The Widespread Problem of Doctor Burnout

By Pauline Chen
The New York Times
Originally published August 23, 2012

Here is an excerpt:

Research over the last 10 years has shown that burnout – the particular constellation of emotional exhaustion, detachment and a low sense of accomplishment – is widespread among medical students and doctors-in-training. Nearly half of these aspiring doctors end up becoming burned out over the course of their schooling, quickly losing their sense of empathy for others and succumbing to unprofessional behavior like lying and cheating.

Now, in what is the first study of burnout among fully trained doctors from a wide range of specialties, it appears that the young are not the only ones who are vulnerable. Doctors who have been practicing anywhere from a year to several decades are just as susceptible to becoming burned out as students and trainees. And the implications of their burnout — unlike that of their younger counterparts, who are often under supervision — may be more devastating and immediate.

Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. The researchers then compared the doctors’ responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender, age, number of hours worked and amount of education, the doctors were still more likely to suffer from burnout.

The entire article is here.

Psychologist pleads guilty to $1M fraud

Rhett E. McCarty admitted filing bogus Medicare, Medicaid claims since 2008

The Lebanon Daily Record
Originally published August 21, 2012

A psychologist who practiced in the Lebanon area pleaded guilty in federal court last week to engaging in a $1 million scheme to defraud Medicare and Medicaid.

Rhett E. McCarty, 67, of Lake Ozark, pleaded guilty before U.S. District Judge Howard F. Sachs to health care fraud and to forgery, according to a media release from David M. Ketchmark, acting U.S. Attorney for the Western District of Missouri.

McCarty is a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area.

The entire story is here.

Rationing Health Care More Fairly

By Eduardo Portor
New York Times - Business Day
Originally published August 24, 2012

Older adults are understandably anxious about the political sniping over the future financing of Medicare. That is precisely the intention of the presidential campaigns.

Yet the cross-fire over who will cut Medicare by how much sidesteps a critical issue about the future of our medical care: If we must ration our care to hold down costs in the future, how can we do it in a fair, efficient and transparent way?

Mitt Romney’s campaign was brazenly misleading in its charge that the president’s health plan would cut medical services to older adults by reducing Medicare spending by $716 billion. The president’s savings will come mostly from smaller payments to managed care companies, which provide the same services as Medicare at a higher cost, and from slower growth in reimbursement rates to health care providers.

But the response of President Obama’s campaign also aimed to stoke voters’ fears. It stressed — rightly — that the plan to curb Medicare costs proposed last year by Representative Paul D. Ryan, Mr. Romney’s vice-presidential running mate, would add thousands of dollars to older Americans’ out-of-pocket expenditures. Yet it ignored Mr. Ryan’s recent efforts to soften the plan.

(cut)

Rationing is inevitable in a world with finite resources. We do it in this country, too, and it is still one of the least fair and most inefficient rationing systems in the world. You get care if you have the money to pay for it; if not, you probably won’t.

The wealthiest 30 percent of the population accounts for nearly 89 percent of health care expenditures, according to a government study. Tens of millions of Americans — those whose employers don’t provide health insurance, who are too poor to pay for it themselves and yet are too rich to use Medicaid — get the least health care of all.

The entire article is here.

Psychopaths Get A Break From Biology: Judges Reduce Sentences If Genetics, Neurobiology Are Blamed

Medical News Today
Originally published August 21, 2012

A University of Utah survey of judges in 19 states found that if a convicted criminal is a psychopath, judges consider it an aggravating factor in sentencing, but if judges also hear biological explanations for the disorder, they reduce the sentence by about a year on average.

The new study, published in the Aug. 17, 2012, issue of the journal Science, illustrates the "double-edged sword" faced by judges when they are given a "biomechanical" explanation for a criminal's mental disorder:

If a criminal's behavior has a biological basis, is that reason to reduce the sentence because defective genes or brain function leave the criminal with less self-control and ability to tell right from wrong? Or is it reason for a harsher sentence because the criminal likely will reoffend?

"In a nationwide sample of judges, we found that expert testimony concerning the biological causes of psychopathy significantly reduced sentencing of the psychopath" from almost 14 years to less than 13 years, says study coauthor James Tabery, an assistant professor of philosophy at the University of Utah.

However, the hypothetical psychopath in the study got a longer sentence than the average nine-year sentence judges usually impose for the same crime - aggravated battery - and there were state-to-state differences in whether judges reduced or increased the sentence when given information on the biological causes of psychopathy.

The entire story is here.

Abstract

We tested whether expert testimony concerning a biomechanism of psychopathy increases or decreases punishment. In a nationwide experiment, U.S. state trial judges (N = 181) read a hypothetical case (based on an actual case) where the convict was diagnosed with psychopathy. Evidence presented at sentencing in support of a biomechanical cause of the convict's psychopathy significantly reduced the extent to which psychopathy was rated as aggravating and significantly reduced sentencing (from 13.93 years to 12.83 years). Content analysis of judges' reasoning indicated that even though the majority of judges listed aggravating factors (86.7%), the biomechanical evidence increased the proportion of judges listing mitigating factors (from 29.7 to 47.8%). Our results contribute to the literature on how biological explanations of behavior figure into theories of culpability and punishment.

The journal article is here.

James Tabery's email address.

FTC decision jeopardizes authority of medical boards, doctors say

By Alicia Gallegos
amednews.com
Originally published August 20, 2012

Physicians are urging a U.S. appeals court to overturn a Federal Trade Commission ruling that doctors say strips medical boards of their right to regulate medicine.

The appeal comes after a North Carolina dental board was found to have violated federal antitrust regulations by attempting to stop nondentists from operating teeth-whitening centers. The FTC said the board is not exempt from antitrust scrutiny because its members are private professionals who compete with others in the marketplace.

If the FTC decision stands, the ruling would significantly imperil state regulation of medicine and put the public’s health at risk, doctors said.

“It would be disruptive to the proper regulation of medicine nationwide,” said Stephen Keene, general counsel for the North Carolina Medical Society. “The notion of having government agency bureaucrats regulate a learned profession is not good for the public. There would be no meaningful oversight of practitioners to deliver safe medicine.”

The entire story is here.

'Gay Cure' Ban Heads For Vote In California

By Lila Shapiro
The Huffington Post
Originally posted August 19, 2012

Here is an except:

Two months ago, Guay testified at a hearing on a new bill in the California State Legislature that would ban the "gay cure," as this type of therapy is known. The bill is the first of its kind in the U.S., and observers expect it to pass by the end of August. If Gov. Jerry Brown (D) signs it, licensed therapists who try to change the sexual orientation of minors will run the risk of losing their licenses.

"I wanted parents to understand that this therapy is crazy," said Sen. Ted Lieu, the California Democrat who authored the bill.

The passage of SB 1172 would be the latest in a series of recent actions signaling a widespread condemnation of the practice. Almost all mainstream mental health organizations, from the American Psychiatric Association to the American Psychological Association, have renounced it. The World Health Organization has released a statement saying that such methods "lack medical justification and represent a serious threat to the health and well-being" of patients. Robert L. Spitzer, a psychiatrist who published a widely cited study supporting the "gay cure" practice in 2003, recently apologized for his work in the journal where the original paper appeared.

The entire post is here.

Haidt on Colbert

Social psychologist Jonathan Haidt discusses his book "The Righteous Mind: Why Good People are Divided by Politics and Religion".

The Colbert Report
Get More: Colbert Report Full Episodes,Political Humor & Satire Blog,Video Archive

Preventing Suicides in US Service Members and Veterans: Concerns After a Decade of War

By Charles W. Hoge, MD, & Carl A. Castro, PhD
JAMA. 2012;308(7):671-672. doi:10.1001/jama.2012.9955

Before the wars in Iraq and Afghanistan, the incidence of suicide in active duty US service members was consistently 25% lower than that in civilians, attributable to "healthy-worker" effects from career selection factors and universal access to health care.

Between 2005 and 2009, the incidence of suicide in Army and Marine personnel nearly doubled.
From 2009 through the first half of 2012, the incidence of suicide among Army soldiers remained elevated (22 per 100 000 per year), with the number dying of suicide each year exceeding the number killed in action.

High rates of suicide have also been reported for US veterans, although incidence studies in veteran populations have drawn conflicting conclusions.

(cut)

"Examining communication strategies is also critical. Stigmatizing attitudes may be unwittingly reflected in cliches, such as 'zero tolerance' or 'one suicide is one too many,' expressed by well-intentioned VA or military leaders.  These slogans convey an implicit message: suicides are different from any other medical condition, the result of a bad 'choice' by the individual or negligence by peers or leaders.  These types of communications would not be used to describe attitudes toward depression, PTSD, or cancer."

The entire article is here.

Thanks to Ken Pope for this information.

U.S. Army suicides reached record monthly high in July

By Collen Jenkins
Reuters
Originally published August 17, 2012

Twenty-six active-duty soldiers are believed to have committed suicide in July, more than double the number reported for June and the most suicides ever recorded in a month since the U.S. Army began tracking detailed statistics on such deaths.

During the first seven months of this year, there were 116 suspected suicides among active-duty soldiers, compared to 165 suicides for all of last year, the Army said. The military branch reported 12 likely suicides during June.

(cut)

"Suicide is the toughest enemy I have faced in my 37 years in the Army," General Lloyd J. Austin III, vice chief of staff of the Army, said in the report released on Thursday.

"To combat it effectively will require sophisticated solutions aimed at helping individuals to build resiliency and strengthen their life coping skills," he said.

The entire story is here.