Damaged Fairview ousts exec

Mark Eustis was linked to firm behind high-pressure debt collections

by Maura Lerner and Tony Kennedy
The Star Tribune
Star Tribue Staff Writers
Originally published May 24, 2012

Mark Eustis, CEO of Fairview Health

Mark Eustis couldn't have known it at the time, but his downfall as president of Fairview Health Services began last summer with the report of a stolen laptop. Within 10 months, the incident had grown into a public relations nightmare that Fairview couldn't shake.

On Thursday, Eustis, 59, abruptly announced plans to retire, one day after Fairview's board voted not to renew his contract. It was just four weeks after Attorney General Lori Swanson released a scathing report about debt collectors badgering patients for money inside Fairview hospitals.

Initially, the board had said Eustis' job was safe. But criticism has mounted over Fairview's association with Accretive Health, the for-profit company Swanson blamed for the collection practices.

Eustis found himself at the center of the turmoil because he was instrumental in hiring Accretive and has a son who works for the firm.

(cut)

Dr. Steve Miles, a University of Minnesota physician and bioethicist, said the most disturbing revelations weren't just about heavy-handed debt collectors, but internal e-mails in which Accretive employees talked about patients as "lowlifes" and "deadbeats."

The entire article is here.

Thanks to Gary Schoener for this lead.

Clinical Challenges in the Internet Era

By Glen O. Gabbard, M.D.
American Journal of Psychiatry

Here's a central passage from the initial case presentation:

[begin excerpt]

Much to the treatment team's surprise, within a week of Mr. R's first outpatient appointment, Mrs. R had begun posting disparaging comments on various web sites about the quality of her son's care, specifically naming the treating resident.

The comments described the treating resident as well as other members of the treatment team in derogatory terms. 

In addition, Mrs. R made comments that were vehemently antipsychiatry, including a statement that psychiatrists collude with pharmaceutical companies to generate profit rather than treat illness.

She posted multiple comments in the days following certain clinic visits; the comments could be found easily by anyone who did a Google search using the treating resident's name.

The comments initially appeared on both a personal blog and a highly popular web site, later cropping up also on web sites that serve as general forums for consumer dissatisfaction and on news outlets as user-generated content.

(cut) 

Two main concerns arose from the ensuing dialogue. Foremost was the potential for the mother's online comments to undermine Mr. R's care. For example, awareness of his mother's comments could exacerbate Mr. R's paranoia, leading to a disruption in his trusting relationship with the resident and a possible interference with his adherence to treatment. Moreover, the tone of the mother's comments suggested a fundamental disagreement with the treatment team's approach to her son's care, one that could potentially lead to an impasse. In the absence of a satisfactory working relationship with Mr. R's mother, the team would need to consider discharging him with a referral to another provider. Were they to do so, however, apart from feeling disappointed at not being able to continue providing Mr. R's care, the team would risk appearing either to be punishing him for his mother's actions or abandoning him for no clear reason. Either interpretation might fuel the paranoid perceptions he had regarding mental health care providers.

The second concern was that the mother's comments could damage the reputation of the treating resident. The resident initially did not think to be worried about his reputation, since he felt confident that he was well regarded by those who knew him and had observed his work with patients. Once this concern was raised, however, the resident thought of the potential impact the mother's public comments might have if he sought employment or further training outside his current institution. Given the fact that there is only limited public commentary concerning residents, a few negative Internet postings might adversely affect the opinions of potential patients, peers, or employers. Hence, the situation presented a quandary regarding how to respond to the comments posted online by Mr. R's mother while trying to avoid both potential harm to the patient and potential harm to the resident.

 (cut)

 Discussion: 

When I was asked to consult on this case, I felt a good deal of empathy for the resident.

Here he was, delivering good psychiatric care to a young man with severe illness, but receiving criticism rather than appreciation from the family. 

I recognized that there is now a public exposure inherent in psychiatric practice that can be daunting even to experienced clinicians but may be especially painful to vulnerable residents who are striving to become competent psychiatrists. 

[end excerpt]

Here's how the article ends:  

What can we do as a profession in the face of these challenges? The proliferation of Facebook, Internet forums, Twitter, blogs, and chat rooms is a juggernaut that cannot be stopped. We must live with these new intrusions into our professional lives and develop creative solutions. Institutions can develop policies so that ad hoc groups do not have to be assembled whenever delicate situations with potential liability arise.

Psychiatrists and other mental health professionals can do periodic Internet searches of themselves to keep abreast of any personal or professional information about them that may have implications for their reputation. In some cases, web site administrators may be contacted who will remove what is posted. Those who use social networking sites like Facebook should probably use all available privacy settings so that personal information about them is not available to the public.

The education of psychiatric residents and other mental health professionals should include discussions of common challenges that occur in the Internet era so that clinicians have some preparation for dealing with them when they emerge. Finally, guidelines regarding how to continue the treatment and how to respond to the attacks should be developed. Academic psychiatry has a long tradition of establishing protocols to deal constructively with difficult events in the trainee's life, such as patient suicide or assault. Similar forms of support and assistance can be brought to bear to assist with challenges stemming from the Internet."

 Thanks to Ken Pope for this information.

 The entire article is here.

Membership is needed to acces this information.

Gabbard GO. Clinical challenges in the internet era. Am J Psychiatry. 2012

May;169(5):460-3. PubMed PMID: 22549206.

Court of Appeal Says Psychologist Can Be Disciplined For Misconduct as Family Law Special Master

By MetNews Staff Writer
Metropolitan News-Enterprise
Originally Published May 11, 2012

The state Board of Psychology properly disciplined a licensee for unethical conduct while serving as a special master in a contentious family law case, the Third District Court of Appeal ruled yesterday.

The justices affirmed Sacramento Superior Court Judge Patrick Marlette’s denial of Dr. Randy Rand’s petition for writ of mandate. Rand was challenging the board’s order placing him on probation for five years, based on findings of unprofessional conduct, gross negligence, violation of statutes governing the practice of psychology, and dishonesty.

The entire article is here.

Thanks to Ken Pope for this information.

The Third Appellate District decision is here.

Vignette 13: Troubles in the ICU

You are a psychologist in a busy acute care hospital where you receive frequent consultation requests by the trauma service.  A physician requests a psychological evaluation of a 46-year-old man who attempted suicide via over dose of prescription medications along with alcohol. You arrive in the intensive care unit where the patient’s respiratory status is rapidly deteriorating. He is marginally coherent and unable to give any consistent responses.  However, upon his arrival in the emergency department, the medical record quotes the patient as saying, “This wasn’t supposed to have happened.”

The ICU nurse asks you to offer an opinion regarding the patient’s capacity to accept or refuse intubation.

While you are there, a family member arrives with a copy of a notarized advance directive, created within the last year, which specifically outlines the patient’s wishes not to be placed on a ventilator or any artificial life support. The ICU staff asks for your input.

What are the ethical issues involved?

What would you do in this situation?

Would your answer differ if the advanced directive was created 7 years ago or greater?

Would your answer differ if there were no advanced directives?

Avoiding Ethical Missteps

By Alan C. Tjeltveit and Michael Gottlieb
The Monitor on Psychology
April 2012, Vol 43, No. 4, page 68

Psychologists want to contribute to human welfare — and the vast majority of them do. But despite their best intentions, they may find themselves in situations where they unwittingly slip into unethical behaviors.

Most psychologists try to prevent such lapses by, for example, learning the APA Ethics Code and attending risk management workshops to better understand ethical risks. Yet research has shown that such efforts are not enough to keep psychologists from ethical blunders.

How then can psychologists prevent such missteps? We suggest that psychologists at all developmental stages — from student to seasoned professional — are wise to examine and better understand their personal feelings and values and how they can lead to ethical problems. Doing so not only reduces the risk of psychologists drifting into ethical trouble, but also helps move the quality of professional practice from merely adequate to optimal.

The problem and efforts at solutions

Psychology training programs accredited by APA are required to provide ethics education to their students. This helps students and colleagues understand where the “floor” in ethical behavior lies and how the standard of care is commonly interpreted. That usually includes learning the APA Ethics Code, as well as state rules and regulations, relevant state and federal statutes and court decisions, and mastering a particular ethical decisionmaking model.

Unfortunately, research suggests that cognitive strategies alone are not sufficient. Although many psychologists and trainees can accurately describe their ethical responsibilities, they report that they might, in certain situations, act otherwise.

The entire story is here.

Alan Tjeltveit will be The Pennsylvania Psychological Association's Ethics Educator of the Year for 2012.  Nice article and great work over the years educating psychologists in Pennsylvania and across the country.

Oh, and Mike Gottlieb is a great guy too.

Counseling Conflict

By Allie Grasgreen
Inside Higher Ed
Originally published March 26, 2012

Georgia State University’s decision this month to replace its counseling center staff with outsourced employees is worrying those in the field, who say such moves are extremely rare and will likely prove detrimental to the mental health services available to students.

The shift is doubly troubling because a number of former staff members (as well as others in the field) are accusing the university of outsourcing services as a retaliation for their complaints that some university policies involving the counseling center had the potential to hurt students. While the outsourcing was announced shortly after the complaints were made, the university says there was no relationship between the two developments. The director and two associate directors will stay on as full-time employees of Georgia State, spokeswoman Andrea Jones said.

The university says it replaced its nine counseling center clinical positions (three of which were vacant) with contracted employees “in order to increase institutional effectiveness in delivering mental health services to students.”

Because the staff were eliminated through a “reduction in force” process, which is done without regard to an employee’s performance, the change could not have been retaliatory, Jones said. The new model will mimic that of Georgia State’s psychiatry services and health center (both of which commonly use independent contractors).

The entire story is here.

Getting Doctors to Think About Costs

By Pauline Chen, MD
The New York Times - Health
Originally Published on March 15, 2012

My first formal lesson on health care costs occurred one afternoon on the wards when I was a medical student. The senior doctor in charge, a silver-haired specialist known for his thoughtful approach to patient care, had assembled several students and doctors-in-training to discuss a theoretical patient with belly pain. After describing the patient’s history and physical exam, he asked what tests we might order.

One doctor-in-training proposed blood work. A fellow student suggested a urine test. Another classmate asked for abdominal X-rays.

My hand shot up. “A CAT scan,” I crowed with confidence. “I’d get a CAT scan!”
There was complete silence. Everyone turned to stare at me.

The senior doctor coughed. “That’s an awfully expensive test,” he said, a grimace appearing on his face. Another student asked him just how much a CT scan cost, and he shifted uncomfortably in his seat and shrugged. “I don’t really know,” he said, “but I do know that we can’t just think about the patient anymore.”

He took a deep breath before continuing, “We are now being forced to consider costs.”

That was 20 years ago, when the managed care movement was first in the headlines. Today his lesson still rings true, as doctors continue to struggle to reconcile cost consciousness with quality care. And doctors-to-be are not getting much help in learning how to do so.

Here is the whole story.

Ethical Issues Related to APA’s 2005 Task Force Report on Psychological Ethics and National Security

On February 29, 2012, I posted an announcement pertaining to a new, APA member-initiated task force related to psychologists’ involvement in national security settings.

There is another group of psychologists involved in trying to shape APA policy on the ethics of psychlogists pertaining to national security: The Coalition for an Ethical Psychology.  They have called for an annulment of APA’s 2005 Task Force Report on Psychological Ethics and National Security (PENS Report).

To be as helpful, transparent, and comprehensive as possible, I posted the APA's PENS report and the Background Statement on Annulment of the APA's PENS Report from The Coalition for an Ethical Psychology in the Articles and Papers section of this site.

Readers are referred to these documents in order to have a deeper and more thorough understanding of the ethical issues related to this ongoing controversy.

John Gavazzi, PsyD ABPP

Psychologist

Board Certified in Clinical Psychology
Editor, Ethics Education and Psychology Site 

Vignette 9: Psychologist as Character Witness?

A psychologist receives a phone message from a former patient.  The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

The psychologist pulls the former patient’s chart.  The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy.  The psychologist remembers the former patient as a likeable person.

How would you feel about receiving this request?

What ethical issues are involved?

What are your potential options?

If you decide to provide information, would you consider communicating with the prior patient’s attorney?  What would you need from the attorney?

Responding to Research Wrongdoing: A User-Friendly Guide

We have added a link to our "Ethics Resources, Guides, and Guidelines" page. 

The entire guide can be found here as well.  In 2010, this guide won an award for Innovation from the Health Improvement Institute for Excellence in Human Research Protection.

The Foreword is posted to give an idea of what is in the guide.

Foreword

Every once in awhile a product comes along that is destined to make a difference. This Guide is such a product. Informed by data generated through surveys and interviews involving more than 2,000 scientists, the Guide gives voice to those researchers willing, some with eagerness and others with relief, to share their stories publicly in their own words. There are stories from scientists who want to do the right thing, but are unsure how to go about it or concerned about negative consequences for them or their junior colleagues. There are accounts from researchers who took action, and are keen to share their successful strategies with others. On the flip side, there are those who hesitated and now lament not having guidance that might have altered the course of past events.

In response to these compelling stories, the Guide adopts a problem-solving approach that looks for ways to preempt wrongdoing in research, to create options for scientists faced with suspicions or evidence of irresponsible science, and to assist researchers in working through those options in a manner that reinforces the integrity of the science without risking career or friendships. The Guide pulls no punches. While it is intended to help researchers achieve a successful resolution of what are often very messy matters, it recognizes that this may not always be possible. It is this honest assessment that will appeal to scientists looking for fair-minded and useful guidance, not pious prescriptions that bear no resemblance to the real world.

Perhaps the most encouraging aspect of the research reported in the Guide is that scientists included in the study proclaimed "overwhelming support for the concept of a researcher’s individual responsibility to intervene when suspecting wrongdoing, especially if it rises to the level of a ‘serious nature’ (94%)." Surely, there is no argument that reporting research wrongdoing and preserving the integrity of the research record will depend largely on the willingness of individuals to intervene. Recognition of one’s professional responsibility to act is a necessary step in that direction, but it is not enough. What is also needed is a good compass that points in the right direction, warns of hazardous terrain ahead, locates where support is available, and helps people assess and reason through their choices. Just as the compass greatly improved the safety and efficiency of travel dating back to the 11th century, so too will this Guide greatly help scientists navigate the challenges they encounter when taking the moral high ground.

Mark S. Frankel
Director, Scientific Freedom, Responsibility and Law Program
American Association for the Advancement of Science

Dr. Frankel served as a consultant to the authors of the Guide.

Dilemma 8: A Session with the Spouse

Dr. Faye Miller receives a referral for a 35-year-old female, Betty Drapier, who is both feeling depressed and experiencing marital problems.  During the first few sessions, Mrs. Drapier indicates that her husband, Don, is depressed and in treatment.  Part of her struggle is that she sees her husband as more depressed now than when he started treatment.  By Mrs. Drapier’s report, he appears more stressed because of his job and drinking alcohol more frequently.  She reports that his treating psychologist, Dr. Cooper, is working with her husband and has allegedly advised him to discontinue his medication in favor of an herbal remedy (St. John’s Wort).  Dr. Miller suggests that she meet with both Mr. and Mrs. Drapier to evaluate the marital situation.

At that time, Dr. Miller not only wanted to evaluate the marriage, but to evaluate how impaired the husband was, and Mrs. Drapier’s ability to assess her husband and the marriage accurately.

During the next session, Mr. and Mrs. Drapier arrive separately, but on time.  Mr. Drapier acknowledges many cognitive, behavioral, and physical symptoms of serious depression.  Mr. Drapier smelled as if he had been drinking.  Mr. Drapier also admits that his alcohol use has increased.  He also divulged that his risk-taking behavior has increased as well, such as speeding. During the session, Mr. Drapier verbalized suicidal ideation in a flip manner (“Sometimes I think it would be better if I just killed myself”).  The marital situation appears deteriorated and Mr. Drapier appears significantly depressed. 

As the session winds down, Mr. Drapier spontaneously asks for a second opinion about his treatment with Dr. Cooper.  He indicated that Dr. Cooper recommended that he discontinue a psychotropic medication in favor of an herbal remedy.  Mr. Drapier mentions that Dr. Cooper sells St. John’s Wort to him directly.

After reiterating the purpose of the session (which was to assess the marital situation and not to assess his current treatment), Dr. Miller states that she feels uncomfortable with the request, although she is concerned about the psychologist’s reported behavior. She is also concerned about Mr. Drapier’s level of depression, alcohol use, and suicidal statement.

Abruptly, Mr. Drapier looks at his watch and leaves the office explaining that he is late for a business meeting.

What are Dr. Miller's potential ethical issues in this situation?

What are some actions that you, as the treating psychologist, may have done differently?

If you were Dr. Miller, what are your emotional reactions to this situation?

What obligations does the psychologist have to Mr. Drapier, Mrs. Drapier, Dr. Cooper, and the public?

Dilemma 6: Referral and Treatment Boundaries

A psychologist receives a phone call from a well-known internist in her area.  The psychologist is involved in a busy practice, specializes in treating eating disorders, and receives only occasional referrals from this physician.  The physician wants the psychologist to treat his 17-year-old daughter, who suffers with what he describes to be an eating disorder and perhaps some Borderline Personality Disorder traits. 

The physician explains that he has been medicating her for about four months with Prozac and Klonopin, once he became aware of her eating disordered behavior.  Because of his status as a well-known internist, he does not want to refer his daughter to a psychiatrist because he believes that he can handle the medication piece of her treatment.  He will also pay for all treatment in cash, as he wants as few people and organizations to know about his daughter’s issues.

Feeling somewhat uncomfortable with the medication management issue, the psychologist indicates that she will have to call him back after looking at her schedule.  The psychologist then phones you for an informal consultation.  The psychologist expresses her concerns about working with a patient whose father is prescribing medication.

Are there any ethical considerations in this dilemma?

What are the potential pitfalls in the scenario?

What are potential advantages in this scenario?

What are some of the suggestions that you may have for the psychologist about accepting or declining the referral?

What concrete steps might be important before calling the physician back?

 Are there additional considerations for how to approach the referring physician when calling back?

91 charged with Medicare fraud across U.S.

By Jerry Markon

The Washington Post

Published September 7, 2011

The Obama administration escalated its crackdown on health-care fraud Wednesday, announcing charges against 91 people in eight cities who are accused of bilking the Medicare system out of nearly $300 million and victimizing the elderly and disabled people who rely on the federal insurance program.

Among those charged in the coordinated series of arrests was a doctor in Detroit who allegedly billed Medicare for services provided to dead people and claimed that he performed psychotherapy treatments more than 24 hours a day. Other doctors, nurses and health-care company owners were charged in various schemes to get paid for services that were medically unnecessary or never provided, officials said.

“From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank,’’ Lanny A. Breuer, assistant attorney general for the Justice Department’s criminal division, said at a news conference in Washington.

It was unclear whether lawyers had been appointed for the defendants, 70 of whom were charged in indictments unsealed this week. The other 21 were charged in recent weeks. More than 55 defendants had been arrested by Wednesday afternoon, in addition to others who turned themselves in to authorities.

The arrests, announced by Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius, marked the latest step in a campaign against fraud that the administration calls a key part of its health-care reform agenda. The health-care overhaul law, President Obama’s signature domestic initiative, is an issue in the presidential campaign, but few have questioned the need to crack down on fraud.

In May 2009, the administration launched the Health Care Fraud Prevention and Enforcement Action Team to seek out illicit billing practices. That team’s Medicare Fraud Strike Force carried out the raids in cities that also included Houston, Baton Rouge, Dallas and Chicago.

In Miami, 45 defendants — including a doctor and a nurse — are accused of participating in $159 million worth of schemes to submit false Medicare billings for home health care and other services. Holder said the victims included “some of the most vulnerable among us — including seniors suffering from dementia and Alzheimer’s disease.’’

Officials said the crackdown will continue. “The health-care system is part of our nation’s infrastructure, and we must do everything in our power to protect the integrity of Medicare,” said FBI Executive Assistant Director Shawn Henry.

The entire story can be read here.

Vignette 5: A Tricky Situation

Dr. Smith is a psychologist who has worked with a young woman for about 9 months. The patient presents with a history of rejection and abandonment as well as persons of power misusing her. She recently received an offer to become a sales representative for a pharmaceutical company. The psychologist and patient discussed the type of job she was entering because she may experience rejection from doctors, nurses, and other office personnel.

After her 6 weeks of training, the company assigns her to a regional director that the psychologist knows personally. Along with the initial anxiety of the new job, her territory, and her boss, she reports a fear of failure and other anxiety related symptoms. The psychologist knows her new boss, Mr. Biggy. The psychologist seeks to reassure the patient that he, the psychologist, knows Mr. Biggy on a personal basis and that “he is a really a good guy” that seems bright, friendly, and fair. He indicates that Mr. Biggy is a good “family man”. The patient is reassured, and reported less anxiety. In actuality, Mr. Biggy’s wife is a very close friend of Dr. Smith’s wife. They have dinner as couples several times per year.

Several weeks into going on sales calls, your patient reports that Mr. Biggy is complimenting her on the way she looks and her ability to make the sale. They start spending more time together. However, she begins to feel uncomfortable as she feels like they are spending too much time together. Mr. Biggy starts asking questions that are more personal, forwards her “funny” emails, and texts some inappropriate remarks to her, mainly about her alluring power that helps make sales.

Mr. Biggy and Dr. Smith meet in an unplanned social venue. Mr. Biggy pulls Dr. Smith aside and explains how he has become very attracted to a new sales representative. He thinks that she is young and impressionable. He confides that he would like to have an affair with her.

Dr. Smith politely explains that he feels uncomfortable with them discussing his more personal marital issues. Mr. Biggy indicates that he wants to talk more about his feelings. Dr. Smith suggests a referral to a psychologist, but Mr. Biggy states that he feels more comfortable talking with Dr. Smith. After some other small talk, Dr. Smith leaves to mingle with other friends.

Dr. Smith is now worried about the entire situation.

In hindsight, what triggered some possible difficulties in this situation?

What are the ethical issues involved in this scenario?

How are the client’s emotional and interpersonal issues related to the psychologist’s dilemma?

What are the options for the psychologist for both his relationship with his patient and his relationship with Mr. Biggy?

Psychologists with Cancer: Clinical, Ethical, and Practical Challenges

Helen L. Coons, Ph.D., ABPP

Jana N. Martin, Ph.D.

From The Pennsylvania Psychologist

Psychologists living with cancer face clinical, ethical and practical challenges while coping with their own diagnosis and treatments. This brief article offers several suggestions to psychologists in practice and other professional settings who are coping with an early or advanced diagnosis of cancer.

Seek support and supervision. While most individuals are remarkably resilient in coping with cancer and its treatments, a new or recurrent diagnosis and the complex treatment decisions which follow can be highly stressful and frightening. Reaching out to colleagues early for support and supervision is important for psychologists with cancer. Ask colleagues if they know psychologists (or other mental health providers) who have experienced cancer treatment. Practical, informational and emotional support from someone with an insiders’ view is invaluable. The PPA listserv and APA Division listservs may also be helpful in identifying other psychologists with cancer.

Formal supervision from a respected colleague is essential to address clinical, ethical and practical issues that emerge as psychologists cope with cancer, and to support them in developing a practice management plan during and after treatments.

Develop a practice management plan. A cancer diagnosis will typically be followed by  treatment decisions related to surgery, chemotherapy, and/or radiation as well as acute, late, and long-term side effects. At any point in the treatment course, psychologists often face a series of challenging questions related to their practice and other professional roles. Some individuals are too ill, tired, or uncomfortable to work during treatment; some will have to work to maintain their income; and most will likely work part- or full-time with breaks for treatment. Psychologists undergoing cancer treatment are confronted with questions such as: (1) should they continue to see patients, teach, supervise, etc; (2) should they work full- or part-time; (3) if, how and when to disclose their diagnosis to patients, keeping in the mind their practice focus (e.g., children, teens, adults); (4) how to deal with breaks in treatment resulting from additional surgery or side effects of chemotherapy and/or radiation; (5) whether or not to treat patients who have or had cancer, are “at risk” for cancer, have lost a loved one to cancer, have significant attachment issues, or require a high degree of treatment consistency, etc; and (6) clinical, ethical and practical issues when closing a practice. Developing a practice management plan in consultation with a supervisor to address these and other questions can be helpful and empowering (Coons, 2010).

A practice management plan during and after cancer treatment may include creating flexibility in the psychologist’s schedule. For example, some psychologists reduce their patient and teaching load, and/or block their schedule after each chemotherapy cycle when side effects (e.g., nausea, fatigue, pain, low blood counts, etc.) are more likely to emerge and may adversely affect one’s ability to work. Some individuals undergoing chemotherapy have also shifted the focus of their clinical work to more testing or consultation so that they can schedule evaluations between cycles when they have more energy. Others have found that the familiarity of work is a healthy break from cancer treatment. A management plan should include finding colleagues to be on standby to call and re-schedule clients (who have provided informed consent) so that psychologists do not have to explain to patients how they are feeling.

Pace yourself during and after treatment. Throughout and after cancer treatment, psychologists need to be mindful of their physical, emotional and cognitive well-being. Psychologists have an ethical obligation to ensure that their own physical and psychological well-being is healthy enough to care for patients, teach, supervise, etc. Fatigue, pain, nausea and vomiting and the medications used to treat these symptoms or side effects may compromise some individuals’ ability to meet the demands of clinical practice. Chemotherapy and other medications used in cancer treatment, for example, can diminish cognitive functioning. While changes in concentration, memory, processing speed, and the ability to multitask are likely to be mild and time-limited, high level clinical decision-making is essential for differential diagnosis and treatment. Psychologists undergoing cancer treatment must evaluate if they are healthy enough to meet the demands of practice and other professional responsibilities.

Designate a clinical power of attorney. Consistent with the APA Ethical Principles of Psychologists and Code of Conduct (2002), psychologists are obligated to ensure that patients will be taken care of if they are not able to meet professional responsibilities because of personal problems or when there are interruptions in therapy or termination. While many psychologists with cancer will continue to practice during and after treatment, it is important to designate a clinical power of attorney in the event that the psychologist is unable to take care of patients. This colleague should be able to access the psychologist’s office (i.e., they have door and file keys), patient lists, appointment schedules, and records; will contact patients and can either reschedule or provide care to patients, or refer them to other colleagues with the appropriate clinical expertise. See Pope and Vasquez, (2007); Spayd & O’Leary Wiley (2009); and www.apapracticecentral.org for more detailed discussions on closing a practice.

Personal experience with cancer and expertise in psychosocial oncology.  Psychologists who undergo their own cancer treatment will have a special understanding of the experience faced by so many adults across the life span. After treatment, they may even consider taking care of patients with cancer. While well meaning, the psychologist’s own treatment experience is very different from having the expertise in psychosocial oncology necessary to provide evidence-based assessment and treatment to adults with early and advanced cancers. Treating patients with cancer requires a highly specialized fund of knowledge and clinical competencies to ensure quality care and outcomes. While psychologists may want to help others deal with this challenge, they still have the ethical obligation to practice within their scope of expertise. Again, supervision from a respected colleague can be invaluable to sort out if and when a psychologist should treat others with or affected by cancer.

References

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. Washington, DC: Author.

Coons, H. L. (2010). Psychologists with early and advanced breast cancer: Clinical, ethical and practical challenges. Manuscript submitted for publication.

Pope, K. S., & Vasquez, M. J. T. (2007). Ethics in psychotherapy and counseling: A practical guide. San Francisco: John Wiley.

Spayd, C. S., & O’Leary Wiley, M. (2009, December). Closing a professional practice: Clinical and practical considerations. The Pennsylvania Psychologist, 69(11), 15-17.

Helen L. Coons, Ph.D., ABPP, is a board certified clinical health psychologist who is President and Clinical Director of Women’s Mental Health Associates in Philadelphia. She has specialized in psychosocial oncology for 30 years, mentors psychologists and other health care providers with cancer, and underwent treatment for breast cancer. Dr. Coons may be reached at hcoons@verizon.net or 215-732-5590.

Jana N. Martin, Ph.D., is a licensed psychologist in independent practice in Long Beach, CA. Some of her work with children, adults, and families has focused on coping with chronic diseases such as cancer, and she is in remission from lymphoma. She may be reached at drjanamartin@verizon.net.