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, February 10, 2014

Vignette 30: The Purloined Patient

Dr. Eddy Kessler received a referral from the Office of Vocational Rehabilitation (OVR) to work therapeutically with Enoch Thompson, who suffers with symptoms of a panic disorder.  Dr. Kessler accepted the referral and started to work with Mr. Thompson on his symptoms of panic and anxiety, as these have interfered with Mr. Thompson’s ability to maintain employment.  Treatment started well, with Mr. Thompson developing better cognitive and behavioral skills to manage his anxiety after the initial eight sessions funded by OVR.  With Mr. Thompson’s consent, Dr. Kessler sent a letter to OVR requesting 10 more sessions over the next five months to reinforce the gains made in treatment.  Dr. Kessler viewed Mr. Thompson as moving toward stable employment with ongoing treatment.  As Mr. Thompson was improving, they agreed to meet in two weeks.

Upon his return two weeks later, Mr. Thompson informed Dr. Kessler that he was recently evaluated by his wife’s psychologist, Dr. Gillian Darmody.  As the patient described it, Mr. Thompson took his wife to her therapy session.  Dr. Darmody asked him to join the session.  The outcome of the session was that Dr. Darmody would be able to get Mr. Thompson on Social Security Disability as she “knows how to write psychological reports” in a way that almost guarantees a favorable disability decision.  She also gave him the name of an attorney to represent him.  He also felt positive about the experience as Dr. Darmody agreed to bill his health insurance for the disability evaluation.  He has a meeting scheduled with the attorney in two weeks.  Mr. Thompson also believes that the consultation with the attorney is free, and that the attorney is paid after disability benefits are awarded.

Dr. Kessler inquired as to why he agreed to the disability evaluation if OVR is trying to return him to work.  Mr. Thompson disclosed that the job market is tough, so he wanted a backup plan in case he gets better and cannot find work.  Mr. Thompson stated he disclosed their treatment relationship.  However, Dr. Darmody deemed their treatment relationship to be inconsequential to the disability evaluation.  The session then focused on Mr. Thompson’s ability to manage anxiety via psychological skills.  Dr. Kessler manages his anger sufficiently to get through the session and scheduled Mr. Thompson in two weeks.

After the session, Dr. Kessler phones you for a consultation.  Dr. Kessler is morally outraged at the other psychologist’s behavior, if true.

What are the possible legal and ethical issues involved in this case?

How would you respond to Dr. Kessler’s moral outrage?

How would you explain the issues to Mr. Thompson?

Are these reasons to terminate your treatment with Mr. Thompson?

If you would continue to work with Mr. Thompson would you change your goals?

How would you document this report from Mr. Thompson in your case notes?

Would you withdraw your request for more sessions from OVR?

What are Dr. Kessler’s options?

If you were Dr. Kessler, what would you do and why?