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

Monday, May 7, 2012

Record Keeping in the Cloud: Ethical Considerations

*Professional Psychology: Research & Practice" has scheduled an article for publication in a future issue of the journal: "Record Keeping in the Cloud: Ethical Considerations."

The authors are Robert L. Devereaux and Michael C. Gottlieb.

Here's an excerpt: "In this article, we briefly review technological advances in electronic storage, define "the cloud" and explain how it functions, discuss risks and benefits of its use, and provide questions for practitioners when considering the appropriateness of maintaining patient records in this manner."

Here's another excerpt: "Consider the following example. A practitioner, using an online patient management system, decides to change service providers for any number of reasons (e.g., cost, poor service). The stored patient data may be contained within a proprietary system that cannot be easily migrated to a new system/provider. As mentioned previously, online service providers each have a unique system and moving from one to another might require unknown amounts of time, resources, and temporary loss of access to patient records during the move. In addition to the possible frustration of a transition process, it would be important for the practitioner to understand how data are deleted from the old system. For example, Facebook, a cloud-based social profile software system, maintains user accounts even after they are inactivated at the user's request. Permanently deleting the account is much more involved, and there is no way of knowing if Facebook maintains historical records of old accounts, although this may be discussed in their Terms and Conditions of Use Agreement. This could also be the case for other online storage or electronic medical record companies, and practitioners are well advised to investigate this matter before agreeing to store records on the cloud. Also, a practitioner would need to decide how much information to disclose to clients as part of a continued informed consent process if/when he or she decides to move records from one company to another. Such disclosure would need to be consistent with the level of detail about record keeping provided to the client at the onset of treatment."

Here's how the article concludes: "With the broad spectrum of electronic storage and management options available to practitioners, the abdication of control to a third-party, cloud-based company may represent unnecessary additional risk at this relatively early stage. In part, aggregation of documents from users worldwide may create a much more appealng target for malicious hackers than a single office with only a few patient documents. Also, the question of liability has not yet been clearly defined. We are responsible for protecting patient information, but computing companies carry no such obligation beyond their own internal policies and contractual obligations. We recommend that practitioners who move their EHR to the cloud do so with caution and careful consideration of the accompanying risks and benefits."

The author note provides the following contact information for reprint requests, questions, or comments: Robert

L. Devereaux, Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9044;  E-mail: robert.devereaux@utsouthwestern.edu

Thanks to Ken Pope for this information.

Sunday, May 6, 2012

Stressed physicians reluctant to seek support


They cite lack of time and fear of hurting their careers as reasons to avoid employee-assistance programs.

By KEVIN B. O'REILLY, amednews staff

Nearly 80% of physicians at an academic medical center said they experienced a personal crisis within the past year, yet most said they would not seek support from physician-health services or employee-assistance programs.

The 108 surgeons, anesthesiologists and emergency physicians surveyed said they experienced a wide range of stressful events, such as serious illnesses or deaths in their families and severe adverse events in their patients. But most they said they were unlikely to turn to institutional sources of support, with 40% saying they would be willing to consult physician-health services and 29% open to using employee-assistance programs. About a third of the doctors had never even heard of these services, said an Archives of Surgery study published in March.

The reason offered most frequently for not getting help was lack of time, with 90% of the physicians surveyed at Brigham and Women’s Hospital in Boston citing it. About 70% feared a lack of confidentiality, negative impact on their careers or the stigma of mental illness. Nearly half feared legal consequences or thought “using services means I am weak.”


Saturday, May 5, 2012

Conflicts Arise As Health Insurers Diversify

By Jay Hancock
Kaiser Health News
Originally published April 29, 2012

Like hospitals and doctorseverywhere, Banner Health fights a daily battle to get paid by insurance companies and government agencies for the care it delivers.

So the hospital system hired a company called Executive Health Resources to fight back against the likes of Medicare and UnitedHealthcare when they deny claims or pay bills for less than what Banner thinks it is owed.

But Banner executives began to worry about EHR's independence when the firm was acquired in 2010 by UnitedHealth Group, UnitedHealthcare's parent.

"It does seem as though there is reason for concern because they can use our own information against us," said Dennis Dahlen, CFO of the Phoenix-based Banner.

Critics call United's ownership of EHR a troubling conflict of interest that could give it confidential information about rivals as well as patients and limit EHR's power to demand payment from its much larger corporate sister. "How is that ownership going to affect the mission of a company whose business is to extract more money from payers?" said Scot Silverstein, a physician and specialist in medical software and patient records at Drexel University. "Imagine going to a plaintiff's lawyer to take your malpractice case and not knowing that plaintiff's lawyer actually works for the hospital that you're suing."

The entire story is here.

U.S. Charges 107 With Defrauding Medicare

By Louise Radnofsky
Wall Street Journal
Originally published on May 2, 2012

Federal officials said Wednesday they had charged 107 people across the country in recent days for allegedly running a string of unrelated Medicare fraud schemes involving a total of $452 million in false claims.

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius said that charges were being brought against defendants in seven cities, including doctors and nurses, for seeking to defraud the federal health program for the elderly and disabled. At least 83 of the defendants were arrested Wednesday morning, officials said.

Among those arrested were seven people in Baton Rouge, La., who were accused of recruiting elderly, mentally ill and drug-addicted patients from nursing homes and homeless shelters.

The entire story is here.

Friday, May 4, 2012

Bounded Ethicality: The Perils of Loss Framing

By Mary C. Kern and Dolly Chugh
Psychological Science
(2009) Volume 20, Number 3, pp 378-384

Abstract

Ethical decision making is vulnerable to the forces of automaticity. People behave differently in the face of a potential loss versus a potential gain, even when the two situations are transparently identical. Across three experiments, decision makers engaged in more unethical behavior if a decision was presented in a loss frame than if the decision was presented in a gain frame. In Experiment 1, participants in the loss-frame condition were more likely to favor gathering ‘‘insider information’’ than were participants in the gain-frame condition. In Experiment 2, negotiators in the loss-frame condition lied more than negotiators in the gain-frame condition. In Experiment 3, the tendency to be less ethical in the loss-frame condition occurred under time pressure and was eliminated through the removal of time pressure.

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Framing

In the studies reported here, we explored the effect of automaticity on the cognitions and behaviors of decision makers in the moment of ethical choice. What are the roles of the decision maker’s cognitive framing of the situation and the decision maker’s available cognitive resources?  We turned to framing effects (Tversky & Kahneman, 1981) as the foundation of our inquiry.  The transformative effects of framing are well established (for reviews, see Camerer, 2000; Kuhberger, 1998). A framing effect occurs when transparently and objectively identical situations generate dramatically different decisions depending on whether the situations are presented, or perceived, as potential losses or gains (Tversky & Kahneman, 1981). Framing effects are integral to prospect theory (Kahneman & Tversky, 1979; Tversky & Kahneman, 1981), a model of choice that describes an ‘‘S-shaped value function’’ to illustrate the differences in how gains and losses, relative to a reference point, are valued. A critical feature of this curve is that it has a steeper slope in the loss domain than in the gain domain. As a result, people are loss averse; that is, they are willing to go to greater lengths to avoid a loss than to obtain a gain of a similar size (Kahneman, Knetsch, & Thaler, 1990; Tversky & Kahneman, 1991).

We considered the implications of framing effects for ethics.  When making decisions, individuals often choose from an array of possible responses, with some choices being more, or less, ethical than others. Given the previous work on framing effects, we reasoned that individuals who perceive a potential outcome as a loss will go to greater lengths, and engage in more unethical behavior, to avert that loss than will individuals who perceive a similarly sized gain. This logic formed the initial basis for the present research.

Penn Dean Put on Leave in Probe over Degree

By Susan Snyder
The Philadelphia Inquirer
Originally published on April 26, 2012

The University of Pennsylvania placed the vice dean of its Graduate School of Education on administrative leave late Wednesday after The Inquirer began asking questions about his false claim to have a doctoral degree.

Doug E. Lynch has claimed on his resumé that he received the degree from Columbia University. A faculty website repeatedly refers to him as "Dr. Lynch."

Earlier Wednesday, Penn officials said they became aware of the misrepresentation a couple of months ago, taking unspecified "appropriate sanctions" but deciding to leave Lynch in his leadership role.

That changed after The Inquirer placed a call to Penn president Amy Gutmann for comment. The university then issued a one-sentence statement from Stephen J. MacCarthy, vice president for university communications.

"Doug Lynch has been placed on administrative leave pending the outcome of an ongoing investigation," MacCarthy's statement said.

The entire story is here.

Thursday, May 3, 2012

CDC Social Media Tools, Guidelines & Best Practices

"The use of social media tools is a powerful channel to reach target audiences with strategic, effective and user-centric health interventions. To assist in the planning, development and implementation of social media activities, the following guidelines have been developed to provide critical information on lessons learned, best practices, clearance information and security requirements. Although these guidelines have been developed for the use of these channels at the Centers for Disease Control and Prevention (CDC), they may be useful materials for other federal, state and local agencies as well as private organizations to reference when developing social media tools."

The site can be found here.

The site includes a Social Media Toolkit, a Guide to Writing for Social Media, and Twitter Guidelines and Best Practices, to name a few.

Thanks to Pauline Wallin for this information.

Another link to these resources can be found on our Resources, Guides, and Guidelines page.

Does Medicine Discourage Gay Doctors?

By Pauline W. Chen, M.D.
The New York Times - Well
Originally published April 26, 2012

During my surgical training, whenever the conversation turned to relationships, one of my colleagues would always joke about his inability to get a date, then abruptly change the subject. I thought he might be gay but never asked him outright, because it didn’t seem important.

But one morning, while we working at the nurses’ station with several of the other doctors-in-training, I realized it was important, because at the hospital, he really couldn’t be himself.

That morning, one of the senior surgeons stormed over. He had found one of his patients feeling slightly short of breath, no doubt because of an insufficient dose of diuretic overnight.

“Which of you idiots,” he growled at us, “gave my patient a homosexual dose of diuretic?”

The entire story is here.

Social media: how doctors can contribute

The Lancet
Volume 379, Issue 9826, page 1562
Published on April 28, 2012

On April 18, The General Medical Council, which regulates medical practice in the UK, opened up its draft guidance on doctors' use of social media for consultation. Comments can be made until June 13, and the results will be published by the end of the year. The guidance emphasises the need to maintain patient confidentiality, provide accurate information, treat colleagues with respect, avoid anonymity online if writing in a professional capacity, be aware of how content is shared, review privacy settings and online presence, declare conflicts of interest, and maintain separate personal and professional profiles.