Leah Somerville
www.sciencemag.org
Originally posted November 20, 2018
Here are two excerpts:
There are many urgent discussions that are needed right now to address the cultural problems in academia. We need to find ways to support trainees who have experienced misconduct, to identify malicious actors, to reconsider departmental and institutional policies, and more. Here, I would like to start a discussion aimed at the scientific community of primarily well-intentioned actors, using my own experiences as a lens to consider how we can all be more attuned to the slippery slope on which a toxic environment can be built.
Blurry boundaries. In scientific laboratories, it can be easy to blur lines between the professional and the personal. People in labs spend a lot of time together, travel together, and in some cases socialize together. Some people covet a close, “family-like” lab environment. For faculty members, what constitutes appropriate boundaries is not always obvious; after all, new faculty members are often barely older than their trainees. But whether founded on good intentions or not, close personal relationships can be a slippery slope because of the inherent power differential between trainee and mentor.
(cut)
Shame and isolation. It is harder to appreciate the sheer dysfunctionality of an environment if you believe you are experiencing it alone. Yet even if multiple individuals have similar experiences, they may hesitate to share them out of fear and shame or a sense of pluralistic ignorance. The result? Toxic environments can remain shrouded in secrecy, allowing them to perpetuate and intensify over time. For example, a friend of mine from this era did not tell me until years later that she was the recipient of an unwanted sexual advance. This event and its aftermath had an excruciating impact on her experience as a graduate student, yet she suffered through this turmoil in silence.
It is crucial that people in positions of power appreciate the shame and isolation that can accompany being a recipient of inappropriate behavior and the great personal cost of coming forward. Silence should not be interpreted as a signal that the events were not serious and damaging. Moreover, students need to perceive that clear channels of support and communication are available to them.
The info is here.
Showing posts with label Boundaries. Show all posts
Showing posts with label Boundaries. Show all posts
Wednesday, December 19, 2018
Sunday, November 11, 2018
Nine risk management lessons for practitioners.
Taube, Daniel O.,Scroppo, Joe,Zelechoski, Amanda D.
Practice Innovations, Oct 04 , 2018
Abstract
Risk management is an essential skill for professionals and is important throughout the course of their careers. Effective risk management blends a utilitarian focus on the potential costs and benefits of particular courses of action, with a solid foundation in ethical principles. Awareness of particularly risk-laden circumstances and practical strategies can promote safer and more effective practice. This article reviews nine situations and their associated lessons, illustrated by case examples. These situations emerged from our experience as risk management consultants who have listened to and assisted many practitioners in addressing the challenges they face on a day-to-day basis. The lessons include a focus on obtaining consent, setting boundaries, flexibility, attention to clinician affect, differentiating the clinician’s own values and needs from those of the client, awareness of the limits of competence, maintaining adequate legal knowledge, keeping good records, and routine consultation. We highlight issues and approaches to consider in these types of cases that minimize risks of adverse outcomes and enhance good practice.
The info is here.
Here is a portion of the article:
Being aware of basic legal parameters can help clinicians to avoid making errors in this complex arena. Yet clinicians are not usually lawyers and tend to have only limited legal knowledge. This gives rise to a risk of assuming more mastery than one may have.
Indeed, research suggests that a range of professionals, including psychotherapists, overestimate their capabilities and competencies, even in areas in which they have received substantial training (Creed, Wolk, Feinberg, Evans, & Beck, 2016; Lipsett, Harris, & Downing, 2011; Mathieson, Barnfield, & Beaumont, 2009; Walfish, McAlister, O’Donnell, & Lambert, 2012).
Practice Innovations, Oct 04 , 2018
Abstract
Risk management is an essential skill for professionals and is important throughout the course of their careers. Effective risk management blends a utilitarian focus on the potential costs and benefits of particular courses of action, with a solid foundation in ethical principles. Awareness of particularly risk-laden circumstances and practical strategies can promote safer and more effective practice. This article reviews nine situations and their associated lessons, illustrated by case examples. These situations emerged from our experience as risk management consultants who have listened to and assisted many practitioners in addressing the challenges they face on a day-to-day basis. The lessons include a focus on obtaining consent, setting boundaries, flexibility, attention to clinician affect, differentiating the clinician’s own values and needs from those of the client, awareness of the limits of competence, maintaining adequate legal knowledge, keeping good records, and routine consultation. We highlight issues and approaches to consider in these types of cases that minimize risks of adverse outcomes and enhance good practice.
The info is here.
Here is a portion of the article:
Being aware of basic legal parameters can help clinicians to avoid making errors in this complex arena. Yet clinicians are not usually lawyers and tend to have only limited legal knowledge. This gives rise to a risk of assuming more mastery than one may have.
Indeed, research suggests that a range of professionals, including psychotherapists, overestimate their capabilities and competencies, even in areas in which they have received substantial training (Creed, Wolk, Feinberg, Evans, & Beck, 2016; Lipsett, Harris, & Downing, 2011; Mathieson, Barnfield, & Beaumont, 2009; Walfish, McAlister, O’Donnell, & Lambert, 2012).
Monday, October 15, 2018
ICP Ethics Code
Institute of Contemporary Psychoanalysis
Psychoanalysts strive to reduce suffering and promote self-understanding, while respecting human dignity. Above all, we take care to do no harm. Working in the uncertain realm of unconscious emotions and feelings, our exclusive focus must be on safeguarding and benefitting our patients as we try to help them understand their unconscious mental life. Our mandate requires us to err on the side of ethical caution. As clinicians who help people understand the meaning of their dreams and unconscious longings, we are aware of our power and sway. We acknowledge a special obligation to protect people from unintended harm resulting from our own human foibles.
In recognition of our professional mandate and our authority—and the private, subjective and influential nature of our work—we commit to upholding the highest ethical standards. These standards take the guesswork out of how best to create a safe container for psychoanalysis. These ethical principles inspire tolerant and respectful behaviors, which in turn facilitate the health and safety of our candidates, members and, most especially, our patients. Ultimately, ethical behavior protects us from ourselves, while preserving the integrity of our institute and profession.
Professional misconduct is not permitted, including, but not limited to dishonesty, discrimination and boundary violations. Members are asked to keep firmly in mind our core values of personal integrity, tolerance and respect for others. These values are critical to fulfilling our mission as practitioners and educators of psychoanalytic therapy. Prejudice is never tolerated whether on the basis of age, disability, ethnicity, gender, gender identity, race, religion, sexual orientation or social class. Institute decisions (candidate advancement, professional opportunities, etc.) are to be made exclusively on the basis of merit or seniority. Boundary violations, including, but not limited to sexual misconduct, undue influence, exploitation, harassment and the illegal breaking of confidentiality, are not permitted. Members are encouraged to seek consultation readily when grappling with any ethical or clinical concerns. Participatory democracy is a primary value of ICP. All members and candidates have the responsibility for knowing these guidelines, adhering to them and helping other members comply with them.
The ethics code is here.
Psychoanalysts strive to reduce suffering and promote self-understanding, while respecting human dignity. Above all, we take care to do no harm. Working in the uncertain realm of unconscious emotions and feelings, our exclusive focus must be on safeguarding and benefitting our patients as we try to help them understand their unconscious mental life. Our mandate requires us to err on the side of ethical caution. As clinicians who help people understand the meaning of their dreams and unconscious longings, we are aware of our power and sway. We acknowledge a special obligation to protect people from unintended harm resulting from our own human foibles.
In recognition of our professional mandate and our authority—and the private, subjective and influential nature of our work—we commit to upholding the highest ethical standards. These standards take the guesswork out of how best to create a safe container for psychoanalysis. These ethical principles inspire tolerant and respectful behaviors, which in turn facilitate the health and safety of our candidates, members and, most especially, our patients. Ultimately, ethical behavior protects us from ourselves, while preserving the integrity of our institute and profession.
Professional misconduct is not permitted, including, but not limited to dishonesty, discrimination and boundary violations. Members are asked to keep firmly in mind our core values of personal integrity, tolerance and respect for others. These values are critical to fulfilling our mission as practitioners and educators of psychoanalytic therapy. Prejudice is never tolerated whether on the basis of age, disability, ethnicity, gender, gender identity, race, religion, sexual orientation or social class. Institute decisions (candidate advancement, professional opportunities, etc.) are to be made exclusively on the basis of merit or seniority. Boundary violations, including, but not limited to sexual misconduct, undue influence, exploitation, harassment and the illegal breaking of confidentiality, are not permitted. Members are encouraged to seek consultation readily when grappling with any ethical or clinical concerns. Participatory democracy is a primary value of ICP. All members and candidates have the responsibility for knowing these guidelines, adhering to them and helping other members comply with them.
The ethics code is here.
Wednesday, September 26, 2018
Navigating the Ethical Boundaries of Grateful Patient Fundraising
Collins ME, Rum SA, Sugarman J.
JAMA. Published online August 27, 2018.
doi:10.1001/jama.2018.11655
Here are two excerpts:
There is limited literature examining the ethical issues that grateful patient fundraising raises for physicians. The last American Medical Association report on this topic was issued in 2004.4 The report recognized the value of philanthropy and physicians’ role in it, but rightly emphasized the paramount importance of patients’ rights and welfare in efforts directed at grateful patient fundraising. As such, the report highlighted the need to ensure that gifts are voluntary, that patients should not perceive an obligation to give, and the need to protect privacy. In addition, the report cautioned against physicians initiating discussions about philanthropy during direct patient care. Furthermore, there is also limited literature about the ethical issues grateful patient fundraising poses for development professionals and the health care institutions they represent. Grappling with the ethical issues in grateful patient fundraising necessitates considering them from all of these perspectives.
(cut)
Among the key issues were challenges related to clinicians having discussions about philanthropy with patients who might be especially vulnerable due to their diseases or conditions, the tensions related to conflicts in regard to clinicians’ primary obligations to patient care and a competing obligation to fundraising, the potential effects of fundraising on patient care, possible unintended consequences of concierge services provided to donors, and concerns about privacy.5 The recommendations for clinicians include those concerning when grateful patient fundraising is appropriate (eg, ideally separate from the clinical encounter, not in situations of heightened vulnerability), minimizing conflicts of obligation and commitment, and respecting the donor’s intent of a gift. The recommendations for fundraising professionals and institutions include the need for transparency in relationships, not interfering with clinical care, attending to confidentiality and privacy, appropriateness of concierge services, and institutional policies and training in grateful patient fundraising.
The info is here.
JAMA. Published online August 27, 2018.
doi:10.1001/jama.2018.11655
Here are two excerpts:
There is limited literature examining the ethical issues that grateful patient fundraising raises for physicians. The last American Medical Association report on this topic was issued in 2004.4 The report recognized the value of philanthropy and physicians’ role in it, but rightly emphasized the paramount importance of patients’ rights and welfare in efforts directed at grateful patient fundraising. As such, the report highlighted the need to ensure that gifts are voluntary, that patients should not perceive an obligation to give, and the need to protect privacy. In addition, the report cautioned against physicians initiating discussions about philanthropy during direct patient care. Furthermore, there is also limited literature about the ethical issues grateful patient fundraising poses for development professionals and the health care institutions they represent. Grappling with the ethical issues in grateful patient fundraising necessitates considering them from all of these perspectives.
(cut)
Among the key issues were challenges related to clinicians having discussions about philanthropy with patients who might be especially vulnerable due to their diseases or conditions, the tensions related to conflicts in regard to clinicians’ primary obligations to patient care and a competing obligation to fundraising, the potential effects of fundraising on patient care, possible unintended consequences of concierge services provided to donors, and concerns about privacy.5 The recommendations for clinicians include those concerning when grateful patient fundraising is appropriate (eg, ideally separate from the clinical encounter, not in situations of heightened vulnerability), minimizing conflicts of obligation and commitment, and respecting the donor’s intent of a gift. The recommendations for fundraising professionals and institutions include the need for transparency in relationships, not interfering with clinical care, attending to confidentiality and privacy, appropriateness of concierge services, and institutional policies and training in grateful patient fundraising.
The info is here.
Thursday, July 19, 2018
The developmental origins of moral concern: An examination of moral boundary decision making throughout childhood
Neldner K, Crimston D, Wilks M, Redshaw J, Nielsen M (2018)
PLoS ONE 13(5): e0197819. https://doi.org/10.1371/journal.pone.0197819
Abstract
Prominent theorists have made the argument that modern humans express moral concern for a greater number of entities than at any other time in our past. Moreover, adults show stable patterns in the degrees of concern they afford certain entities over others, yet it remains unknown when and how these patterns of moral decision-making manifest in development. Children aged 4 to 10 years (N = 151) placed 24 pictures of human, animal, and environmental entities on a stratified circle representing three levels of moral concern. Although younger and older children expressed similar overall levels of moral concern, older children demonstrated a more graded understanding of concern by including more entities within the outer reaches of their moral circles (i.e., they were less likely to view moral inclusion as a simple in vs. out binary decision). With age children extended greater concern to humans than other forms of life, and more concern to vulnerable groups, such as the sick and disabled. Notably, children’s level of concern for human entities predicted their prosocial
behavior. The current research provides novel insights into the development of our moral reasoning and its structure within childhood.
The paper is here.
PLoS ONE 13(5): e0197819. https://doi.org/10.1371/journal.pone.0197819
Abstract
Prominent theorists have made the argument that modern humans express moral concern for a greater number of entities than at any other time in our past. Moreover, adults show stable patterns in the degrees of concern they afford certain entities over others, yet it remains unknown when and how these patterns of moral decision-making manifest in development. Children aged 4 to 10 years (N = 151) placed 24 pictures of human, animal, and environmental entities on a stratified circle representing three levels of moral concern. Although younger and older children expressed similar overall levels of moral concern, older children demonstrated a more graded understanding of concern by including more entities within the outer reaches of their moral circles (i.e., they were less likely to view moral inclusion as a simple in vs. out binary decision). With age children extended greater concern to humans than other forms of life, and more concern to vulnerable groups, such as the sick and disabled. Notably, children’s level of concern for human entities predicted their prosocial
behavior. The current research provides novel insights into the development of our moral reasoning and its structure within childhood.
The paper is here.
Wednesday, April 25, 2018
Dear Therapist: I Google-Stalked My Therapist
Lori Gottlieb
The Atlantic
Originally published March 21, 2108
Here is an excerpt:
Most of us wonder who our therapists are outside of the therapy room, usually because we like them so much. Sometimes, of course, people Google their therapists if something feels off—to see if their credentials check out, or if other patients have posted similar concerns. More often, though, our curiosity is a reflection of how important our therapist has become to us, and in some cases, it’s a way to feel connected to the therapist between sessions. The problem is, of course, that we want therapy to be a space where we feel free to talk about absolutely anything. And no matter what we discover—a bombshell like yours, or something more mundane—the fallout of a Google binge becomes a secret that takes that freedom away.
Carl Jung called secrets “psychic poison” for good reason. When I finally confessed my Google-stalking to my therapist, all the air returned to the room. My verbal shackles were removed, and we talked about what was behind my desire to type his name into my search engine. But more important, the way I handled the situation before fessing up taught me something interesting about how I handle discomfort—something far more interesting than anything I learned about my therapist online.
And I think the same might prove true for you.
What people do in therapy is pretty much what they do in their outside lives. In other words, if a patient tends to feel dissatisfied with people in her life, it’s likely that she’ll eventually feel dissatisfied with me. If she tries to please people, she’ll probably try to please me too. And if she avoids people when she feels hurt by them, I’ll be on the lookout for signs that I’ve said something that may have hurt her, too (she cancels her next session, or clams up, or comes late).
The information is here.
The Atlantic
Originally published March 21, 2108
Here is an excerpt:
Most of us wonder who our therapists are outside of the therapy room, usually because we like them so much. Sometimes, of course, people Google their therapists if something feels off—to see if their credentials check out, or if other patients have posted similar concerns. More often, though, our curiosity is a reflection of how important our therapist has become to us, and in some cases, it’s a way to feel connected to the therapist between sessions. The problem is, of course, that we want therapy to be a space where we feel free to talk about absolutely anything. And no matter what we discover—a bombshell like yours, or something more mundane—the fallout of a Google binge becomes a secret that takes that freedom away.
Carl Jung called secrets “psychic poison” for good reason. When I finally confessed my Google-stalking to my therapist, all the air returned to the room. My verbal shackles were removed, and we talked about what was behind my desire to type his name into my search engine. But more important, the way I handled the situation before fessing up taught me something interesting about how I handle discomfort—something far more interesting than anything I learned about my therapist online.
And I think the same might prove true for you.
What people do in therapy is pretty much what they do in their outside lives. In other words, if a patient tends to feel dissatisfied with people in her life, it’s likely that she’ll eventually feel dissatisfied with me. If she tries to please people, she’ll probably try to please me too. And if she avoids people when she feels hurt by them, I’ll be on the lookout for signs that I’ve said something that may have hurt her, too (she cancels her next session, or clams up, or comes late).
The information is here.
Wednesday, February 7, 2018
Ben Carson’s family ethics drama, explained
Emily Stewart
Vox.com
Originally posted February 3, 2018
Here is an excerpt:
Still, questions persist. Secretary Carson’s family has had more involvement in official business than is par for the course — executive branch officials aren’t supposed to use their offices to advance private or commercial interests, and anti-nepotism laws bar officials from employing or promoting the interests of their relatives. Documents obtained by Democratic-leaning nonprofit American Oversight and shared with CNN this week show multiple HUD-organized meetings for Carson Jr. and “friends.” Emails also suggest Ben Carson’s wife, Candy Carson, pushed for her son to get a meeting with Transportation Secretary Elaine Chao.
In a statement on Thursday, Carson asked his agency’s inspector general to look into his listening tour. “In my role as HUD secretary, I try to be as inclusive as possible and talk with a wide variety of people because when it comes to increasing access to affordable housing, no rock should remain unturned,” he said.
Carson just can’t seem to stay out of hot water, ethically speaking
This isn’t the first time Carson has been the subject of ethics scrutiny. Carson’s appearance at a campaign-style rally alongside President Trump in August raised questions about whether he had violated the Hatch Act, which bars executive branch officials from using their government positions to influence elections. Ethics watchdogs eventually agreed it was probably not a violation.
The article is here.
Vox.com
Originally posted February 3, 2018
Here is an excerpt:
Still, questions persist. Secretary Carson’s family has had more involvement in official business than is par for the course — executive branch officials aren’t supposed to use their offices to advance private or commercial interests, and anti-nepotism laws bar officials from employing or promoting the interests of their relatives. Documents obtained by Democratic-leaning nonprofit American Oversight and shared with CNN this week show multiple HUD-organized meetings for Carson Jr. and “friends.” Emails also suggest Ben Carson’s wife, Candy Carson, pushed for her son to get a meeting with Transportation Secretary Elaine Chao.
In a statement on Thursday, Carson asked his agency’s inspector general to look into his listening tour. “In my role as HUD secretary, I try to be as inclusive as possible and talk with a wide variety of people because when it comes to increasing access to affordable housing, no rock should remain unturned,” he said.
Carson just can’t seem to stay out of hot water, ethically speaking
This isn’t the first time Carson has been the subject of ethics scrutiny. Carson’s appearance at a campaign-style rally alongside President Trump in August raised questions about whether he had violated the Hatch Act, which bars executive branch officials from using their government positions to influence elections. Ethics watchdogs eventually agreed it was probably not a violation.
The article is here.
Friday, December 22, 2017
Professional Self-Care to Prevent Ethics Violations
Claire Zilber
The Ethical Professor
Originally published December 4, 2017
Here is an excerpt:
Although there are many variables that lead a professional to violate an ethics rule, one frequent contributing factor is impairment from stress caused by a family member's illness (sick child, dying parent, spouse's chronic health condition, etc.). Some health care providers who have been punished by their licensing board, hospital board or practice group for an ethics violation tell similar stories of being under unusual levels of stress because of a family member who was ill. In that context, they deviated from their usual behavior.
For example, a surgeon whose son was mentally ill prescribed psychotropic medications to him because he refused to go to a psychiatrist. This surgeon was entering into a dual relationship with her child and prescribing outside of her area of competence, but felt desperate to help her son. Another physician, deeply unsettled by his wife’s diagnosis with and treatment for breast cancer, had an extramarital affair with a nurse who was also his employee. This physician sought comfort without thinking about the boundaries he was violating at work, the risk he was creating for his practice, or the harm he was causing to his marriage.
Physicians cannot avoid stressful events at work and in their personal lives, but they can exert some control over how they adapt to or manage that stress. Physician self-care begins with self-awareness, which can be supported by such practices as mindfulness meditation, reflective writing, supervision, or psychotherapy. Self-awareness increases compassion for the self and for others, and reduces burnout.
The article is here.
The Ethical Professor
Originally published December 4, 2017
Here is an excerpt:
Although there are many variables that lead a professional to violate an ethics rule, one frequent contributing factor is impairment from stress caused by a family member's illness (sick child, dying parent, spouse's chronic health condition, etc.). Some health care providers who have been punished by their licensing board, hospital board or practice group for an ethics violation tell similar stories of being under unusual levels of stress because of a family member who was ill. In that context, they deviated from their usual behavior.
For example, a surgeon whose son was mentally ill prescribed psychotropic medications to him because he refused to go to a psychiatrist. This surgeon was entering into a dual relationship with her child and prescribing outside of her area of competence, but felt desperate to help her son. Another physician, deeply unsettled by his wife’s diagnosis with and treatment for breast cancer, had an extramarital affair with a nurse who was also his employee. This physician sought comfort without thinking about the boundaries he was violating at work, the risk he was creating for his practice, or the harm he was causing to his marriage.
Physicians cannot avoid stressful events at work and in their personal lives, but they can exert some control over how they adapt to or manage that stress. Physician self-care begins with self-awareness, which can be supported by such practices as mindfulness meditation, reflective writing, supervision, or psychotherapy. Self-awareness increases compassion for the self and for others, and reduces burnout.
The article is here.
Wednesday, December 6, 2017
Disturbing allegations against psychologist at VT treatment center
Jennifer Costa
WCAX.com
Originally published November 17, 2017
Here is an excerpt:
Simonds is accused making comments about female patients, calling them "whores" or saying they look "sexy" and asking inappropriate details about their sex lives. Staff members allege he showed young women favoritism, made promises about drug treatment and bypassed waiting lists to get them help ahead of others.
He's accused of yelling and physically intimidating patients. Some refused to file complaints fearing he would pull their treatment opportunities.
Staffers go on to paint a nasty picture of their work environment, telling the state Simonds routinely threatened, cursed and yelled at them, calling them derogatory names like "retarded," "monkeys," "fat and lazy," and threatening to fire them at will while sexually harassing female subordinates.
Co-workers claim Simonds banned them from referring residential patients to facilities closer to their homes, instructed them to alter referrals to keep them in the Maple Leaf system and fired a clinician who refused to follow these orders. He is also accused of telling staff members to lie to the state about staffing to maintain funding and of directing clinicians to keep patients longer than necessary to drum up revenue.
The article is here.
WCAX.com
Originally published November 17, 2017
Here is an excerpt:
Simonds is accused making comments about female patients, calling them "whores" or saying they look "sexy" and asking inappropriate details about their sex lives. Staff members allege he showed young women favoritism, made promises about drug treatment and bypassed waiting lists to get them help ahead of others.
He's accused of yelling and physically intimidating patients. Some refused to file complaints fearing he would pull their treatment opportunities.
Staffers go on to paint a nasty picture of their work environment, telling the state Simonds routinely threatened, cursed and yelled at them, calling them derogatory names like "retarded," "monkeys," "fat and lazy," and threatening to fire them at will while sexually harassing female subordinates.
Co-workers claim Simonds banned them from referring residential patients to facilities closer to their homes, instructed them to alter referrals to keep them in the Maple Leaf system and fired a clinician who refused to follow these orders. He is also accused of telling staff members to lie to the state about staffing to maintain funding and of directing clinicians to keep patients longer than necessary to drum up revenue.
The article is here.
Sunday, September 17, 2017
Genitals photographed, shared by UPMC hospital employees: a common violation in health care industry
David Wenner
The Patriot News/PennLive.com
Updated September 16, 2017
You might assume anyone in healthcare would know better. Smart phones aren't new. Health care providers have long wrestled with the patient privacy- and medical ethics-related ramifications. Yet once again, smart phones have contributed to a very public black eye for a health care provider.
UPMC Bedford in Everett, Pa. has been cited by the Pennsylvania Department of Health after employees snapped and shared photos and video of an unconscious patient who needed surgery to remove an object from a genital. Numerous employees, including two doctors, were disciplined for being present.
It's not the first time unauthorized photos were taken of a hospital patient and shared or posted on social media.
The Patriot News/PennLive.com
Updated September 16, 2017
You might assume anyone in healthcare would know better. Smart phones aren't new. Health care providers have long wrestled with the patient privacy- and medical ethics-related ramifications. Yet once again, smart phones have contributed to a very public black eye for a health care provider.
UPMC Bedford in Everett, Pa. has been cited by the Pennsylvania Department of Health after employees snapped and shared photos and video of an unconscious patient who needed surgery to remove an object from a genital. Numerous employees, including two doctors, were disciplined for being present.
It's not the first time unauthorized photos were taken of a hospital patient and shared or posted on social media.
- Last year, a nurse in New York lost her license after taking a smart phone photo of an unconscious patient's penis and sending it to some of her co-workers. She also pleaded guilty to misdemeanor criminal charges.
- The Los Angeles Times in 2013 wrote about an anesthesiologist in California who put a sticker of a mustache on the face of an unconscious female patient, with a nurse's aid then taking a picture. That article also reported allegations of a medical device salesman taking photos of a naked woman without her knowledge.
- In 2010, employees at a hospital in Florida were disciplined after taking and posting online photos of a shark attack victim who didn't survive. No one was fired, with the hospital concluding the incident was the "result of poor judgement rather than malicious intent," according to an article in Radiology Today.
- Many such incidents have involved nursing homes. An article published by the American Association of Nurse Assessment Coordination in 2016 stated, "In the shadow of the social media revolution, a disturbing trend has begun to emerge of [nursing home] employees posting and sharing degrading images of their residents on social media." An investigation published by ProPublica in 2015 detailed 47 cases since 2012 of workers at nursing homes and assisted living facilities sharing photos or videos of residents on Facebook.
Tuesday, September 5, 2017
Ethical behaviour of physicians and psychologists: similarities and differences
Ferencz Kaddari M, Koslowsky M, Weingarten MA
Journal of Medical Ethics Published Online First: 18 August 2017.
Abstract
Objective
To compare the coping patterns of physicians and clinical psychologists when confronted with clinical ethical dilemmas and to explore consistency across different dilemmas.
Population 88 clinical psychologists and 149 family physicians in Israel.
Method
Six dilemmas representing different ethical domains were selected from the literature. Vignettes were composed for each dilemma, and seven possible behavioural responses for each were proposed, scaled from most to least ethical. The vignettes were presented to both family physicians and clinical psychologists.
Results
Psychologists’ aggregated mean ethical intention score, as compared with the physicians, was found to be significantly higher (F(6, 232)=22.44, p<0.001, η2=0.37). Psychologists showed higher ethical intent for two dilemmas: issues of payment (they would continue treating a non-paying patient while physicians would not) and dual relationships (they would avoid treating the son of a colleague). In the other four vignettes, psychologists and physicians responded in much the same way. The highest ethical intent scores for both psychologists and physicians were for confidentiality and a colleague's inappropriate practice due to personal problems.
Conclusions
Responses to the dilemmas by physicians and psychologists can be categorised into two groups: (1) similar behaviours on the part of both professions when confronting dilemmas concerning confidentiality, inappropriate practice due to personal problems, improper professional conduct and academic issues and (2) different behaviours when confronting either payment issues or dual relationships.
The research is here.
Journal of Medical Ethics Published Online First: 18 August 2017.
Abstract
Objective
To compare the coping patterns of physicians and clinical psychologists when confronted with clinical ethical dilemmas and to explore consistency across different dilemmas.
Population 88 clinical psychologists and 149 family physicians in Israel.
Method
Six dilemmas representing different ethical domains were selected from the literature. Vignettes were composed for each dilemma, and seven possible behavioural responses for each were proposed, scaled from most to least ethical. The vignettes were presented to both family physicians and clinical psychologists.
Results
Psychologists’ aggregated mean ethical intention score, as compared with the physicians, was found to be significantly higher (F(6, 232)=22.44, p<0.001, η2=0.37). Psychologists showed higher ethical intent for two dilemmas: issues of payment (they would continue treating a non-paying patient while physicians would not) and dual relationships (they would avoid treating the son of a colleague). In the other four vignettes, psychologists and physicians responded in much the same way. The highest ethical intent scores for both psychologists and physicians were for confidentiality and a colleague's inappropriate practice due to personal problems.
Conclusions
Responses to the dilemmas by physicians and psychologists can be categorised into two groups: (1) similar behaviours on the part of both professions when confronting dilemmas concerning confidentiality, inappropriate practice due to personal problems, improper professional conduct and academic issues and (2) different behaviours when confronting either payment issues or dual relationships.
The research is here.
Sunday, June 11, 2017
Beyond Googling: The Ethics of Using Patients' Electronic Footprints in Psychiatric Practice
Carl Fisher and Paul Appelbaum
Harvard Review of Psychiatry
Abstract
Electronic communications are an increasingly important part of people's lives, and much information is accessible through such means. Anecdotal clinical reports indicate that mental health professionals are beginning to use information from their patients' electronic activities in treatment and that their data-gathering practices have gone far beyond simply searching for patients online. Both academic and private sector researchers are developing mental health applications to collect patient information for clinical purposes. Professional societies and commentators have provided minimal guidance, however, about best practices for obtaining or using information from electronic communications or other online activities. This article reviews the clinical and ethical issues regarding use of patients' electronic activities, primarily focusing on situations in which patients share information with clinicians voluntarily. We discuss the potential uses of mental health patients' electronic footprints for therapeutic purposes, and consider both the potential benefits and the drawbacks and risks. Whether clinicians decide to use such information in treating any particular patient-and if so, the nature and scope of its use-requires case-by-case analysis. But it is reasonable to assume that clinicians, depending on their circumstances and goals, will encounter circumstances in which patients' electronic activities will be relevant to, and useful in, treatment.
The article is here.
Harvard Review of Psychiatry
Abstract
Electronic communications are an increasingly important part of people's lives, and much information is accessible through such means. Anecdotal clinical reports indicate that mental health professionals are beginning to use information from their patients' electronic activities in treatment and that their data-gathering practices have gone far beyond simply searching for patients online. Both academic and private sector researchers are developing mental health applications to collect patient information for clinical purposes. Professional societies and commentators have provided minimal guidance, however, about best practices for obtaining or using information from electronic communications or other online activities. This article reviews the clinical and ethical issues regarding use of patients' electronic activities, primarily focusing on situations in which patients share information with clinicians voluntarily. We discuss the potential uses of mental health patients' electronic footprints for therapeutic purposes, and consider both the potential benefits and the drawbacks and risks. Whether clinicians decide to use such information in treating any particular patient-and if so, the nature and scope of its use-requires case-by-case analysis. But it is reasonable to assume that clinicians, depending on their circumstances and goals, will encounter circumstances in which patients' electronic activities will be relevant to, and useful in, treatment.
The article is here.
Tuesday, February 21, 2017
Let's not be friends: A risk of Facebook
By Amy Novotney
The Monitor on Psychology
2017, Vol 48, No. 2
Print version: page 18
Here is an excerpt:
Talking to clients about their privacy concerns.
Kolmes advises all clinicians to discuss privacy risks involved in using social media with their clients and to work through how to handle a situation in which a therapist's name pops up under their "People You May Know" tab.
"It's about having clear and open conversations with your clients about what you're going to do to protect their privacy and confidentiality and avoid inviting a multiple relationship, and letting them know they can also discuss this with the therapist if it comes up on their end," Kolmes says. When she does receive a friend request from a client on Facebook, she waits until she sees him or her next in session and checks to see if the request was accidental or not. Regardless of whether they searched for her or just had her recommended as a friend, she reminds them about the importance of patient confidentiality and privacy, and notes that following one another on social media can add a "social" element to their work and can complicate matters when it comes to what the therapist is supposed to know or not know about them.
The article is here.
The Monitor on Psychology
2017, Vol 48, No. 2
Print version: page 18
Here is an excerpt:
Talking to clients about their privacy concerns.
Kolmes advises all clinicians to discuss privacy risks involved in using social media with their clients and to work through how to handle a situation in which a therapist's name pops up under their "People You May Know" tab.
"It's about having clear and open conversations with your clients about what you're going to do to protect their privacy and confidentiality and avoid inviting a multiple relationship, and letting them know they can also discuss this with the therapist if it comes up on their end," Kolmes says. When she does receive a friend request from a client on Facebook, she waits until she sees him or her next in session and checks to see if the request was accidental or not. Regardless of whether they searched for her or just had her recommended as a friend, she reminds them about the importance of patient confidentiality and privacy, and notes that following one another on social media can add a "social" element to their work and can complicate matters when it comes to what the therapist is supposed to know or not know about them.
The article is here.
Monday, August 15, 2016
Medical students track former patients' electronic health records
By Stephen Feller
United Press International
Originally published July 26, 2016
Although it is suspected to be largely for educational purposes, researchers in a recent study say the following of patient electronic health records as part of training poses ethical questions for the handling of those records.
A majority of medical students reported they find it beneficial to follow patient medical histories by accessing electronic health records, but some are checking cases they are not involved with out of curiosity -- which may not pose an actual problem, but poses an ethical one, say researchers at Northwestern University.
Some doctors have complained that electronic records, considered essential for better coordination of patient care and improvement of precision medicine, is too significant a burden on their time.
At the same time, most hospitals and doctors have invested heavily in moving to electronic records, with some groups of medical professionals saying the shift from paper to digital has made their jobs easier.
The article is here.
United Press International
Originally published July 26, 2016
Although it is suspected to be largely for educational purposes, researchers in a recent study say the following of patient electronic health records as part of training poses ethical questions for the handling of those records.
A majority of medical students reported they find it beneficial to follow patient medical histories by accessing electronic health records, but some are checking cases they are not involved with out of curiosity -- which may not pose an actual problem, but poses an ethical one, say researchers at Northwestern University.
Some doctors have complained that electronic records, considered essential for better coordination of patient care and improvement of precision medicine, is too significant a burden on their time.
At the same time, most hospitals and doctors have invested heavily in moving to electronic records, with some groups of medical professionals saying the shift from paper to digital has made their jobs easier.
The article is here.
Friday, July 29, 2016
Doctors disagree about the ethics of treating friends and family
By Elisabeth Tracey
The Pulse
Originally published July 1, 2016
Here is an excerpt:
Gold says the guidelines are in place for good reason. One concern is that a physician may have inappropriate emotional investment in the care of a friend or family member.
"It may cloud your ability to make a good judgment, so you might treat them differently than you would treat a patient in your office," Gold says. "For example you might order extra tests for the family member that you wouldn't order for someone else."
Physicians may also avoid broaching uncomfortable topics with someone they know personally.
"Sometimes we're talking about sensitive issues," says Gold. "If someone has a sexually transmitted disease, it's very awkward with a family member to go into a lot of detail with them... even though with a patient you would have those discussions."
The article is here.
The Pulse
Originally published July 1, 2016
Here is an excerpt:
Gold says the guidelines are in place for good reason. One concern is that a physician may have inappropriate emotional investment in the care of a friend or family member.
"It may cloud your ability to make a good judgment, so you might treat them differently than you would treat a patient in your office," Gold says. "For example you might order extra tests for the family member that you wouldn't order for someone else."
Physicians may also avoid broaching uncomfortable topics with someone they know personally.
"Sometimes we're talking about sensitive issues," says Gold. "If someone has a sexually transmitted disease, it's very awkward with a family member to go into a lot of detail with them... even though with a patient you would have those discussions."
The article is here.
Wednesday, April 6, 2016
Social Media & Ethics: Psychologists self-reflect when engaging through technology
John Gavazzi
The National Psychologist
Originally published March 9,, 2016
Many times, psychologists experience fear, dread and anxiety when the concept of ethics is introduced. Simultaneously, many psychologists use social media for both professional and personal reasons. Since social media comes in various forms, psychologists may think they are not sufficiently learned or practiced in social media, which may add to feelings of apprehension.
Finally, social media is expanding quickly, so practicing psychologists may feel overwhelmed with the diversity of options. The purpose of this article is to help psychologists engage in meaningful reflection prior to engaging in social media. Thoughtful contemplation may prevent ethical breaches when engaging with social media.
The National Psychologist
Originally published March 9,, 2016
Many times, psychologists experience fear, dread and anxiety when the concept of ethics is introduced. Simultaneously, many psychologists use social media for both professional and personal reasons. Since social media comes in various forms, psychologists may think they are not sufficiently learned or practiced in social media, which may add to feelings of apprehension.
Finally, social media is expanding quickly, so practicing psychologists may feel overwhelmed with the diversity of options. The purpose of this article is to help psychologists engage in meaningful reflection prior to engaging in social media. Thoughtful contemplation may prevent ethical breaches when engaging with social media.
Thursday, March 17, 2016
Cross-Sectional Analysis of the 1039 U.S. Physicians Reported to the National Practitioner Data Bank for Sexual Misconduct, 2003-2013
Azza AbuDagga , Sidney M. Wolfe , Michael Carome , Robert E. Oshel
PLoS ONE 11(2): e0147800.
Background
Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine the number of these physicians and compare their age groups’ distribution with that of the general U.S. physician population; (2) compare the type of disciplinary actions taken against these physicians with actions taken against physicians disciplined for other offenses; (3) compare the characteristics and type of injury among victims of these physicians with those of victims in reports for physicians with other offenses in malpractice-payment reports; and (4) determine the percentages of physicians with clinical-privileges or malpractice-payment reports due to sexual misconduct who were not disciplined by medical boards.
The article is here.
PLoS ONE 11(2): e0147800.
Background
Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine the number of these physicians and compare their age groups’ distribution with that of the general U.S. physician population; (2) compare the type of disciplinary actions taken against these physicians with actions taken against physicians disciplined for other offenses; (3) compare the characteristics and type of injury among victims of these physicians with those of victims in reports for physicians with other offenses in malpractice-payment reports; and (4) determine the percentages of physicians with clinical-privileges or malpractice-payment reports due to sexual misconduct who were not disciplined by medical boards.
The article is here.
Thursday, January 14, 2016
Unleash the badness! Why the art world needs more sleaze and less morality
By Jonathan Jones
The Guardian
Originally published December 29, 2015
Here is an excerpt:
Art is always at its most dangerous and liberating when it frees us from conventional morality and piety. That is why bohemian manners and the avant garde go together. It was not just artistic licence that upset people when Manet painted Olympia. It was not mere artistic fashion that drew Picasso to the garrets and brothels of Paris. Modern art was a rebellion against bourgeois normality. All the great artists who created modernism took huge risks in the way they lived. Their art is an incitement to do the same.
The article is here.
The Guardian
Originally published December 29, 2015
Here is an excerpt:
Art is always at its most dangerous and liberating when it frees us from conventional morality and piety. That is why bohemian manners and the avant garde go together. It was not just artistic licence that upset people when Manet painted Olympia. It was not mere artistic fashion that drew Picasso to the garrets and brothels of Paris. Modern art was a rebellion against bourgeois normality. All the great artists who created modernism took huge risks in the way they lived. Their art is an incitement to do the same.
The article is here.
Saturday, November 14, 2015
The Strange Case of Anna Stubblefield
By Daniel Engber
The New York Times Magazine
Originally published October 20, 2015
Here are two excerpts:
Then there was a lull in the conversation after Wesley came back in, and Anna took hold of D.J.’s hand. ‘‘We have something to tell you,’’ they announced at last. ‘‘We’re in love.’’
‘‘What do you mean, in love?’’ P. asked, the color draining from her face.
To Wesley, she looked pale and weak, like ‘‘Caesar when he found out that Brutus betrayed him.’’ He felt sick to his stomach. What made them so uncomfortable was not that Anna was 41 and D.J. was 30, or that Anna is white and D.J. is black, or even that Anna was married with two children while D.J. had never dated anyone. What made them so upset — what led to all the arguing that followed, and the criminal trial and million-dollar civil suit — was the fact that Anna can speak and D.J. can’t; that she was a tenured professor of ethics at Rutgers University in Newark and D.J. has been declared by the state to have the mental capacity of a toddler.
(cut)
Sitting at the keyboard, D.J. also seemed to have a lot to say. His messages were simple and misspelled at first, but his skill and fluency improved. Eventually he could hit a letter every second, and if Anna guessed the word before he finished typing, he would hit the ‘‘Y’’ key to confirm. Anna brought books for him to read, Maya Angelou and others, and discovered that he read like a savant — 10 pages every minute. (She turned the pages for him.) They discussed the possibility of his enrolling in a G.E.D. program.
As D.J. came into his own, Anna kept her mother posted on his progress. In the spring of 2010, Sandra asked if D.J. might like to give a paper for a panel she was organizing at a conference of the Society for Disability Studies in Philadelphia. The panel was on Article 21 of the United Nations Convention on the Rights of Persons With Disabilities, which lays out the right to freedom of expression and opinion. D.J. wasn’t sure he could do it, Anna said, but she convinced him he should try.
The entire article is here.
Note to readers: The article is long, detailed and (from my perspective) creepy. This case appears to demonstrate where compassion and personal values override good judgment, research, and professional responsibilities.
The New York Times Magazine
Originally published October 20, 2015
Here are two excerpts:
Then there was a lull in the conversation after Wesley came back in, and Anna took hold of D.J.’s hand. ‘‘We have something to tell you,’’ they announced at last. ‘‘We’re in love.’’
‘‘What do you mean, in love?’’ P. asked, the color draining from her face.
To Wesley, she looked pale and weak, like ‘‘Caesar when he found out that Brutus betrayed him.’’ He felt sick to his stomach. What made them so uncomfortable was not that Anna was 41 and D.J. was 30, or that Anna is white and D.J. is black, or even that Anna was married with two children while D.J. had never dated anyone. What made them so upset — what led to all the arguing that followed, and the criminal trial and million-dollar civil suit — was the fact that Anna can speak and D.J. can’t; that she was a tenured professor of ethics at Rutgers University in Newark and D.J. has been declared by the state to have the mental capacity of a toddler.
(cut)
Sitting at the keyboard, D.J. also seemed to have a lot to say. His messages were simple and misspelled at first, but his skill and fluency improved. Eventually he could hit a letter every second, and if Anna guessed the word before he finished typing, he would hit the ‘‘Y’’ key to confirm. Anna brought books for him to read, Maya Angelou and others, and discovered that he read like a savant — 10 pages every minute. (She turned the pages for him.) They discussed the possibility of his enrolling in a G.E.D. program.
As D.J. came into his own, Anna kept her mother posted on his progress. In the spring of 2010, Sandra asked if D.J. might like to give a paper for a panel she was organizing at a conference of the Society for Disability Studies in Philadelphia. The panel was on Article 21 of the United Nations Convention on the Rights of Persons With Disabilities, which lays out the right to freedom of expression and opinion. D.J. wasn’t sure he could do it, Anna said, but she convinced him he should try.
The entire article is here.
Note to readers: The article is long, detailed and (from my perspective) creepy. This case appears to demonstrate where compassion and personal values override good judgment, research, and professional responsibilities.
Monday, October 12, 2015
Would I Accept My Patient’s Gift?
By Judith Warren
The New York Times - Opinionator
Originally published September 29, 2015
Here is an excerpt:
Delighting in the sweets, I thought of Tim’s gift as revealing both a yearning for connection and an ability to create and give something of himself. He was turning his trauma into a kind of art. I also realized that my eating his candy was an act of faith that Tim did not want to destroy our work together, even though we had struggled with many hard moments in which it seemed as if he did.
I’m embarrassed to say that I ate half the box and then fell peacefully asleep.
At his next session, I told Tim how much I enjoyed his candy. He smiled broadly, looked squarely in my eyes, and said, “So, you believed me.”
Eating Tim’s candy did not magically cure his distrust of me. But he remained in treatment for a long time. We later talked about the various meanings of this gift.
The entire article is here.
The New York Times - Opinionator
Originally published September 29, 2015
Here is an excerpt:
Delighting in the sweets, I thought of Tim’s gift as revealing both a yearning for connection and an ability to create and give something of himself. He was turning his trauma into a kind of art. I also realized that my eating his candy was an act of faith that Tim did not want to destroy our work together, even though we had struggled with many hard moments in which it seemed as if he did.
I’m embarrassed to say that I ate half the box and then fell peacefully asleep.
At his next session, I told Tim how much I enjoyed his candy. He smiled broadly, looked squarely in my eyes, and said, “So, you believed me.”
Eating Tim’s candy did not magically cure his distrust of me. But he remained in treatment for a long time. We later talked about the various meanings of this gift.
The entire article is here.
Subscribe to:
Posts (Atom)