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 Patients. Show all posts
Showing posts with label Patients. Show all posts

Monday, May 13, 2024

Ethical Considerations When Confronted by Racist Patients

Charles Dike
Psychiatric News
Originally published 26 Feb 24

Here is an excerpt:

Abuse of psychiatrists, mostly verbal but sometimes physical, is common in psychiatric treatment, especially on inpatient units. For psychiatrists trained decades ago, experiencing verbal abuse and name calling from patients—and even senior colleagues and teachers—was the norm. The abuse began in medical school, with unconscionable work hours followed by callous disregard of students’ concerns and disparaging statements suggesting the students were too weak or unfit to be doctors.

This abuse continued into specialty training and practice. It was largely seen as a necessary evil of attaining the privilege of becoming a doctor and treating patients whose uncivil behaviors can be excused on account of their ill health. Doctors were supposed to rise above those indignities, focus on the task at hand, and get the patients better in line with our core ethical principles that place caring for the patient above all else. There was no room for discussion or acknowledgement of the doctors’ underlying life experiences, including past trauma, and how patients’ behavior would affect doctors.

Moreover, even in recent times, racial slurs or attacks against physicians of color were not recognized as abuse by the dominant group of doctors; the affected physicians who complained were dismissed as being too sensitive or worse. Some physicians, often not of color, have explained a manic patient’s racist comments as understandable in the context of disinhibition and poor judgment, which are cardinal symptoms of mania, and they are surprised that physicians of color are not so understanding.

Here is a summary:

This article explores the ethical dilemma healthcare providers face when treating patients who express racist views. It acknowledges the provider's obligation to care for the patient's medical needs, while also considering the emotional toll of racist remarks on both the provider and other staff members.

The article discusses the importance of assessing the urgency of the patient's medical condition and their mental capacity. It explores the option of setting boundaries or termination of treatment in extreme cases, while also acknowledging the potential benefits of attempting a dialogue about the impact of prejudice.

Monday, October 31, 2022

Longest Strike Ends: California Mental Health Care Workers Win Big

Cal Wilslow
Originally posted 24 OCT 22

Two thousand mental health clinicians have won; Kaiser Permanente has lost. The 10- week strike has ended in near total victory for the National Union of Healthcare Workers (NUHW). The therapists, walked out on August 15; it became the longest mental health care workers’ strike recorded.

Two issues dominated negotiations from the start: workload for Kaiser therapists and wait time for Kaiser patients. The strikers won on both, forcing concessions until now all but unheard of. The strikers won break through provisions to retain staff, reduce wait times for patients and a plan to collaborate on transforming Kaiser’s model for providing mental health care. The new four-year contract is retroactive to September 2021 and expires in September 2025. Darrell Steinberg, Mayor of Sacramento served as a mediator. Members of the NUHW voted 1561 to 36 to ratify it.

Braving three- digit heat, strikers walked picket lines throughout Northern California and the Central Valley. They picketed, marched and rallied at Kaiser hospitals – in a strike that caught the attention of mental health care advocates everywhere. “Our strike was difficult and draining, but it was worth it,” said Natalie Rogers, a therapist for Kaiser in Santa Rosa. We stood up to the biggest nonprofit in the nation, and we made gains that will help better serve our patients and will advance the cause of mental health parity throughout the country.”

The mental health clinicians I’ve met are almost universally modest and careful in their choice of words, and here is an example. To say that that Kaiser is “the biggest non-profit” is an understatement to say the least – its revenues are in the billions, and its managers make millions while this giant among giants, typically in the world of corporate health care, oversees its empire as if it were making cars and trucks.

I’ve seen NUHW rallies well-attended by patients themselves, also family members and supporters who are angry, bitter. Where frequently they carry signs to the effect that the issues here are life and death, rallies where speakers break down in tears, where placards tell us that suicide can be the outcome of care denied – “Stop the Suicides!” It’s a wonder more therapists don’t move on. The world of pain of the mental health patient can be just as acute as that of the medical patient. Ask a therapist. It’s not that the clinicians don’t want to tell us this.; it’s that, in their own way, they are telling us. It’s why they fight so hard.

Saturday, July 13, 2019

The Worst Patients in the World

David Freedman
The Atlantic - July 2019 Issue

Here are two excerpts:

Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Surely, some might add, a program like Medicare for All would help by discouraging high-cost, ineffective treatments.

But lost in these discussions is, well, us. We ought to consider the possibility that if we exported Americans to those other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?


American patients’ flagrant disregard for routine care is another problem. Take the failure to stick to prescribed drugs, one more bad behavior in which American patients lead the world. The estimated per capita cost of drug noncompliance is up to three times as high in the U.S. as in the European Union. And when Americans go to the doctor, they are more likely than people in other countries to head to expensive specialists. A British Medical Journal study found that U.S. patients end up with specialty referrals at more than twice the rate of U.K. patients. They also end up in the ER more often, at enormous cost. According to another study, this one of chronic migraine sufferers, 42 percent of U.S. respondents had visited an emergency department for their headaches, versus 14 percent of U.K. respondents.

Finally, the U.S. stands out as a place where death, even for the very aged, tends to be fought tooth and nail, and not cheaply. “In the U.K., Canada, and many other countries, death is seen as inevitable,” Somava Saha said. “In the U.S., death is seen as optional. When [people] become sick near the end of their lives, they have faith in what a heroic health-care system will accomplish for them.”

The info is here.

Friday, May 18, 2018

Increasing patient engagement in healthcare decision-making

Jennifer Blumenthal-Barby
Baylor College of Medicine Blogs
Originally posted March 10, 2017

Making decisions is hard. Anyone who has ever struggled to pick a restaurant for dinner knows well – choosing between options is difficult even when the stakes are low and you have full access to information.

But what happens when the information is incomplete or difficult to comprehend? How does navigating a health crisis impact our ability to choose between different treatment options?

The Wall Street Journal published an article about something I have spent considerable time studying: the importance of decision aids in helping patients make difficult medical decisions. They note correctly that simplifying medical jargon and complicated statistics helps patients take more control over their care.

But that is only part of the equation.

The blog post is here.

Friday, March 9, 2018

Dealing with Racist Patients

Kimani Paul-Emile, Alexander K. Smith, Bernard Lo, and Alicia Fernández
N Engl J Med 2016; 374:708-711

Here is an excerpt:

Beyond these general legal rules, when patients reject physicians on the basis of their race or ethnic background, there is little guidance for hospitals and physicians regarding ways of effectively balancing patients’ interests, medical personnel’s employment rights, and the duty to treat. We believe that sound decision making in this context will turn on five ethical and practical factors: the patient’s medical condition, his or her decision-making capacity, options for responding to the request, reasons for the request, and effect on the physician (see flow chart). It’s helpful for physicians to consider these factors as they engage in negotiation, persuasion, and (in some cases) accommodation within the practical realities of providing effective care for all patients.

The patient’s medical condition and the clinical setting should drive decision making. In an emergency situation with a patient whose condition is unstable, the physician should first treat and stabilize the patient. Reassignment requests based on bigotry may be attributable to delirium, dementia, or psychosis, and patients’ preferences may change if reversible disorders are identified and treated. Patients with significantly impaired cognition are generally not held to be ethically responsible.

The article is here.

Tuesday, August 1, 2017

Henderson psychologist charged with murder can reopen practice

David Ferrara
Las Vegas Review-Journal
Originally posted July 14, 2017

A psychologist accused of killing his wife and staging her death as a suicide can start practicing medicine again in less than four months, the Nevada Board of Psychological Examiners decided Friday.

Suspected of abusing drugs and obtaining prescription drugs from patients, Gregory “Brent” Dennis, who prosecutors say poisoned attorney Susan Winters inside their Henderson home, also must undergo up to seven years of drug treatment, the seven-member panel ruled as they signed a settlement agreement that made no mention of the murder charge.

“It’s clear that the board members do not know what Brent Dennis was arrested for,” Keith Williams, a lawyer for the Winters family, told a Las Vegas Review-Journal reporter after the meeting. “We’re confident that they did not know what they were voting on today.”

Henderson police arrested Dennis on the murder charge in February.

The article is here.

Saturday, November 28, 2015

Penn study: Pay patients to take their pills

By Tom Avril
Originally posted November 8, 2015

Here are two excerpt:

While the field of medicine has moved increasingly toward paying doctors for performance, there has been little controlled research on whether it works. Studies of patients, meanwhile, have found that incentives can encourage healthy behaviors such as giving up cigarettes.

But in a study of 1,503 patients announced Sunday, the Penn team reported that the most effective approach, at least where statins are concerned, may be to reward both patient and physician.

"In some respects, it takes two to tango," said lead author David A. Asch, a professor at Penn's Perelman School of Medicine.


Even if money helps, the notion of paying people to do the right thing may rub some the wrong way.

"We shouldn't have to," said Bobbi Cecco, president of the Hackensack, N.J., chapter of the Mended Hearts patient support group. "But if that's what it comes down to . . ."

Wei, the Michigan physician, said she already is motivated to help her patients stick with their medicine.

"Financial incentives wouldn't change my values or patient care," she said. "I am also an idealist."

The entire article is here.

Friday, July 31, 2015

Mind Perception Is the Essence of Morality

Kurt Gray , Liane Young , Adam Waytz
Psychological Inquiry 
Vol. 23, Iss. 2, 2012


Mind perception entails ascribing mental capacities to other entities, whereas moral judgment entails labeling entities as good or bad or actions as right or wrong. We suggest that mind perception is the essence of moral judgment. In particular, we suggest that moral judgment is rooted in a cognitive template of two perceived minds—a moral dyad of an intentional agent and a suffering moral patient. Diverse lines of research support dyadic morality. First, perceptions of mind are linked to moral judgments: dimensions of mind perception (agency and experience) map onto moral types (agents and patients), and deficits of mind perception correspond to difficulties with moral judgment. Second, not only are moral judgments sensitive to perceived agency and experience, but all moral transgressions are fundamentally understood as agency plus experienced suffering—that is, interpersonal harm—even ostensibly harmless acts such as purity violations. Third, dyadic morality uniquely accounts for the phenomena of dyadic completion (seeing agents in response to patients, and vice versa), and moral typecasting (characterizing others as either moral agents or moral patients). Discussion also explores how mind perception can unify morality across explanatory levels, how a dyadic template of morality may be developmentally acquired, and future directions.

The entire article is here.

Friday, May 15, 2015

Navigating the Google Blind Spot

An Emerging Need for Professional Guidelines to Address Patient-Targeted Googling

By Maria J. Baker, Daniel R. George and Gordon L. Kauffman
Journal of General Internal Medicine
Originally published September 17, 2014

Many physicians would agree that seeking information about their patients via Google seems to be an invasion of privacy, violating trust between patients and their healthcare providers. However, it may be viewed as ethically valid, and even warranted under certain circumstances. Although guidelines developed by the American Medical Association and the Federation of State Medical Boards (FSMB) provide general guidance on the appropriate use of the Internet, they do not specifically address the crucial issue of whether physicians should ‘google’ their patients, and, if so, under what circumstances. As a result, physicians are left to navigate this “google blind spot” independently, and to decipher on a case-by-case basis where the boundary of professionalism lies with regard to patient-targeted googling.

Two case scenarios illustrate the moral ambiguity present within this “blind spot.”

The entire article is here.

Saturday, July 12, 2014

Who’s Googled whom?

Trainees’ Internet and online social networking experiences, behaviors, and attitudes with clients and supervisors.

By P. Asay and Ashwini Lal
Training and Education in Professional Psychology, Vol 8(2), May 2014, 105-111.
doi: 10.1037/tep0000035


The ubiquity of the Internet and online social networking creates rapidly developing opportunities and challenges for psychologists and trainees in the domains of relationships, privacy, and connection. As trainees increasingly are natives of an Internet culture, questions arise about the ways in which developing psychologists may view Internet issues and the guidance they receive from professional psychologists for whom the Internet is a significant cultural shift. A national survey of graduate students (n = 407) assessed student Internet behaviors (e.g., “Googling” clients, online social networking), training about online issues, attitudes toward online social networking and client or supervisor contact via these networks, and fears and comfort about making decisions regarding these networks. The survey also assessed what students reported they would do and what they would think if clients and supervisors contacted them via social networks. Results indicate that most trainees have changed and monitored their online presence since beginning graduate school. A quarter of respondents had “Googled” clients, and almost half had “Googled” supervisors. A small number indicated that both clients and supervisors had reported “Googling” the trainee. Students expressed concerns about making ethical decisions about online social networks. Half reported discussing Internet issues in their graduate training programs, whereas a quarter indicated they had discussed Internet issues at their training sites. Implications for training are discussed, with recommendations of program disclosure of Internet policies to students, discussion of Internet issues before trainee clinical work, role plays of ethical issues, and supervisor-initiated discussions of Internet issues.

The entire article is here.