The lesser of two evils: Explaining a bad choice by revealing the choice set

Andras Molnar & Shereen J. Chaudhry
PsyArXiv
Last edited 4 Feb 20

Abstract

Making the right choice does not always lead to a good outcome—sometimes there are only bad outcomes to choose from. Situations like this are likely to lead others to misunderstand the decision maker’s intentions. However, simply revealing the choice set could set the record straight. Are decision-makers intrinsically driven to fix this misjudgment? If so, why, and what is the effect on the audience? Previous studies could not examine this desire to be understood because the research designs used did not isolate the decision to reveal information from the original choice. In two experiments (N=448 pairs), we address this gap in the literature and show that people are willing to pay ex post to reveal their choice set to the person who was negatively affected by their decision (the recipient), even after a one-shot anonymous interaction with no reputational consequences, and in some cases even when doing so reveals their selfish intentions. We find that this revealing behavior is effective at improving recipients’ rating of their outcome when it signals generous intentions, but not when it signals selfish intentions. It follows that the choice to reveal is driven by concern for the thoughts and feelings of strangers, but only when revealing signals generous intentions; those who reveal a choice that appears selfish report doing so out of a desire to be and/or appear honest. Individual differences in the drive to reveal cannot be explained by selection effects or mistakes in predicting the observer’s reaction. Thus, we find that people are intrinsically (i.e., even in one-shot anonymous settings) driven to correct a misunderstanding of their intentions, but they may do so for a variety of reasons, not all of which are self-enhancing. And though some people leave a misunderstanding in place when it is self-enhancing to do so, almost no one is willing to create a misunderstanding (by hiding the other option), even when it could conceal selfish behavior.

The research is here.

Dear Therapist: I Google-Stalked My Therapist

Lori Gottlieb
The Atlantic
Originally published March 21, 2108

Here is an excerpt:

Most of us wonder who our therapists are outside of the therapy room, usually because we like them so much. Sometimes, of course, people Google their therapists if something feels off—to see if their credentials check out, or if other patients have posted similar concerns. More often, though, our curiosity is a reflection of how important our therapist has become to us, and in some cases, it’s a way to feel connected to the therapist between sessions. The problem is, of course, that we want therapy to be a space where we feel free to talk about absolutely anything. And no matter what we discover—a bombshell like yours, or something more mundane—the fallout of a Google binge becomes a secret that takes that freedom away.

Carl Jung called secrets “psychic poison” for good reason. When I finally confessed my Google-stalking to my therapist, all the air returned to the room. My verbal shackles were removed, and we talked about what was behind my desire to type his name into my search engine. But more important, the way I handled the situation before fessing up taught me something interesting about how I handle discomfort—something far more interesting than anything I learned about my therapist online.

And I think the same might prove true for you.

What people do in therapy is pretty much what they do in their outside lives. In other words, if a patient tends to feel dissatisfied with people in her life, it’s likely that she’ll eventually feel dissatisfied with me. If she tries to please people, she’ll probably try to please me too. And if she avoids people when she feels hurt by them, I’ll be on the lookout for signs that I’ve said something that may have hurt her, too (she cancels her next session, or clams up, or comes late).

The information is here.

State Supreme Court Establishes Right To Sue Over Medical Record Breaches

Edmund H. Mahony
Hartford Courant
Originally published January 10, 2018

The state Supreme Court established Thursday that patients in Connecticut have the right to sue doctors and other health care providers for the unauthorized and negligent disclosure of their confidential medical records.

The majority decision creates new state law and adds Connecticut to a growing number of states that allow patients to sue for damages over the release of private records by their physicians. Courts in Connecticut have held previously — as have courts elsewhere — that private suits were blocked by federal law under the 1996 Health Insurance Portability and Accountability Act or HIPAA law.

HIPAA laws establish procedures to protect medical records and empower government to impose civil and criminal penalties for violation. But HIPAA does not permit private suits to collect damages for unauthorized disclosures.

“Finally we have a remedy in Connecticut that recognizes that there is a duty of confidentiality, the breach of which can lead to compensation for damages,” said attorney Bruce L. Elstein of Trumbull, whose client, Emily Byrne, sued over an unauthorized release of her medical history.

The article is here.

‘Ethical responsibility’ or ‘a whole can of worms’

Differences in opinion on incidental finding review and disclosure in neuroimaging research from focus group discussions with participants, parents, IRB members, investigators, physicians and community members

Caitlin Cole, Linda E Petree, John P Phillips, Jody M Shoemaker, Mark Holdsworth, Deborah L Helitzer
J Med Ethics doi:10.1136/medethics-2014-102552

Abstract
Purpose 
To identify the specific needs, preferences and expectations of the stakeholders impacted by returning neuroimaging incidental findings to research participants.

Methods
Six key stakeholder groups were identified to participate in focus group discussions at our active neuroimaging research facility: Participants, Parents of child participants, Investigators, Institutional Review Board (IRB) Members, Physicians and Community Members. A total of 151 subjects attended these discussions. Transcripts were analysed using principles of Grounded Theory and group consensus coding.

Results 
A series of similar and divergent themes were identified across our subject groups. Similarities included beliefs that it is ethical for researchers to disclose incidental findings as it grants certain health and emotional benefits to participants. All stakeholders also recognised the potential psychological and financial risks to disclosure. Divergent perspectives elucidated consistent differences between our ‘Participant’ subjects (Participants, Parents, Community Members) and our ‘Professional’ subjects (IRB Members, Investigators and Physicians). Key differences included (1) what results should be reported, (2) participants’ autonomous right to research information and (3) the perception of the risk–benefit ratio in managing results.

Conclusions 
Understanding the perceived impact on all stakeholders involved in the process of disclosing incidental findings is necessary to determine appropriate research management policy. Our data further demonstrate the challenge of this task as different stakeholders evaluate the balance between risk and benefit related to their unique positions in this process. These findings offer some of the first qualitative insight into the expectations of the diverse stakeholders affected by incidental finding disclosure.

The entire article is here.

Privacy and Security for EHR: US and EU Compared

PRIVACY AND SECURITY IN THE IMPLEMENTATION OF

HEALTH INFORMATION TECHNOLOGY (ELECTRONIC

HEALTH RECORDS): U.S. AND EU COMPARED

By Janine Hiller, Matthew McMullen, Wade Chumey, and David Baumer

Abstract

The importance of the adoption of Electronic Health Records (EHRs) and the associated cost savings cannot be ignored as an element in the changing delivery of health care. However, the potential cost savings predicted in the use of EHR are accompanied by potential risks, either technical or legal, to privacy and security. The U.S. legal framework for healthcare privacy is a combination of constitutional, statutory, and regulatory law at the federal and state levels. In contrast, it is generally believed that EU protection of privacy, including personally identifiable medical information, is more comprehensive than that of U.S. privacy laws. Direct comparisons of U.S. and EU medical privacy laws can be made with reference to the five Fair Information Practices Principles (FIPs) adopted by the Federal Trade Commission and other international bodies. The analysis reveals that while the federal response to the privacy of health records in the U.S. seems to be a gain over conflicting state law, in contrast to EU law, U.S. patients currently have little choice in the electronic recording of sensitive medical information if they want to be treated, and minimal control over the sharing of that information. A combination of technical and legal improvements in EHRs could make the loss of privacy associated with EHRs de minimis. The EU has come closer to this position, encouraging the adoption of EHRs and confirming the application of privacy protections at the same time. It can be argued that the EU is proactive in its approach; whereas because of a different viewpoint toward an individual’s right to privacy, the U.S. system lacks a strong framework for healthcare privacy, which will affect the  implementation of EHRs. If the U.S. is going to implement EHRs effectively, technical and policy aspects of privacy must be central to the discussion.

The entire .pdf can be found here.

Thanks to Ken Pope for this lead.