The Psych Approach

By DAVID BROOKS
The New York Times
Originally Published: September 27, 2012

Here are some excerpts:


Tough’s book is part of what you might call the psychologizing of domestic policy. In the past several decades, policy makers have focused on the material and bureaucratic things that correlate to school failure, like poor neighborhoods, bad nutrition, schools that are too big or too small. But, more recently, attention has shifted to the psychological reactions that impede learning — the ones that flow from insecure relationships, constant movement and economic anxiety.

Attention has shifted toward the psychological for several reasons. First, it’s become increasingly clear that social and emotional deficits can trump material or even intellectual progress. Schools in the Knowledge Is Power Program, or KIPP, are among the best college prep academies for disadvantaged kids. But, in its first survey a few years ago, KIPP discovered that three-quarters of its graduates were not making it through college. It wasn’t the students with the lower high school grades that were dropping out most. It was the ones with the weakest resilience and social skills. It was the pessimists.

Second, over the past few years, an array of psychological researchers have taught us that motivation, self-control and resilience are together as important as raw I.Q. and are probably more malleable.

Finally, pop culture has been far out front of policy makers in showing how social dysfunction can ruin lives. You can turn on an episode of “Here Comes Honey Boo Boo,” about a train wreck working-class family. You can turn on “Alaska State Troopers” and see trailer parks filled with drugged-up basket cases. You can listen to rappers like Tyler, The Creator whose songs are angry howls from fatherless men.

The entire article is here.

Gay Conversion Therapy Law Temporarily Blocked By Federal Judge

By LISA LEFF
The Huffington Post
Originally published December 4, 2012


A federal judge on Monday temporarily blocked California from enforcing a first-of-its-kind law that bars licensed psychotherapists from working to change the sexual orientations of gay minors, but he limited the scope of his order to just the three providers who have appealed to him to overturn the measure.

U.S. District Court Judge William Shubb made a decision just hours after a hearing on the issue, ruling that the First Amendment rights of psychiatrists, psychologists and other mental health professionals who engage in "reparative" or "conversion" therapy outweigh concern that the practice poses a danger to young people.

"Even if SB 1172 is characterized as primarily aimed at regulating conduct, it also extends to forms of (conversion therapy) that utilize speech and, at a minimum, regulates conduct that has an incidental effect on speech," Shubb wrote.

The judge also disputed the California Legislature's finding that trying to change young people's sexual orientation puts them at risk for suicide or depression, saying it was based on "questionable and scientifically incomplete studies."

The law, which was passed by the Legislature and signed by Gov. Jerry Brown in October, states that therapists and counselors who use "sexual orientation change efforts" on clients under 18 would be engaging in unprofessional conduct and subject to discipline by state licensing boards. It is set to take effect on Jan. 1.

The entire story is here.

Human Enhancements at Work Pose Ethical Dilemmas

By Kate Holland
Reuters Health Information
Originally published November 8, 2012


Retinal implants to help pilots see at night, stimulant drugs to keep surgeons alert and steady handed, cognitive enhancers to focus the minds of executives for a big speech or presentation.

Medical and scientific advances are bringing human enhancements into work but with them, according to a report by British experts, come not only the potential to help society and boost productivity, but also a range of ethical dilemmas.

"We're not talking science fiction here, we're talking about advances that could impact significantly on the way we work...in the near future," said Genevra Richardson, a professor of law at Kings College London and one of the authors of the report.

The report was published after a joint workshop involving four major British scientific institutions which looked at emerging technologies like cognitive enhancing drugs, bionic limbs and retinal implants that have the potential to change workplaces dramatically in future.

Richardson said while such developments may benefit society in important ways, such as by boosting workforce productivity, their use also had "significant policy implications" to be considered by governments, employers, workers and trades unions.

The entire article is here.

DSM-5 Wins APA Board Approval

By John Gever, Senior Editor
MedPage Today
Originally published December 1, 2012

The American Psychiatric Association's board of trustees has approved the fifth edition of its influential diagnostic manual, dubbed DSM-5, the group announced Saturday.

The board vote is the last step before the manual is formally released at the APA's annual meeting next May. The association's Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV.

According to an APA statement, changes include an end to the system of "axes" used to class diagnoses into broad groups, and an associated restructuring of diagnostic groups to bring disorders thought to be biologically related under the same headings.

Also, many of the diagnostic criteria will now include so-called dimensional assessments to indicate severity of symptoms.

Specific language in DSM-5 was not immediately released, and probably won't be until the formal unveiling in May. Detailed criteria that had been published on the APA's DSM5.org website for public review and comment have now been removed.

However, the statement released Saturday indicated that the manual will include many of the most controversial of the proposed changes from DSM-IV.

The entire article is here.

When Is It Okay to Date a Patient?

By Shelly Reese
Medscape Ethics Report 2012
Originally published November 15, 2012


Introduction

To the besotted poet, love is intoxicating, exasperating, invigorating. To the doctor -- if the would-be paramour is a patient -- it's also unethical.

But physician responses to Medscape's 2012 ethics survey clearly indicate that many physicians aren't willing to condemn every romance. When asked, "Is it ever acceptable to become involved a romantic or sexual relationship with a patient?" more than two thirds (68%) of the 24,000 doctors who responded resoundingly say "no."

In contrast, nearly one third are more nuanced in their view. Only a tiny minority (1%) give romance with current patients a green light, but a sizable share (22%) say that a romantic relationship with a former patient may be acceptable, as long as at least 6 months have passed since the professional relationship was terminated. Another 9% say the ethics depend on the situation.

Whereas the American Medical Association (AMA) clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct, it takes a fuzzier position on relationships that might develop later. The AMA notes that the prior doctor/patient relationship may unduly influence the patient and that such a relationship is unethical if the doctor "uses or exploits trust, knowledge, emotions or influence derived from the previous professional relationship."

Ethicists, such as Dr. Richard Martinez, director of forensic psychiatry services at Denver Health Medical Center and the author of several articles on ethical decision-making and the patient/physician relationship, says the AMA was wise to leave a little wiggle room in its opinion.

"Relationships are complicated," he says. "Every ethical dilemma has to be evaluated and considered on a case-by-case basis."

The entire story is here.

Thanks to Gary Schoener for this information.

Dealing With Doctors Who Take Only Cash

By PAUL SULLIVAN
The New York Times
Originally published: November 23, 2012

Here is an excerpt:

The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife’s diet. Within two days, our baby was sleeping through the night and we were all feeling better.

The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.

A couple of weeks later, our insurance company said it wouldn’t pay anything. Here’s how the company figured it: First, it said a fair price for our doctor’s fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.

While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.

Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?

The entire story is here.

Hanging Suicides Up in United States

By Steven Reinberg
HealthDay Reporter
Originally published November 20, 2012

A surge in hanging deaths among middle-aged adults appears to be responsible for the notable increase in U.S. suicides between 2000 and 2010, a new study finds.


Hangings accounted for 26 percent of suicides in 2010, up from 19 percent at the start of the decade. Among those aged 45 to 59, suicide by hanging increased 104 percent in that time period, according to the report documenting changing suicide patterns.

Overall, 16 percent more Americans took their own lives in 2010 than in 2000. That's equivalent to 12.1 suicides per 100,000 people compared to 10.4 per 100,000 previously.

"It is important that the huge increase in suicide by hanging be recognized," said lead researcher Susan Baker, founding director of the Johns Hopkins Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The entire story is here.

Online Patient Access to Records May Boost Visits

By John Gever, Senior Editor
MedPage Today
Published: November 20, 2012


Patients with access to their physicians' electronic health record systems had more office visits, hospital admissions, and emergency room encounters than those without such access, researchers said.

Participants in a Kaiser Permanente program giving them access to their electronic records, including a secure email system for communicating with clinicians, showed significant increases in nearly all measures of healthcare utilization, relative to the period before they joined the program, Ted E. Palen, MD, PhD, MSPH, of Kaiser Permanente Colorado in Denver, and colleagues reported in the Nov. 20 issue of the Journal of the American Medical Association.

(cut)

In an accompanying editorial, two researchers at Brigham and Women's Hospital in Boston noted that the study findings stood in contrast to Kaiser investigations in other regions, which had found reductions in utilization associated with so-called patient portals to electronic health records.

The entire story is here.

Medicare Is Faulted on Shift to Electronic Records

By REED ABELSON
The New York Times
Originally Published: November 29, 2012

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

The entire article is here.