Santa Monica’s Headspace Health laid off dozens of therapists. Their patients don’t know where they went

Jaimie Ding

The Los Angeles Times

Originally posted 7 July 23

When Headspace Health laid off 33 of its therapists June 29, patients were told their providers had left the platform.

What they didn’t know was their therapists had lost their jobs. And they suddenly had no way to contact them.

Several therapists who were let go from Headspace, the Santa Monica meditation app and remote mental health care company, have raised alarm over their treatment and that of their patients after the companywide layoff of 181 total employees, which amounts to 15% of the workforce.

After the layoffs were announced in the morning without warning, these therapists said they immediately lost access to their patient care systems. Appointments, they said, were canceled without explanation, potentially causing irreparable harm to their patients and forcing them to violate the ethical guidelines of their profession.

One former therapist, who specializes in working with the LGBTQ+ community, said one of his clients had just come out in a session the day before he lost his job. The therapist requested anonymity because he was still awaiting severance from Headspace and feared retribution.

“I’m the first person they’ve ever talked to about it,” he said. “They’re never going back to therapy. They just had the first person she talked to about it abandon them.”

He didn’t know he had been laid off until 10 minutes after his first appointment was supposed to start and he had been unable to log into the system.

The info is here.

Some thoughts and analysis from me.  There are clear ethical and legal concerns here.

Abandoning patients: Headspace Health did not provide patients with any notice or information about where their therapists had gone. This is a violation of the ethical principle of fidelity, which requires healthcare providers to act in the best interests of their patients. It also leaves patients feeling abandoned and without a source of care.

Potential for harm to patients: The sudden loss of a therapist can be disruptive and stressful for patients, especially those who are in the middle of treatment. This could lead to relapses, increased anxiety, or other negative consequences. In more extreme, but realistic cases, it could even lead to suicide.

In addition to the ethical and legal problems outlined above, the article also raises questions about the quality of care that patients can expect from Headspace Health. If the company is willing to abruptly lay off therapists without providing any notice or information to patients, it raises concerns about how they value the well-being of their patients. It also raises questions about the company's commitment to providing quality care.  Headspace may believe itself to be a tech company, but it is a healthcare company subject to many rules, regulations, and standards.

Social Workers’ Perceptions of Their Peers’ Unprofessional Behavior

Gricus, M., & Wysiekierski, L. (2021).

Journal of Social Work. 

https://doi.org/10.1177/14680173211012576

Abstract

Summary

This article explores social workers’ perceptions of their colleagues’ professional mistakes, and the influences of those opinions. Vignettes in a factorial survey helped to determine whether certain variables related to the social worker or the situation influenced the perception of others’ professional errors and ethical violations. The changed variables included personal characteristics of the offending social worker such as perceived race, gender, and sexual orientation of the social worker, and characteristics of the situation, such as the length of time involved in unprofessional behavior.

Findings

Licensed social workers in six U.S. states (n = 5596) read vignettes based on real cases brought before licensing boards (n = 22,127) and assigned levels of seriousness and importance to discipline. The vignettes rated most highly involved perceived harm to a client or other vulnerable individual. Those on the lower end of seriousness and importance to discipline were those violations against the profession of social work. Analysis of changed variables indicated respondents’ ratings were influenced by several situational factors, but not by personal characteristics of the social worker involved in the vignette.

Applications

Our findings provide some insight into the decision-making factors important to social workers. The results may be helpful to licensing boards considering the contextual factors of unprofessional behavior and whether to discipline certain actions.

From the article:

The availability heuristic proposes that people make judgments based only on the information available at the time (Croskerry, 2002; Shah & Oppenheimer, 2008). The representativeness heuristic allows people to judge whether an example belongs to a given category (Bowes et al., 2020). In clinical settings, this heuristic can play out in diagnosing similar, but not identical, clinical presentations with the same diagnosis. The representativeness heuristic can also cause people to make judgments based on race and gender stereotypes (Bowes et al., 2020). Bisking et al. (2003) (as cited in Salvador, 2019) found that when individuals are involved in enacting sanctions on someone perceived to have engaged in misconduct, their decisions are influenced by characteristics of the offender such as gender. The anchoring and adjustment heuristic, also known as focalism or priming, reveals that people form judgments largely based on the first piece of information they receive and weigh it against all other information (Bowes et al., 2020). Focalism can help to explain why misinformation can be difficult to disprove.

The research is here.

Responding to Unprofessional Behavior by Trainees — A “Just Culture” Framework

J. A. Wasserman, M. Redinger, and T. Gibb
New England Journal of Medicine
February 20, 2020
doi: 10.1056/NEJMms1912591

Professionalism lapses by trainees can be addressed productively if viewed through a lens of medical error, drawing on “just culture” principles. With this approach, educators can promote a formative learning environment while fairly addressing problematic behaviors.

Addressing lapses in professionalism is critical to professional development. Yet characterizing the ways in which the behavior of emerging professionals may fall short and responding to those behaviors remain difficult.

Catherine Lucey suggests that we “consider professionalism lapses to be either analogous to or a form of medical error,” in order to create “a ‘just environment’ in which people are encouraged to report professionalism challenges, lapses, and near misses.” Applying a framework of medical error promotes an understanding of professionalism as a set of skills whose acquisition requires a psychologically safe learning environment.

 Lucey and Souba also note that professionalism sometimes requires one to act counter to one’s other interests and motivations (e.g., to subordinate one’s own interests to those of others); the skills required to navigate such dilemmas must be acquired over time, and therefore trainees’ behavior will inevitably sometimes fall short.

We believe that lapses in professional behavior can be addressed productively if we view them through this lens of medical error, drawing on “just culture” principles and related procedural approaches.

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The Just Culture Approach

Thanks to a movement catalyzed by an Institute of Medicine report, error reduction has become a priority of health systems over the past two decades. Their efforts have involved creating a “culture of psychological safety” that allows for open dialogue, dissent, and transparent reporting. Early iterations involved “blame free” approaches, which have increasingly given way to an emphasis on balancing individual and system accountability.

Drawing on these just culture principles, a popular approach for defining and responding to medical error recognizes the qualitative differences among inadvertent human error, at-risk behavior, and reckless behavior (the Institute for Safe Medication Practices also provides an excellent elaboration of these categories).

“Inadvertent human errors” result from suboptimal individual functioning, but without intention or the knowledge that a behavior is wrong or error-prone (e.g., an anesthesiologist inadvertently grabbing a paralyzing agent instead of a reversal agent). These errors are not considered blameworthy, and proper response involves consolation and assessment of systemic changes to prevent them in the future.

Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

Martinez W, Lehmann LS, Thomas EJ, et al
BMJ Qual Saf Published Online First: 25 April 2017.

Background Open communication between healthcare professionals about care concerns, also known as ‘speaking up’, is essential to patient safety.

Objective Compare interns' and residents' experiences, attitudes and factors associated with speaking up about traditional versus professionalism-related safety threats.

Design Anonymous, cross-sectional survey.

Setting Six US academic medical centres, 2013–2014.

Participants 1800 medical and surgical interns and residents (47% responded).

Measurements Attitudes about, barriers and facilitators for, and self-reported experience with speaking up. Likelihood of speaking up and the potential for patient harm in two vignettes. Safety Attitude Questionnaire (SAQ) teamwork and safety scales; and Speaking Up Climate for Patient Safety (SUC-Safe) and Speaking Up Climate for Professionalism (SUC-Prof) scales.

Results Respondents more commonly observed unprofessional behaviour (75%, 628/837) than traditional safety threats (49%, 410/837); p<0.001, but reported speaking up about unprofessional behaviour less commonly (46%, 287/628 vs 71%, 291/410; p<0.001). Respondents more commonly reported fear of conflict as a barrier to speaking up about unprofessional behaviour compared with traditional safety threats (58%, 482/837 vs 42%, 348/837; p<0.001). Respondents were also less likely to speak up to an attending physician in the professionalism vignette than the traditional safety vignette, even when they perceived high potential patient harm (20%, 49/251 vs 71%, 179/251; p<0.001). Positive perceptions of SAQ teamwork climate and SUC-Safe were independently associated with speaking up in the traditional safety vignette (OR 1.90, 99% CI 1.36 to 2.66 and 1.46, 1.02 to 2.09, respectively), while only a positive perception of SUC-Prof was associated with speaking up in the professionalism vignette (1.76, 1.23 to 2.50).

Conclusions Interns and residents commonly observed unprofessional behaviour yet were less likely to speak up about it compared with traditional safety threats even when they perceived high potential patient harm. Measuring SUC-Safe, and particularly SUC-Prof, may fill an existing gap in safety culture assessment.

The article is here.

Physician Congressman Fined for Having Sex With 2 Patients

By Robert Lowes
Medscape Medical News
Originally published on May 24, 2014

Rep. Scott DesJarlais, MD (R-TN), was fined $500 by the state medical board in Tennessee for having sexual relationships with 2 female patients in 2000, according to a consent order approved by the board on May 22.

The Board of Medical Examiners of Tennessee also reprimanded Dr. DesJarlais, characterizing his behavior as "unprofessional conduct."

Dr. DesJarlais, a general practitioner who was first elected to represent Tennessee's Fourth Congressional District in 2010, signed the consent order on May 20.

The consent order describes in bare-bones fashion what was laid out in voluminous detail about Dr. DesJarlais' personal life during and after his 2012 reelection campaign. From roughly January 2000 to May 2000, Dr. DesJarlais "had a sexual relationship with 2 female patients," the order states. "No documentation exists to show whether or not the physician-patient relationship was severed prior to the commencement of a romantic relationship with either female patient."

The board fined Dr. DesJarlais $250 for each patient. He also is responsible for the state's cost of prosecuting the case, up to $1000.

The rest of the story is here.

Medical Boards Discipline Physicians for Online Behavior

By Jenni Laidman
Medscape Medical News
Originally published March 20, 2012

Most medical licensing boards have received at least 1 complaint about unprofessional online behavior by physicians, and many of these complaints resulted in serious disciplinary actions, including license revocation, according to a research letter published in the March 21 issue of JAMA.

S. Ryan Greysen, MD, from the Division of Hospital Medicine, University of California, San Francisco, and colleagues report that 48 (71%) of the 68 executive directors of medical licensing boards responded to the study survey. Of those, 44 (92%; 95% confidence interval [CI], 86% - 98%) indicated receiving at least 1 complaint about an online professional breach.

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"We've just found a new way to violate our own standards," Jason Jent, PhD, assistant professor of clinical pediatrics, Division of Clinical Psychology, Department of Pediatrics, University of Miami Miller School of Medicine, Florida, said to Medscape Medical News.

The entire story is here.