When Patients Become Colleagues

Charles C. Dike

Psychiatric News

Published Online:27 Oct 2022

Dr. Jones, a psychiatrist in private practice, described to me a conundrum she was trying to resolve. A patient she has been treating for eight years with psychotherapy and medication was recently certified as a therapist. The patient intends to terminate treatment with her and set up a private practice in the same district as the psychiatrist. The new therapist is asking for a collaborative relationship with the psychiatrist in which he would refer patients to the psychiatrist for medication management. The psychiatrist is not comfortable with the proposal and worries that her deep knowledge of her ex-patient’s flaws would negatively influence her view of the patient as a therapist. Most importantly, however, she is concerned about the risks of boundary violations and a breach in confidentiality, for example, when patients ask about the relationship between the psychiatrist and their referring therapist, as often happens.

The APA Ethics Committee has received questions about similar situations. One such question involved a patient who had received psychiatric treatment at an institution for years and was now applying to work as a clinician at the same institution a decade later. In this case, the Ethics Committee affirmed the need for psychiatrists “to support the concept that treatment matters and that people can recover and live full lives by addressing the challenges of mental illness. Psychiatrists should model that seeking treatment is a healthful and positive behavior and not a stigmatized act that will forever preclude a person, once a patient, from joining a team of respected mental health professionals. A history of mental health treatment should not be used to ban employment; a history of appropriate qualifications and pursuit of necessary medical treatment should be positive indicators for employment.”

Nonetheless, every such situation requires deep reflection to avoid potential ethics breaches. In some cases, the guidance is clear. For example, it is unethical for a psychiatrist in a solo private practice to employ a former patient because the pre-existing doctor-patient relationship is likely to influence the working relationship on both sides with potential negative consequences. In Dr. Jones’s case, however, the situation has ethics considerations that need to be addressed. Here is the advice that I gave to Dr. Jones: After celebrating her patient’s success, she should schedule a private meeting to discuss the contours of their new professional relationship. She should clarify that it would be a challenge to be his psychiatrist in the future should he suffer a relapse and need care. Further, Dr. Jones should point out that a personal relationship with a former patient could be unethical, especially if intimate, and therefore, all social interactions should be avoided as much as possible. When it is not possible to avoid them, they should carefully manage their interactions, social or professional, making sure boundaries are not breached. Dr. Jones should also discuss possible circumstances that could insinuate to others that she and the therapist had a prior treatment relationship as any such acknowledgment on her part would be a breach of her patient’s confidentiality. The fact that her former patient discloses their relationship to others does not absolve the psychiatrist of this ethical injunction. Such a discussion would prevent future problems and set the stage for the next chapter of their relationship.

The info is here.

The Robotic Disruption of Morality

John Danaher
Philosophical Disquisitions
Originally published August 2, 2019

Here is an excerpt:

2. The Robotic Disruption of Human Morality

From my perspective, the most interesting aspect of Tomasello’s theory is the importance he places on the second personal psychology (an idea he takes from the philosopher Stephen Darwall). In essence, what he is arguing is that all of human morality — particularly the institutional superstructure that reinforces it — is premised on how we understand those with whom we interact. It is because we see them as intentional agents, who experience and understand the world in much the same way as we do, that we start to sympathise with them and develop complex beliefs about what we owe each other. This, in turn, was made possible by the fact that humans rely so much on each other to get things done.

This raises the intriguing question: what happens if we no longer rely on each other to get things done? What if our primary collaborative and cooperative partners are machines and not our fellow human beings? Will this have some disruptive impact on our moral systems?

The answer to this depends on what these machines are or, more accurately, what we perceive them to be. Do we perceive them to be intentional agents just like other human beings or are they perceived as something else — something different from what we are used to? There are several possibilities worth considering. I like to think of these possibilities as being arranged along a spectrum that classifies robots/AIs according to how autonomous or tool-like they perceived to be.

At one extreme end of the spectrum we have the perception of robots/AIs as tools, i.e. as essentially equivalent to hammers and wheelbarrows. If we perceive them to be tools, then the disruption to human morality is minimal, perhaps non-existent. After all, if they are tools then they are not really our collaborative partners; they are just things we use. Human actors remain in control and they are still our primary collaborative partners. We can sustain our second personal morality by focusing on the tool users and not the tools.

The blog post is here.

Psychiatrist suspended for ‘inappropriate relationship.’ He got a $196K state job.

Steve Contorno & Lawrence Mower
www.miamiherald.com
Originally posted February 28, 2019

Less than a year ago, Domingo Cerra Fernandez was suspended from practicing medicine in the state of Florida.

The Ocala psychiatrist allegedly committed one of the cardinal sins of his discipline: He propositioned a patient to have a sexual and romantic relationship with him. He then continued to treat her.

But just months after his Florida suspension ended, Cerra Fernandez has a new job. He’s a senior physician at the North Florida Evaluation and Treatment Center, a maximum-security state-run treatment facility for mentally disabled adult male patients.

How did a recently suspended psychiatrist find himself working with some of Florida’s most vulnerable and dangerous residents, with a $196,000 annual salary?

The Department of Children and Families, which runs the facility, knew about his case before hiring him to a job that had been vacant for more than a year. DaMonica Smith, a department spokeswoman, told the Herald/Times that Cerra Fernandez was up front about his discipline.

The info is here.

Bannon May Have Violated Ethics Pledge by Communicating With Breitbart

Lachlan Markay
Daily Beast
Originally published March 30, 2017

Here is an excerpt:

Bannon, Breitbart’s former chairman, has spoken directly to two of the company’s top editors since joining the White House. Trump’s predecessor publicly waived portions of the ethics pledge for similar communications, but the White House confirmed this week that it has not done so for Bannon.

“It seems to me to be a very clear violation,” Richard Painter, who was White House counsel for President George W. Bush, told The Daily Beast in an interview.

A White House spokesperson confirmed that every Trump appointee has signed the ethics pledge required by an executive order imposed by the president in January. No White House employees have received waivers to the pledge, the spokesperson added.

All incoming appointees are required to certify that they “will not for a period of 2 years from the date of my appointment participate in any particular matter involving specific parties that is directly and substantially related to my former employer or former clients.”

The article is here.

Dimensions of Moral Emotions

By Kurt Gray and Daniel M. Wegner
Emotion Review Vol. 3, No. 3 (July 2011) 258–260

Abstract

Anger, disgust, elevation, sympathy, relief. If the subjective experience of each of these emotions is the same whether elicited by moral or nonmoral events, then what makes moral emotions unique? We suggest that the configuration of moral emotions is special—a configuration given by the underlying structure of morality. Research suggests that people divide the moral world along the two dimensions of valence (help/harm) and moral type (agent/patient). The intersection of these two dimensions gives four moral exemplars—heroes, villains, victims and beneficiaries—each of which elicits unique emotions. For example, victims (harm/patient) elicit sympathy and sadness. Dividing moral emotions into these four quadrants provides predictions about which emotions reinforce, oppose and complement each other.

The entire article is here.

Decline Facebook 'Friend' Appeals from Patients, Groups Say

By  David Pittman
Washington Correspondent, MedPage Today
Originally published April 12, 2013, and still relevant today

Physicians should avoid making or accepting "friend" requests through social networking websites with past or current patients, a new policy statement advises.

Instead, doctors should separate their professional and social lives online and direct patients to correct avenues of information if they contact doctors through social networks, according to the policy statement issued jointly on Thursday by the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).

"There's this notion of blurring of our identity, blurring of our persona," David Fleming, MD, chair of ACP's Ethics, Professionalism, and Human Rights Committee, which helped draft the guidelines, said here at the ACP's annual meeting.

The entire article is here.