Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Ethical Practice. Show all posts
Showing posts with label Ethical Practice. Show all posts

Monday, July 14, 2014

Episode 11: Why Marketing is our Ethical Duty (and why Public Education is an ideal way to do it)

In this episode, John talks with Pauline Wallin, PhD, expert in marketing, public education, and media as well as a cofounder of The Practice Institute, where she helps clinicians build their practices.  It is important for psychologists to understand why marketing a psychological practice helps protect the public and raise awareness of how psychotherapy can improve people's lives.  Pauline makes the distinction between marketing and selling.  We also discuss four ethical ways to market psychological services via public education.

The end of this podcast, the listener will be able to:

1. Describe two ways that marketing your practice benefits the public.
2. List four ways to use public education to market your practice.
3. Describe two potential ethical pitfalls in marketing via public education, and how to avoid them.

Find this podcast on iTunes

For 1 APA-approved credit, click here.

Listen directly on this site here.



Resources

Dr. Pauline Wallin's website  @DoctorWallin

The Practice Institute  @PracticeHelp

APA Code of Conduct: Standard 5 - Advertising and Other Public Statements

National Institute of Health Information on Mental Health

American Psychological Association Media Referral Service

"Psychology Works" Facts Sheets - Canadian Psychological Association

Help a Reporter Out

Thursday, August 15, 2013

Sherman and Rowes: Psychological Warfare (Licensed) in Kentucky

By PAUL SHERMAN  AND JEFF ROWES
The Wall Street Journal
Originally published July 16, 2013

Was Dear Abby a career criminal? Can "The Dr. Oz Show" show be censored? Absolutely—at least according to the Kentucky attorney general and the state's Board of Examiners of Psychology, which just banned one of the most popular advice columns in the United States from all of Kentucky's newspapers.

This act of censorship has forced a showdown in federal court over one of the most important unanswered questions in First Amendment law: Can occupational-licensing laws—which require the government's permission to work—trump free speech? Some government licensing boards, which function increasingly as censors, certainly think the answer is yes.

The entire story is here.

Thanks to Don McAleer for this story.

Saturday, July 27, 2013

Social networking ethics: Developing best practices for the new small world.

Lannin, Daniel G.; Scott, Norman A.
Professional Psychology: Research and Practice, Vol 44(3), Jun 2013, 135-141.
doi: 10.1037/a0031794

Emerging trends online, and especially in social network sites, may be creating an environment for psychologists where transparency is increasingly unavoidable. Thus, most psychological practitioners may now have to engage in small world ethics—ethical acuity that requires an application of ethical principles to the increasingly interconnected and transparent world that is burgeoning from online culture. Fortunately, rural psychology has already provided a helpful roadmap for how to demonstrate flexibility and prudence when applying ethical principles in cultures with great transparency. Therefore, professional psychologists and psychologists in training may need to draw upon this wisdom when conceptualizing best online practices for the field that relate to social networking and personal online activity. To remain relevant, psychotherapy must adapt to the new digital culture but maintain its identity as a profession guided by its historical values and ethical principles.

The article can be found here.

Click here for one example of a social media policy via Dr. Keely Kolmes, psychologist and social media guru.

Thanks to Dr. Patricia Fox for this information.

Friday, May 24, 2013

Why Groupon and other social coupons are unethical in healthcare

By Deniza Gertzberg
www.kevinmd.com
Originally published on May 16, 2013

In addition to the possible legal pitfalls of advertising on Groupon-type websites, there are also ethical and practice management concerns to be weighed by healthcare practitioners before agreeing to such arrangements. Even with the recent announcement that companies such as Groupon and LivingSocial may be offering contracts to healthcare providers that take into consideration the prohibition against fee splitting, practitioners should nonetheless proceed with caution.

The concerns about social coupons in the healthcare context extend further than what is strictly legal as doctors also face the more basic question of whether such advertising practices are appropriate. It is not surprising that we find an increasing number of professional organizations speaking out about the ethical implications of providing social discounts to consumers. Several past presidents of the British Association of Aesthetic Plastic Surgeons, for example, in 2011 spoke out strongly against the practice of advertising discounts for plastic surgeries online.

Similarly, in the United States, we are seeing professional societies discussing the legality and ethical implications of such arrangements. The American Dental Association (ADA) last year, for example, issued an advisory opinion prohibiting the use of social coupons if such an arrangement would constitute fee splitting.

The entire blog post is here.

Thanks to Ed Zuckerman for this lead.

Tuesday, April 16, 2013

Why Should We Behave Ethically?

Stephen A. Ragusea, PsyD, ABPP

Guest Blog

Every psychologist must read and know the basic tenets of the American Psychological Association’s Code of Ethics in order to get through graduate school and obtain a license to practice psychology.  We’ve all read it.  We’ve all learned it.  We’ve all tried to apply it.  How many of us have asked the question, “Why bother?”  Obviously, the entire concept of ethical behavior is rooted in our system of morality and, although the word “should” often has a negative connotation in our psychotherapeutic lexicon, any ethics code is all about what we should and should not do.  Codes attempt to answer the question, “What’s the right thing to do in this situation?”

It’s interesting to me that nowhere in the current Ethics Code is this question directly addressed.  The issue is addressed only obliquely.  The Preamble states,

“Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society.  Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication.  They strive to help the public in developing informed judgments and choices concerning human behavior.  In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness.  This Ethics Code provides a common set of principles and standards upon which psychologists build their professional and scientific work.”

It seems to me, what the preamble does is one thing.  It advises us that this code of shoulds and should nots is intended to guide our behavior to facilitate our work as psychologists.  Essentially, the Ethics Code advises us that we’ll do a better job of being psychologists if we follow the principles articulated there in.  It helps us do our work.

What is our work?  The jobs that psychologists do could fill a book, in fact, they fill many books.  But for most of the membership of this state psychological association, our work consists largely of psychological assessment and psychotherapy.  It’s important work. 

This Christmas, I was reminded of the importance of the work we do via a Christmas card I received from one of my former patients.   Here’s the story.   Almost three decades ago, I was asked to evaluate a family because one of the parents had been found guilty of abusing a child.  In response to a child’s episode of enuresis, the parent placed the child in a bathtub full of ice cubes and cold water for half an hour.  The community’s response was to place all three children in foster care.  When I was asked to evaluate the family, I administered a variety of psychological tests to the entire family.

Through the assessment process, I uncovered important information as I worked with this very poor, rural family. The parents had graduated from high school as Special Education students, with Wechsler IQs near the bottom of the borderline range.  But they also had near perfect handwriting and spelling on the Rotter and WRAT and that told me they were capable of learning.  The father worked as a laborer and the mother, while somewhat disabled, worked as a homemaker caring for her family.  While talking with the parents during interviews, I found them to be loving, devoted people.  I learned that they had treated the enuresis problem using the same disciplinary technique used on them when they were children.  In their minds, they weren’t being abusive; they were being good parents.  I established a good relationship with them during the evaluation and ultimately worked with them in family therapy, which largely consisted of psycho-education – I had them read Dr. Spock’s Baby and Child Care and then we discussed it, section by section.  We worked hard.  These two parents eventually got their kids back and raised them as well as they could given the limits of their intellect, education, and finances.  What would you expect to be the outcome?  Here’s what was in their annual Christmas card to me this year.  Obviously, the information has been disguised to protect identities.  However, the original punctuation is maintained.

“Our son, Tim, is in Columbus going through college at Ohio State, business engineering, our daughter Martha is going through college at Indiana University in Indiana, criminal justice she wants to be a detective and she also works at the grocery store.  Our youngest moved to Erie, PA, in July she works at a Walgreen pharmacy.  John and I are just fine.  Hope all is fine and well where you are.  Take care….”
  
We all have cases like this in our files, don't we?  We do very important work out there and sometimes we forget that reality.

There were a number of significant ethical issues in this case.  For example, all the potential dangers regarding multiple relationships needed to be navigated.  Clarifying the identity of my client or clients at various points was a challenge.  I didn’t always adhere to the letter of the then current Ethics Code,  but I certainly tried to adhere to the spirit of the document.  It helped me to do what I think was good work.  I think our system of ethics helps us all to do good work.  And, I think that’s why we have an Ethics Code and why we should behave ethically.   Maybe you’ve got a better reason, but that’s the best answer I can come up with.  It helps us do good work. And that’s why we’re here, isn’t it? 

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073. 

If you have specific suggestions for topics to be covered in The Ethics Corner, please e-mail me with your suggestions.  My e-mail address is ragusea@aol.com. 

Sunday, April 7, 2013

Psychiatrists Top List of Big Pharma Payments Again

By Deborah Brauser
Medscape Medical News
Originally published March 14, 2013

Once again, psychiatrists top the updated Dollars for Docs list of large payments from pharmaceutical companies to individual US clinicians.

On March 12, the investigative journalism group ProPublica released the names of the 22 physicians who, since 2009, received more than $500,000 from these companies in speaking and consulting fees. Mirroring the organization's first report released in 2010, psychiatrists dominate the list.

This time, the top recipient was Jon Draud, MD, medical director of the psychiatric and addiction medicine program at Baptist Hospital in Nashville, Tennessee, and from the Middle Tennessee Medical Center in Murfreesboro.

(cut)

APA Reaction

"My immediate, honest response was that this boggles the mind," James Scully, MD, CEO of the American Psychiatric Association (APA), told Medscape Medical News.

The entire story is here.

Thanks to Ed Zuckerman for this story.

Thursday, December 6, 2012

Vignette 20: Has the Psychologist Done too Much?


Dr. Plenty lives and practices psychology in a rural area.  She began to provide psychotherapy to Mr. DiMencha, a 52-year-old, who suffered with depression.  After six sessions, Mr. DiMencha suffered a significant concussion while at work.  His impairment is noticeable by Dr. Plenty without any type of testing.  He struggles with understanding concepts and becomes tangential during the next two sessions.

Mr. DiMencha’s co-worker, Janet, helped him find an attorney so that his rights are protected.  Dr. Plenty had Mr. DiMencha sign a release to talk with the attorney as well as Janet.  From a phone call with the attorney, Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. DiMencha is.  The patient has never met the attorney face-to-face, just by email and phone contacts.

Mr. DiMencha demonstrates a variety of cognitive deficits.  He needs assistance and monitoring with daily tasks, such as home care, shopping, transportation, understanding the settlement process, reading his mail, and paying his bills. He will likely need to go into an assisted living facility. His family lives at a distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn't appear to understand his legal rights or the settlement process.

Prior to providing extra-therapy support, Dr. Plenty had Mr. DiMencha sign a document explaining her fees for the additional services.  She is not sure that he completely understands what is happening or her version of informed consent for the additional services.  The psychologist has been doing much of the case management work, e.g. locating a long-time friend who is willing to help him at home, referring him to a neuropsychologist for testing, engaging in lengthy discussions with his primary care physician and neurologist, participating in multiple conversations with the attorney, and trying to find a guardian or power of attorney.

In the midst of all of this activity, the psychologist contacts you for an ethics consultation.

What are the potential ethical issues with this case?

What are the competing ethical principles?

Is Dr. Plenty acting beyond the limits of her competency?

Is she practicing outside of her scope of her license?

What problems may occur as a function of Dr. Plenty engaging in a multiple relationship role in Mr. DiMencha’s care?

What suggestions would you make to Dr. Plenty?


Friday, August 31, 2012

The Widespread Problem of Doctor Burnout

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

Here is an excerpt:


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

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

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

Friday, July 6, 2012

To Evaluate or Not To Evaluate

Dr. Joey Bishop has been conducting pre-ordination evaluations for a religious institution for many years. The purpose of these psychological evaluations is to identify individuals who have gross psychopathology, strong personality disorders, or other characteristics that would make them incapable of performing their religious duties adequately. Dr. Bishop developed a strong relationship with this institution and they have been quite satisfied with his work.

One day, Dr. Bishop receives a phone call from his contact at the institution.  The contact is now requesting that Dr. Bishop begin to screen individuals for "homosexual tendencies" because, according to the doctrines of the denomination, such individuals are not eligible to become clergy.

Dr. Bishop feels uneasy about this situation, as “homosexuality” has not been considered a mental illness since the 1970s.  Simultaneously, the religious institution is adamant about this requirement. 

Dr. Bishop calls you for a consult about this situation.

What are the ethical issues involved in this scenario?

If you were the psychologist, what would be your emotion response to this situation?

What are some potential responses that you could offer Dr. Bishop?

Thursday, March 22, 2012

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.

Tuesday, March 20, 2012

Antipsychotic Drugs Grow More Popular for Patients without Mental Illness

By Sandra G. Boodman
The Washington Post
Published March 12, 2012

Adriane Fugh-Berman was stunned by the question: Two graduate students who had no symptoms of mental illness wondered if she thought they should take a powerful schizophrenia drug each had been prescribed to treat insomnia.

“It’s a total outrage,” said Fugh-Berman, a physician who is an associate professor of pharmacology at Georgetown University. “These kids needed some basic sleep [advice], like reducing their intake of caffeine and alcohol, not a highly sedating drug.”

Those Georgetown students exemplify a trend that alarms medical experts, policymakers and patient advocates: the skyrocketing increase in the off-label use of an expensive class of drugs called atypical antipsychotics. Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.

But these days atypical antipsychotics — the most popular are Seroquel, Zyprexa and Abilify — are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports have found that youth in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness.

Tuesday, March 6, 2012

Vignette 11: An Unexpected Inheritance

A psychologist receives a letter from an attorney indicating that he inherited an old car from Frank Palmer.  Upon reflection, the psychologist recalls that he had treated Mr. Palmer a number of years ago.  Looking through his files, the psychologist cannot find his file, so it must have been more than five years ago.

The psychologist phones the attorney and discovers that Mr. Palmer left him a 1993 four-wheel drive Ford Explorer.  He asked the attorney if anyone is contesting the will.  Apparently, no one is.  The executor is Mr. Palmer’s brother, who lives in a different state.

The psychologist obtains the keys and title for the vehicle.  He drives the car to a local dealer who indicated that the Explorer is worth about $3,500.

The psychologist cannot remember many details about the patient.   He recalled that he was an older person with significant depression who eventually became better.  There is nothing unusual that stands out about their therapeutic relationship.

Feeling guilty, the psychologist calls you on the phone to discuss his feelings and any possible ethical concerns.

What are the potential ethical concerns about this scenario, if any?

What suggestions or options would you give the psychologist?

=============================

While a similar experience happened to a psychologist, for further discussion with students, supervisees, or colleagues, the educator or group leader may want to compare and contrast the ethics and options with different details.

Use the same scenario with an antique car worth $50,000 and a family member is contesting the psychologist’s portion of the will.

Would your opinions change about the ethical issues and options related to the situation.  If so, what is different that changes the opinions?

Monday, January 23, 2012

School Psychologists and Ethical Practice: Information for Parents and Educators

SchoolPsychsEthicalPractice