings such as when a psychiatrist in private practice agrees that a patient may pay off treatment costs by doing some work for the psychiatrist. Other examples include a psychiatrist hiring a patient, for example, a skilled plumber, to work in the psychiatrist’s office or home at the patient’s going rate or obtaining investment tips from a successful investment banker patient. In these situations, questions arise about the physician-patient relationship. Even when the psychiatrist believes he or she is treating the patient fairly—such as paying the going rate for work done for the psychiatrist—the psychiatrist is clueless regarding how the patient is interpreting the arrangement: Does the patient experience it as exploitative? What are the patient’s unspoken expectations? What if the patient’s work in the psychiatrist’s office is inferior or the investment advice results in a loss? Would these outcomes influence the physician-patient relationship? Even compassionate acts such as writing off the bill of patients who are unable to pay or paying for an indigent patient’s medications should make the psychiatrist pause for thought. To avoid potential misinterpretation of the psychiatrist’s intentions or complaints of inequitable practices or favoritism, the psychiatrist should be ready to do the same for other indigent patients. It would be better to establish neutral policies for all indigent patients than to appear to favor some over others.

Monday, October 10, 2022

7 tell-tale red flags of medical gaslighting

Ashley Laderer
Insider.com
Originally published 29 AUG 2022

Here is an except:

"Medical gaslighting is a term recently used to describe when health care providers dismiss a patient's concerns, feelings, or complaints," says Faith Fletcher, an assistant professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine and a senior advisor to the Hastings Center, a bioethics research institute. 

Numerous studies over the years have found examples of medical gaslighting, whether it's interrupting a patient or misdiagnosing them based on unconscious biases about race or gender. Gaslighting in the medical field tends to affect marginalized groups the most.

"These interactions don't take place in a vacuum and are rooted in long-standing structural and social injustices such as racism, sexism, and class oppression in the US healthcare system," Fletcher says. 

Here are seven signs your doctor may be gaslighting you and the consequences it can have on your health.

1. They interrupt you
2. They rush you 
3. They won't discuss your symptoms with you
4. They let underlying biases affect diagnosis 
5. They say it's all in your head
6. They question the legitimacy of your medical history 
7. They're uncollaborative on treatment options

Friday, September 23, 2022

Facial attractiveness is more associated with individual warmth than with competence: Behavioral and neural evidence

Mengxue Lan, et al. (2022) 
Social Neuroscience, 17:3, 225-235
DOI: 10.1080/17470919.2022.2069152

Abstract

Individuals appear to infer others’ psychological characteristics according to facial attractiveness and these psychological characteristics can be classified into two categories in social cognition, that is, warmth and competence. However, which category of psychological characteristic is more associated with face attractiveness and its neural mechanisms have not been explored. To address this, participants were asked to judge others’ warmth and competence traits based on face attractiveness, while their brains were scanned using functional magnetic resonance imaging (fMRI). They also assessed the attractiveness of faces after scanning. Behavioral results showed that the correlation between face attractiveness and warmth ratings was significantly higher than that with competence ratings. fMRI results demonstrated that the dorsomedial prefrontal cortex (dmPFC), temporoparietal junction (TPJ), lateral prefrontal cortex, and lateral temporal lobe were more involved in the warmth task. Moreover, attractiveness ratings were negatively correlated with activation of the dmPFC and TPJ only in the warmth task. Furthermore, the attractiveness ratings were negatively correlated with the defined dmPFC, region related to attractiveness judgment, only in the warmth task. In conclusion, people are more inclined to infer others’ warmth than competence characteristics from face attractiveness, that is, face attractiveness is more associated with warmth than with competence.

Thursday, August 18, 2022

Dunning–Kruger effects in reasoning: Theoretical implications of the failure to recognize incompetence

Pennycook, G., Ross, R.M., Koehler, D.J. et al. 
Psychon Bull Rev 24, 1774–1784 (2017). 
https://doi.org/10.3758/s13423-017-1242-7

Abstract

The Dunning–Kruger effect refers to the observation that the incompetent are often ill-suited to recognize their incompetence. Here we investigated potential Dunning–Kruger effects in high-level reasoning and, in particular, focused on the relative effectiveness of metacognitive monitoring among particularly biased reasoners. Participants who made the greatest numbers of errors on the cognitive reflection test (CRT) overestimated their performance on this test by a factor of more than 3. Overestimation decreased as CRT performance increased, and those who scored particularly high underestimated their performance. Evidence for this type of systematic miscalibration was also found on a self-report measure of analytic-thinking disposition. Namely, genuinely nonanalytic participants (on the basis of CRT performance) overreported their “need for cognition” (NC), indicating that they were dispositionally analytic when their objective performance indicated otherwise. Furthermore, estimated CRT performance was just as strong a predictor of NC as was actual CRT performance. Our results provide evidence for Dunning–Kruger effects both in estimated performance on the CRT and in self-reported analytic-thinking disposition. These findings indicate that part of the reason why people are biased is that they are either unaware of or indifferent to their own bias.

General discussion

Our results provide empirical support for Dunning–Kruger effects in both estimates of reasoning performance and self-reported thinking disposition. Particularly intuitive individuals greatly overestimated their performance on the CRT—a tendency that diminished and eventually reversed among increasingly analytic individuals. Moreover, self-reported analytic-thinking disposition—as measured by the Ability and Engagement subscales of the NC scale—was just as strongly (if not more strongly) correlated with estimated CRT performance than with actual CRT performance. In addition, an analysis using an additional performance-based measure of analytic thinking—the heuristics-and-biases battery—revealed a systematic miscalibration of self-reported NC, wherein relatively intuitive individuals report that they are more analytic than is justified by their objective performance. Together, these findings indicate that participants who are low in analytic thinking (so-called “intuitive thinkers”) are at least somewhat unaware of (or unresponsive to) their propensity to rely on intuition in lieu of analytic thought during decision making. This conclusion is consistent with previous research that has suggested that the propensity to think analytically facilitates metacognitive monitoring during reasoning (Pennycook et al., 2015b; Thompson & Johnson, 2014). Those who are genuinely analytic are aware of the strengths and weaknesses of their reasoning, whereas those who are genuinely nonanalytic are perhaps best described as “happy fools” (De Neys et al., 2013).

Tuesday, June 15, 2021

Diagnostic Mistakes a Big Contributor to Malpractice Suits, Study Finds

Joyce Friedan
MedPageToday.com
Originally posted 26 May 21

Here are two excerpts

One problem is that "healthcare is inherently risky," she continued. For example, "there's ever-changing industry knowledge, growing bodies of clinical options, new diseases, and new technology. There are variable work demands -- boy, didn't we experience that this past year! -- and production pressure has long been a struggle and a challenge for our providers and their teams." Not to mention variable individual competency, an aging population, complex health issues, and evolving workforces.

(cut)

Cognitive biases can also trigger diagnostic errors, Siegal said. "Anchor bias" occurs when "a provider anchors on a diagnosis, early on, and then through the course of the journey looks for things to confirm that diagnosis. Once they've confirmed it enough that 'search satisfaction' is met, that leads to premature closure" of the patient's case. But that causes a problem because "it means that there's a failure to continue exploring other options. What else could it be? It's a failure to establish, perhaps, every differential diagnosis."

To avoid this problem, providers "always want to think about, 'Am I anchoring too soon? Am I looking to confirm, rather than challenge, my diagnosis?'" she said. According to the study, 25% of cases didn't have evidence of a differential diagnosis, and 36% fell into the category of "confirmation bias" -- "I was looking for things to confirm what I knew, but there were relevant signs and symptoms or positive tests that were still present that didn't quite fit the picture, but it was close. So they were somehow discounted, and the premature closure took over and a diagnosis was made," she said.

She suggested that clinicians take a "diagnostic timeout" -- similar to a surgical timeout -- when they're arriving at a diagnosis. "What else could this be? Have I truly explored all the other possibilities that seem relevant in this scenario and, more importantly, what doesn't fit? Be sure to dis-confirm as well."

Friday, January 15, 2021

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Menon NK, Shanafelt TD, Sinsky CA, et al. 
JAMA Netw Open. 2020;3(12):e2028780. 
doi:10.1001/jamanetworkopen.2020.28780

Key Points

Question  Is burnout associated with increased suicidal ideation and self-reported medical errors among physicians after accounting for depression?

Findings  In this cross-sectional study of 1354 US physicians, burnout was significantly associated with increased odds of suicidal ideation before but not after adjusting for depression and with increased odds of self-reported medical errors before and after adjusting for depression. In adjusted models, depression was significantly associated with increased odds of suicidal ideation but not self-reported medical errors.

Meaning  The findings suggest that depression but not burnout is directly associated with suicidal ideation among physicians.

Conclusions and Relevance  The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

Monday, December 14, 2020

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

Rokach, A., & Boulazreg, S. (2020). 
Current psychology,1–18. 
Advance online publication. 

Abstract

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians’ awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

Here is an excerpt:

Navigating Ethical Dilemmas

An important impact of competence constellations is its aid to clinicians facing challenging dilemmas in the therapy room. While numerous guidelines and recommendations based on a code of ethics exist, real-life situations often blur the line between what the professional wishes to do, rather than what the recommended ethical action is most optimal to the sovereignty of the client. Simply put, “no code of ethics provides a blueprint for resolving all ethical issues, nor does the avoidance of violations always equate with ideal ethical practice, but codes represent the best judgment of one’s peers about common problems and shared professional values.” (Welfel, 2015, p. 10).

As the literature asserts—even in the face of colleagues acting unethically, or below thresholds of competence, psychologists don’t feel comfortable directly approaching their coworkers as they feel concerned about harming their colleagues’ reputation, concerned that the regulatory board may punish their colleague too harshly, or concerned that by reporting a colleague to the regulatory board they will be ostracized by their colleagues (Barnett, 2008; Bernard, Murphy, & Little, 1987; Johnson et al., 2012; Smith & Moss, 2009).

Thus, a constellation network allows a mental health professional to provide feedback without fear of these potential repercussions. Whether it is guised under friendly advice or outright anonymous, these peer networks would allow therapists to exchange information knowingly and allow for constructive criticism to be taken non-judgmentally.

Saturday, December 12, 2020

‘All You Want Is to Be Believed’: The Impacts of Unconscious Bias in Health Care

April Dembosky
KHN.com
Originally published 21 Oct 20

Here is an excerpt:

Research shows how doctors’ unconscious bias affects the care people receive, with Latino and Black patients being less likely to receive pain medications or get referred for advanced care than white patients with the same complaints or symptoms, and more likely to die in childbirth from preventable complications.

In the hospital that day in May, Monterroso was feeling woozy and having trouble communicating, so she had a friend and her friend’s cousin, a cardiac nurse, on the phone to help. They started asking questions: What about Karla’s accelerated heart rate? Her low oxygen levels? Why are her lips blue?

The doctor walked out of the room. He refused to care for Monterroso while her friends were on the phone, she said, and when he came back, the only thing he wanted to talk about was Monterroso’s tone and her friends’ tone.

“The implication was that we were insubordinate,” Monterroso said.

She told the doctor she didn’t want to talk about her tone. She wanted to talk about her health care. She was worried about possible blood clots in her leg and she asked for a CT scan.

“Well, you know, the CT scan is radiation right next to your breast tissue. Do you want to get breast cancer?” Monterroso recalled the doctor saying to her. “I only feel comfortable giving you that test if you say that you’re fine getting breast cancer.”

Monterroso thought to herself, “Swallow it up, Karla. You need to be well.” And so she said to the doctor: “I’m fine getting breast cancer.”

He never ordered the test.

Monterroso asked for a different doctor, for a hospital advocate. No and no, she was told. She began to worry about her safety. She wanted to get out of there. Her friends, all calling every medical professional they knew to confirm that this treatment was not right, came to pick her up and drove her to the University of California-San Francisco. The team there gave her an EKG, a chest X-ray and a CT scan.

Thursday, December 3, 2020

The psychologist rethinking human emotion

David Shariatmadari
The Guardian
Originally posted 25 Sept 20

Here is an excerpt:

Barrett’s point is that if you understand that “fear” is a cultural concept, a way of overlaying meaning on to high arousal and high unpleasantness, then it’s possible to experience it differently. “You know, when you have high arousal before a test, and your brain makes sense of it as test anxiety, that’s a really different feeling than when your brain makes sense of it as energised determination,” she says. “So my daughter, for example, was testing for her black belt in karate. Her sensei was a 10th degree black belt, so this guy is like a big, powerful, scary guy. She’s having really high arousal, but he doesn’t say to her, ‘Calm down’; he says, ‘Get your butterflies flying in formation.’” That changed her experience. Her brain could have made anxiety, but it didn’t, it made determination.”

In the lectures Barrett gives to explain this model, she talks of the brain as a prisoner in a dark, silent box: the skull. The only information it gets about the outside world comes via changes in light (sight), air pressure (sound) exposure to chemicals (taste and smell), and so on. It doesn’t know the causes of these changes, and so it has to guess at them in order to decide what to do next.

How does it do that? It compares those changes to similar changes in the past, and makes predictions about the current causes based on experience. Imagine you are walking through a forest. A dappled pattern of light forms a wavy black shape in front of you. You’ve seen many thousands of images of snakes in the past, you know that snakes live in the forest. Your brain has already set in train an array of predictions.

The point is that this prediction-making is consciousness, which you can think of as a constant rolling process of guesses about the world being either confirmed or proved wrong by fresh sensory inputs. In the case of the dappled light, as you step forward you get information that confirms a competing prediction that it’s just a stick: the prediction of a snake was ultimately disproved, but not before it grew so strong that neurons in your visual cortex fired as though one was actually there, meaning that for a split second you “saw” it. So we are all creating our world from moment to moment. If you didn’t, your brain wouldn’t be able make the changes necessary for your survival quickly enough. If the prediction “snake” wasn’t already in train, then the shot of adrenaline you might need in order to jump out of its way would come too late.

Sunday, November 1, 2020

Believing in Overcoming Cognitive Biases

T. S. Doherty & A. E. Carroll
AMA J Ethics. 2020;22(9):E773-778. 
doi: 10.1001/amajethics.2020.773.

Abstract

Like all humans, health professionals are subject to cognitive biases that can render diagnoses and treatment decisions vulnerable to error. Learning effective debiasing strategies and cultivating awareness of confirmation, anchoring, and outcomes biases and the affect heuristic, among others, and their effects on clinical decision making should be prioritized in all stages of education.

Here is an excerpt:

The practice of reflection reinforces behaviors that reduce bias in complex situations. A 2016 systematic review of cognitive intervention studies found that guided reflection interventions were associated with the most consistent success in improving diagnostic reasoning. A guided reflection intervention involves searching for and being open to alternative diagnoses and willingness to engage in thoughtful and effortful reasoning and reflection on one’s own conclusions, all with supportive feedback or challenge from a mentor.

The same review suggests that cognitive forcing strategies may also have some success in improving diagnostic outcomes. These strategies involve conscious consideration of alternative diagnoses other than those that come intuitively. One example involves reading radiographs in the emergency department. According to studies, a common pitfall among inexperienced clinicians in such a situation is to call off the search once a positive finding has been noticed, which often leads to other abnormalities (eg, second fractures) being overlooked. Thus, the forcing strategy in this situation would be to continue a search even after an initial fracture has been detected.

Friday, October 23, 2020

Ethical Dimensions of Using Artificial Intelligence in Health Care

Michael J. Rigby
AMA Journal of Ethics
February 2019

An artificially intelligent computer program can now diagnose skin cancer more accurately than a board-certified dermatologist. Better yet, the program can do it faster and more efficiently, requiring a training data set rather than a decade of expensive and labor-intensive medical education. While it might appear that it is only a matter of time before physicians are rendered obsolete by this type of technology, a closer look at the role this technology can play in the delivery of health care is warranted to appreciate its current strengths, limitations, and ethical complexities.

Artificial intelligence (AI), which includes the fields of machine learning, natural language processing, and robotics, can be applied to almost any field in medicine, and its potential contributions to biomedical research, medical education, and delivery of health care seem limitless. With its robust ability to integrate and learn from large sets of clinical data, AI can serve roles in diagnosis, clinical decision making, and personalized medicine. For example, AI-based diagnostic algorithms applied to mammograms are assisting in the detection of breast cancer, serving as a “second opinion” for radiologists. In addition, advanced virtual human avatars are capable of engaging in meaningful conversations, which has implications for the diagnosis and treatment of psychiatric disease. AI applications also extend into the physical realm with robotic prostheses, physical task support systems, and mobile manipulators assisting in the delivery of telemedicine.

Nonetheless, this powerful technology creates a novel set of ethical challenges that must be identified and mitigated since AI technology has tremendous capability to threaten patient preference, safety, and privacy. However, current policy and ethical guidelines for AI technology are lagging behind the progress AI has made in the health care field. While some efforts to engage in these ethical conversations have emerged, the medical community remains ill informed of the ethical complexities that budding AI technology can introduce. Accordingly, a rich discussion awaits that would greatly benefit from physician input, as physicians will likely be interfacing with AI in their daily practice in the near future.

Saturday, October 17, 2020

New Texas rule lets social workers turn away clients who are LGBTQ or have a disability

Edgar Walters
Texas Tribune
Originally posted 14 Oct 2020

Texas social workers are criticizing a state regulatory board’s decision this week to remove protections for LGBTQ clients and clients with disabilities who seek social work services.

The Texas State Board of Social Work Examiners voted unanimously Monday to change a section of its code of conduct that establishes when a social worker may refuse to serve someone. The code will no longer prohibit social workers from turning away clients on the basis of disability, sexual orientation or gender identity.

Gov. Greg Abbott’s office recommended the change, board members said, because the code’s nondiscrimination protections went beyond protections laid out in the state law that governs how and when the state may discipline social workers.

“It’s not surprising that a board would align its rules with statutes passed by the Legislature,” said Abbott spokesperson Renae Eze. A state law passed last year gave the governor’s office more control over rules governing state-licensed professions.

The nondiscrimination policy change drew immediate criticism from a professional association. Will Francis, executive director of the Texas chapter of the National Association of Social Workers, called it “incredibly disheartening.”

He also criticized board members for removing the nondiscrimination protections without input from the social workers they license and oversee.


Note: All psychotherapy services are founded on the principle of beneficence: the desire to help others and do right by them.  This decision from the Texas State Board of Social Work Examiners is terrifyingly unethical.  The unanimous decision demonstrates the highest levels of incompetence and bigotry.

Tuesday, September 15, 2020

Morality has been stripped from public life. Here’s a four-step plan to revive it

Boris Johnson and Donald TrumpRoger Paxton
TheGuardian.com
Originally posted 13 Sept 20

Here is an excerpt:

From the top down, public morality is corroded. If morality, not to mention competence, were valued by the electorate, the approval ratings of Boris Johnson (and Donald Trump) would surely have plummeted, but they haven’t. As others have noted, for many people truth has become unimportant. Selfishness is assumed and encouraged, and opponents, dissenters and people seen as “other” are denigrated and worse. The most important thing is one’s own short-term interest.

What can be done about the crisis? Of course a new government is needed, but even if a Labour government is elected, the divisions and the damage done to public morality will need to be repaired. Just as there is a need to promote physical and mental wellbeing, so morality could be promoted by means of the concept of moral wellbeing.

For physical wellbeing, we have the dietary advice of five-a-day; for mental wellbeing the New Economics Foundation’s five ways to wellbeing, as used by the NHS. For moral wellbeing there is a similar framework that could be useful: the psychological model developed by James Rest, outlining the four components of moral reasoning.

This is a framework for improving thoughtfulness and clarity about moral matters. The first stage is moral sensitivity – recognising when an issue is one of morality, rather than a personal preference or practicality. The second component is moral reasoning. Having identified that a question is one of right and wrong, you then decide what the right thing to do would be. Third comes moral motivation – acknowledging other interests and motives that influence your thinking about the issue, and then weighing up the conflicting motives. The fourth and final stage is moral implementation, which means bringing moral reasoning and moral motivation together to make and act on a decision.

The information is here.

Wednesday, August 5, 2020

How to Combat Zoom Fatigue

Liz Fosslien and Mollie West Duffy
Harvard Business Review
Originally posted 29 April 20

If you’re finding that you’re more exhausted at the end of your workday than you used to be, you’re not alone. Over the past few weeks, mentions of “Zoom fatigue” have popped up more and more on social media, and Google searches for the same phrase have steadily increased since early March.

Why do we find video calls so draining? There are a few reasons.

In part, it’s because they force us to focus more intently on conversations in order to absorb information. Think of it this way: when you’re sitting in a conference room, you can rely on whispered side exchanges to catch you up if you get distracted or answer quick, clarifying questions. During a video call, however, it’s impossible to do this unless you use the private chat feature or awkwardly try to find a moment to unmute and ask a colleague to repeat themselves.

The problem isn’t helped by the fact that video calls make it easier than ever to lose focus. We’ve all done it: decided that, why yes, we absolutely can listen intently, check our email, text a friend, and post a smiley face on Slack within the same thirty seconds. Except, of course, we don’t end up doing much listening at all when we’re distracted. Adding fuel to the fire is many of our work-from-home situations. We’re no longer just dialing into one or two virtual meetings. We’re also continuously finding polite new ways to ask our loved ones not to disturb us, or tuning them out as they army crawl across the floor to grab their headphones off the dining table. For those who don’t have a private space to work, it is especially challenging.

Finally, “Zoom fatigue” stems from how we process information over video. On a video call the only way to show we’re paying attention is to look at the camera. But, in real life, how often do you stand within three feet of a colleague and stare at their face? Probably never. This is because having to engage in a “constant gaze” makes us uncomfortable — and tired. In person, we are able to use our peripheral vision to glance out the window or look at others in the room. On a video call, because we are all sitting in different homes, if we turn to look out the window, we worry it might seem like we’re not paying attention.

The info is here.

Monday, July 13, 2020

Our Minds Aren’t Equipped for This Kind of Reopening

TessWilkinson-Ryan
The Atlantic
Originally published 6 July 20

Here is the conclusion:

At the least, government agencies must promulgate clear, explicit norms and rules to facilitate cooperative choices. Most people congregating in tight spaces are telling themselves a story about why what they are doing is okay. Such stories flourish under confusing or ambivalent norms. People are not irrevocably chaotic decision makers; the level of clarity in human thinking depends on how hard a problem is. I know with certainty whether I’m staying home, but the confidence interval around “I am being careful” is really wide. Concrete guidance makes challenges easier to resolve. If masks work, states and communities should require them unequivocally. Cognitive biases are the reason to mark off six-foot spaces on the supermarket floor or circles in the grass at a park.

For social-distancing shaming to be a valuable public-health tool, average citizens should reserve it for overt defiance of clear official directives—failure to wear a mask when one is required—rather than mere cases of flawed judgment. In the meantime, money and power are located in public and private institutions that have access to public-health experts and the ability to propose specific behavioral norms. The bad judgments that really deserve shaming include the failure to facilitate testing, failure to protect essential workers, failure to release larger numbers of prisoners from facilities that have become COVID-19 hot spots, and failure to create the material conditions that permit strict isolation. America’s half-hearted reopening is a psychological morass, a setup for defeat that will be easy to blame on irresponsible individuals while culpable institutions evade scrutiny.

The info is here.

Tuesday, June 16, 2020

Prejudiced and unaware of it: Evidence for the Dunning-Kruger model in the domains of racism and sexism

K. West and A. A. Eaton
Personality and Individual Differences
Volume 146, 1 August 2019, Pages 111-119

Abstract

Prior research, and high-prolife contemporary examples, show that individuals tend to underestimate their own levels of bias. This underestimation is partially explained by motivational factors. However, (meta-) cognitive factors may also be involved. Conceptualising contemporary egalitarianism as type of skill or competence, this research proposed that egalitarianism should conform to the Dunning-Kruger model. That is, individuals should overestimate their own ability, and this overestimation should be strongest in the least competent individuals. Furthermore, training should improve metacognition and reduce this overestimation. Two studies on racism (N = 148), and sexism (N = 159) partially supported these hypotheses. In line with the Dunning-Kruger model, participants overestimated their levels of racial and gender-based egalitarianism, and this pattern was strongest among the most prejudiced participants. However, diversity training did not affect participants' overestimation of their egalitarianism. Implications for contemporary prejudice, and prejudice-reducing strategies are discussed.

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Conclusions

For many reasons, contemporary discussions of prejudice can be quite acrimonious. Members of socially advantaged groups may find such discussions difficult, unpleasant, or threatening Apfelbaum, Pauker, Ambady, Sommers, & Norton, 2008; Dover, Major, & Kaiser, 2016; Norton et al., 2006). Political divisions may lead members of both advantaged and disadvantaged groups to attribute overly negative motivations to the other group (Goff et al., 2014; Reeder, 2005; Taber, Brook, & Franklin, 2006). Motivation certainly forms an important part of the picture. However, this research suggests that, even if such motivational considerations were accounted for, there may be important cognitive hindrances to understanding and reducing prejudice that would have to be addressed. In line with the Dunning-Kruger model, this research found that very prejudiced individuals (i.e., those low in egalitarianism) may be genuinely unaware of their shortcomings because they lack the meta-cognition necessary to perceive them. It is thus possible that some solutions to contemporary prejudice may rely less on motivation and more on education.

The research is here.

Thursday, June 11, 2020

Personal Therapy and Self-Care in the Making of Psychologists

Jake S. Ziede & John C. Norcross (2020)
The Journal of Psychology
DOI: 10.1080/00223980.2020.1757596

Abstract

Psychologists are skilled in assessing, researching, and treating patients’ distress, but frequently experience difficulty in applying these talents to themselves. The authors offer 13 research-supported and theoretically neutral self-care strategies catered to psychologists and those in training: valuing the person of the psychologist, refocusing on the rewards, recognizing the hazards, minding the body, nurturing relationships, setting boundaries, restructuring cognitions, sustaining healthy escapes, maintaining mindfulness, creating a flourishing environment, cultivating spirituality and mission, fostering creativity and growth, and profiting from personal therapy. The latter deserves special emphasis in the making of health care psychologists. These strategies are recommended both during training and throughout the career span. Recommendations are offered for enhancing and publicizing systems of self-care throughout the profession.

The article is here.