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 Patient Welfare. Show all posts
Showing posts with label Patient Welfare. Show all posts

Wednesday, January 10, 2018

Failing better

Erik Angner
BPP Blog, the companion blog to the new journal Behavioural Public Policy
Originally posted June 2, 2017

Cass R. Sunstein’s ‘Nudges That Fail’ explores why some nudges work, why some fail, and what should be done in the face of failure. It’s a useful contribution in part because it reminds us that nudging – roughly speaking, the effort to improve people’s welfare by helping them make better choices without interfering with their liberty or autonomy – is harder than it might seem. When people differ in beliefs, values, and preferences, or when they differ in their responses to behavioral interventions, for example, it may be difficult to design a nudge that benefits at least some without violating anyone’s liberty or autonomy. But the paper is a useful contribution also because it suggests concrete, positive steps that may be taken to help us get better simultaneously at enhancing welfare and at respecting liberty and autonomy.

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Moreover, even if a nudge is on the net welfare enhancing and doesn’t violate any other values, it does not follow that it should be implemented. As economists are fond of telling you, everything has an opportunity cost, and so do nudges. If whatever resources would be used in the implementation of the nudge could be put to better use elsewhere, we would have reason not to implement it. If we did anyway, we would be guilty of the Econ 101 fallacy of ignoring opportunity costs, which would be embarrassing.

The blog post is here.

Sunday, March 3, 2013

Essential Knowledge about Suicide Prevention




The New York Psychological Association
Published on Jan 31, 2013

"Essential Knowledge about Suicide Prevention-Evidence-Based Practices for Mental Health Professionals," sponsored by the NYS Psychological Association and the NYS OMH Suicide Prevention Initiative provides concepts and resources for clinicians as a starting point to build competency and preparedness for a suicide event, before it becomes a reality. Featuring Dr. Richard Juman, Dr. John Draper and Dr. Shane Owens, the video addresses issues including clinician anxiety about suicide, suicide and professional liability, and core competencies for suicide prevention in clinical practices, providing perspectives from both experts and clinicians.

NAASP: Clinical Care & Intervention Task Force Report

Sunday, February 17, 2013

Mislabeling Medical Illness

By ALLEN FRANCES, MD
The Health Care Blog
Originally published on February 12, 2013


Many readers of my previous blog listing the 10 worst suggestions in DSM 5 were shocked that I failed to mention an 11th dangerous mistake — that DSM-5 will harm people who are medically ill by mislabeling their medical problems as mental disorder. They are absolutely right. I apologize for my previous failure to attend to this danger and hope it is not now too late to influence the process.

Adding to the woes of the medically ill could be one of the biggest problems caused by DSM-5. It will do this in two ways: 1) by encouraging a quick jump to the erroneous conclusion that someone’s physical symptoms are ‘all in the head’; and 2) by mislabeling as mental disorders what are really just the normal emotional reactions that people understandably have in response to a medical illness.

UK health advocate, Suzy Chapman, has closely monitored every step in the development of DSM-5. Her website is the best available resource for finding just about everything you need to know about DSM-5 and ICD-11. Ms Chapman sent me a troubling email that summarizes where DSM-5 has gone wrong and the many harmful consequences that will follow. More details are available at: ‘Somatic Symptom Disorder could capture millions more under mental health diagnosis’ (http://wp.me/pKrrB-29B )

Ms Chapman writes:
…The DSM-5 Somatic Symptom Disorders Work Group is planning to eliminate several little used DSM-IV Somatoform Disorders and replace them instead with an extremely broad new category that is likely to be wildly overused (‘Somatic Symptom Disorder’ — SSD).
A person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.
The entire blog post is here.


Monday, January 7, 2013

Doctors Warned on ‘Divided Loyalty’


By ROBERT PEAR
The New York Times
Published: December 26, 2012

With hospitals buying up medical practices around the country and seeking to make the most of their investment, the American Medical Association reached out to doctors this week to remind them that patient welfare must always come first and not be overridden by the economic interests of hospitals that now employ doctors in ever-growing numbers.

“In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority,” says a policy statement adopted by the association.

“A physician’s paramount responsibility is to his or her patients,” the association said. At the same time, it added, a doctor “owes a duty of loyalty to his or her employer,” and “this divided loyalty can create conflicts of interest, such as financial incentives to over- or under-treat patients.”

The association is disseminating its policy to doctors at a time when more of them are becoming hospital employees. About one-third of new doctors say they would prefer to be employed by hospitals, rather than practice on their own. The association is urging hospitals and medical groups to adopt similar policies.

A major goal of the guidelines is to protect the professional autonomy of doctors. Hospital employment agreements often include provisions that discourage doctors from sending patients to providers of services that are not affiliated with the hospital.

The guidelines say that “physicians should always make treatment and referral decisions based on the best interests of their patients.” Moreover, the association says, patients should be told whenever a hospital provides financial incentives that encourage, discourage or restrict referrals or treatment options.