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 Physicians. Show all posts
Showing posts with label Physicians. Show all posts

Monday, October 30, 2023

The Mental Health Crisis Among Doctors Is a Problem for Patients

Keren Landman
vox.com
Originally posted 25 OCT 23

Here is an excerpt:

What’s causing such high levels of mental distress among doctors?

Physicians have high rates of mental distress — and they’re only getting higher. One 2023 survey found six out of 10 doctors often had feelings of burnout, compared to four out of 10 pre-pandemic. In a separate 2023 study, nearly a quarter of doctors said they were depressed.

Physicians die by suicide at rates higher than the general population, with women’s risk twice as high as men’s. In a 2022 survey, one in 10 doctors said they’d thought about or attempted suicide.

Not all doctors are at equal risk: Primary care providers — like emergency medicine, internal medicine, and pediatrics practitioners — are most likely to say they’re burned out, and female physicians experience burnout at higher rates than male physicians.

(It’s worth noting that other health care professionals — perhaps most prominently nurses — also face high levels of mental distress. But because nurses are more frequently unionized than doctors and because their professional culture isn’t the same as doctor culture, the causes and solutions are also somewhat different.)


Here is my summary:

The article discusses the mental health crisis among doctors and its implications for patients. It notes that doctors are at a higher risk of suicide than any other profession, and that they also experience high rates of burnout and depression.

The mental health crisis among doctors is a problem for patients because it can lead to impaired judgment, medical errors, and reduced quality of care. Additionally, the stigma associated with mental illness can prevent doctors from seeking the help they need, which can further exacerbate the problem.

The article concludes by calling for more attention to the mental health of doctors and for more resources to be made available to help them.

I treat a number of physicians in my practice.

Friday, August 18, 2023

Evidence for Anchoring Bias During Physician Decision-Making

Ly, D. P., Shekelle, P. G., & Song, Z. (2023).
JAMA Internal Medicine, 183(8), 818.
https://doi.org/10.1001/jamainternmed.2023.2366

Abstract

Introduction

Cognitive biases are hypothesized to influence physician decision-making, but large-scale evidence consistent with their influence is limited. One such bias is anchoring bias, or the focus on a single—often initial—piece of information when making clinical decisions without sufficiently adjusting to later information.

Objective

To examine whether physicians were less likely to test patients with congestive heart failure (CHF) presenting to the emergency department (ED) with shortness of breath (SOB) for pulmonary embolism (PE) when the patient visit reason section, documented in triage before physicians see the patient, mentioned CHF.

Design, Setting, and Participants

In this cross-sectional study of 2011 to 2018 national Veterans Affairs data, patients with CHF presenting with SOB in Veterans Affairs EDs were included in the analysis. Analyses were performed from July 2019 to January 2023.

Conclusions and Relevance

In this cross-sectional study among patients with CHF presenting with SOB, physicians were less likely to test for PE when the patient visit reason that was documented before they saw the patient mentioned CHF. Physicians may anchor on such initial information in decision-making, which in this case was associated with delayed workup and diagnosis of PE.

Here is the conclusion of the paper:

In conclusion, among patients with CHF presenting to the ED with SOB, we find that ED physicians were less likely to test for PE when the initial reason for visit, documented before the physician's evaluation, specifically mentioned CHF. These results are consistent with physicians anchoring on initial information. Presenting physicians with the patient’s general signs and symptoms, rather than specific diagnoses, may mitigate this anchoring. Other interventions include refining knowledge of findings that distinguish between alternative diagnoses for a particular clinical presentation.

Quick snapshot:

Anchoring bias is a cognitive bias that causes us to rely too heavily on the first piece of information we receive when making a decision. This can lead us to make inaccurate or suboptimal decisions, especially when the initial information is not accurate or relevant.

The findings of this study suggest that anchoring bias may be a significant factor in physician decision-making. This could lead to delayed or missed diagnoses, which could have serious consequences for patients.

Saturday, February 18, 2023

More Physicians Are Experiencing Burnout and Depression

Christine Lehmann
Medscape.com
Originally poste 1 FEB 23

More than half of physicians reported feeling burned out this year and nearly 1 in 4 doctors reported feeling depressed — the highest percentages in 5 years, according to the 'I Cry but No One Cares': Physician Burnout & Depression Report 2023.

"Burnout leaves you feeling like someone you're not," said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.

"When someone is burned out, they experience extreme exhaustion in the workplace, depersonalization, and a sense that their best is no longer good enough. Over time, this may spill into the rest of their lives, affecting their relationships as well as their general health and well-being," said Sánchez.

When feelings of burnout continue without effective interventions, they can lead to depression, anxiety, and more, she said.

Burnout can persist for months to even years — nearly two thirds of doctors surveyed said their burnout lasted for at least 13 months, and another 30% said it lasted for more than 2 years.

The majority of doctors attributed their burnout to too many bureaucratic tasks, although more than one third said it was because their co-workers treated them with a lack of respect.

"This disrespect can take many forms from demeaning comments toward physicians in training to the undermining of a physicians' decade-long education and training to instances of rudeness or incivility in the exam room. Unfortunately, medical professionals can be the source of bad behavior and disrespect. They may be burned out too, and doing their best to work in a broken healthcare system during an extremely difficult time," said Sánchez.

Wednesday, December 28, 2022

Physician-assisted suicide is not protected by Massachusetts Constitution, top state court rules

Chris Van Buskirk
masslive.com
Originally posted 6 Dec 22

The state’s highest court ruled Monday morning that the Massachusetts state constitution does not protect physician-assisted suicide and that laws around manslaughter may prohibit the practice.

The decision affects whether doctors can prescribe lethal amounts of medication to terminally ill patients that would end their life. The plaintiffs, a doctor looking to provide physician-assisted suicide and a patient with an incurable cancer, argued that patients with six months or less to live have a constitutional right to bring about their death on their own terms.

But defendants in the case have said that the decision to legalize or formalize the procedure here in Massachusetts is a question best left to state lawmakers, not the courts. And in an 89-page ruling, Associate Justice Frank Gaziano wrote that the Supreme Judicial Court agreed with that position.

The court, he wrote, recognized the “paramount importance and profound significance of all end-of-life decisions” but that the Massachusetts Declaration of Rights does not reach so far as to protect physician-assisted suicide.

“Our decision today does not diminish the critical nature of these interests, but rather recognizes the limits of our Constitution, and the proper role of the judiciary in a functioning democracy. The desirability and practicality of physician-assisted suicide raises not only weighty philosophical questions about the nature of life and death, but also difficult technical questions about the regulation of the medical field,” Gaziano wrote. “These questions are best left to the democratic process, where their resolution can be informed by robust public debate and thoughtful research by experts in the field.”

Plaintiff Roger Kligler, a retired physician, was diagnosed with stage four metastatic prostate cancer, and in May 2018, a doctor told him that there was a fifty percent chance that he would die within five years.

Kligler, Gaziano wrote in the ruling, had not yet received a six-month prognosis, and his cancer “currently has been contained, and his physician asserts that it would not be surprising if Kligler were alive ten years from now.”

Monday, April 4, 2022

Pushed to Their Limits, 1 in 5 Physicians Intends to Leave Practice

Abbasi J.
JAMA. Published online March 30, 2022.
doi:10.1001/jama.2022.5074

Here is an excerpt:

Worsening staffing issues are now the biggest stressor for clinicians. Health care worker shortages, especially in rural and otherwise underserved areas of the country, have reached critical and unsustainable levels, according to the National Institute for Occupational Safety and Health (NIOSH).

“The evidence shows that health workers have been leaving the workforce at an alarming rate over the past 2 years,” Thomas R. Cunningham, PhD, a senior behavioral scientist at NIOSH, wrote in a statement emailed to JAMA.

In the absence of national data, Etz says the Green Center data point to a meaningful reduction in the primary care workforce during the pandemic. In the February 2022 survey, 62% of 847 clinicians had personal knowledge of other primary care clinicians who retired early or quit during the pandemic and 29% knew of practices that had closed up shop. That’s on top of a preexisting shortage of general and family medicine physicians. “I think we have a platform that is collapsed, and we haven’t recognized it yet,” Etz said.

In fact, surveys indicate that a “great clinician resignation” lies ahead. A quarter of clinicians said they planned to leave primary care within 3 years in Etz’s February survey. The Coping With COVID study predicts a more widespread clinician exodus: in the pandemic’s first year, 23.8% of the more than 9000 physicians from various disciplines in the study and 40% of 2301 nurses planned to exit their practice in the next 2 years. (The Coping With COVID study was funded by the American Medical Association, the publisher of JAMA.)

A lesson that’s been underscored during the pandemic is that physician wellness has a lot to do with other health workers’ satisfaction. “The ‘great resignation’ is affecting a lot of our staff, who don’t feel necessarily cared for by their organizations,” Linzer said. “The staff are leaving, which leaves the physicians to do more nonphysician work. So really, in order to solve this, we need to pay attention to all of our health care workers.”

Nurses who said they intended to leave their positions within 6 months cited 3 main drivers in an American Nurses Foundation survey: work negatively affecting their health and well-being, insufficient staffing, and a lack of employer support during the pandemic.

“Health care is a team sport,” L. Casey Chosewood, MD, MPH, director of the NIOSH Office for Total Worker Health, wrote in the agency’s emailed statement. “When nurses and other support personnel are under tremendous strain or not able to perform at optimal levels, or when staffing is inadequate, the impact flows both upstream to physicians who then face a heavier workload and loss of efficiency, and downstream impacting patient care and treatment outcomes.”

Saturday, April 10, 2021

Ethical and Professionalism Implications of Physician Employment and Health Care Business Practices

De Camp, M, & Sulmasy, L. S.
Annals of Internal Medicine
Position Paper: 16 March 21

Abstract

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient–physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.

Here is an excerpt:

Employment of physicians likewise has advantages, such as financial stability, practice management assistance, and opportunities for collaboration and continuing education, but there is also the potential for dual loyalty when physicians try to be accountable to both their patients and their employers. Dual loyalty is not new; for example, mandatory reporting of communicable diseases may place societal interests in preventing disease at odds with patient privacy interests. However, the ethics of everyday business models and practices in medicine has been less explored.

Trust is the foundation of the patient–physician relationship. Trust, honesty, fairness, and respect among health care stakeholders support the delivery of high-value, patient-centered care. Trust depends on expertise, competence, honesty, transparency, and intentions or goodwill. Institutions, systems, payers, purchasers, clinicians, and patients should recognize and support “the intimacy and importance of patient–clinician relationships” and the ethical duties of physicians, including the primary obligation to act in the patient's best interests (beneficence).

Business ethics does not necessarily conflict with the ethos of medicine. Today, physician leadership of health care organizations may be vital for delivering high-quality care and building trust, including in health care institutions. Truly trustworthy institutions may be more successful (in patient care and financially) in the long term.

Blanket statements about business practices and contractual provisions are unhelpful; most have both potential positives and potential negatives. Nevertheless, it is important to raise awareness of business practices relevant to ethics and professionalism in medical practice and promote the physician's ability to advocate for arrangements that align with medicine's core values. In this paper, the American College of Physicians (ACP) highlights 6 contemporary issues and offers ethical guidance for physicians. Although the observed trends toward physician employment and organizational consolidation merit reflection, certain issues may also resonate with independent practices and in other practice settings.

Friday, January 15, 2021

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Menon NK, Shanafelt TD, Sinsky CA, et al. 
JAMA Netw Open. 2020;3(12):e2028780. 
doi:10.1001/jamanetworkopen.2020.28780

Key Points

Question  Is burnout associated with increased suicidal ideation and self-reported medical errors among physicians after accounting for depression?

Findings  In this cross-sectional study of 1354 US physicians, burnout was significantly associated with increased odds of suicidal ideation before but not after adjusting for depression and with increased odds of self-reported medical errors before and after adjusting for depression. In adjusted models, depression was significantly associated with increased odds of suicidal ideation but not self-reported medical errors.

Meaning  The findings suggest that depression but not burnout is directly associated with suicidal ideation among physicians.

Conclusions and Relevance  The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

Thursday, January 14, 2021

Memorial Sloan Kettering Gave Top Doctor $1.5 Million After He Was Forced to Resign Over Conflicts of Interest

Katie Thomas & Charles Ornstein
ProPublica
Originally published 22 Dec 20

Here is an excerpt:

After months of review, Memorial Sloan Kettering overhauled its conflict-of-interest policy, barring its top executives from serving on corporate boards of drug and health care companies and placing limits on how executives and top researchers could profit from work developed at the institution.

Like other major hospitals, Memorial Sloan Kettering’s finances have taken a hit during the coronavirus pandemic. For the first three quarters of 2020, the hospital reported an operating loss of $453 million compared with an operating profit of nearly $77 million in the first nine months of 2019. The hospital saw a decline in surgical procedures and clinic visits, as well as clinical trials and other research. The hospital did receive $100 million in relief funds as part of the Coronavirus Aid, Relief and Economic Security (CARES) Act.

Baselga wasn’t the only former official to receive severance from Memorial Sloan Kettering in 2019. It also paid more than $250,000 in severance to Avice Meehan, the hospital’s former chief communications officer, according to its IRS filing. Meehan declined to comment.

Laurie Styron, the executive director of CharityWatch, an independent watchdog group, said that hospitals often compensate their staff generously because they must attract highly trained and educated doctors who would be well-paid elsewhere. Still, she said, the multimillion-dollar sums can surprise donors, who typically give money to support research or patient care.

Monday, July 27, 2020

Doctors are seen as Godlike: Moral typecasting in medicine

A. Goranson, P. Sheeran, J. Katz, & K. Gray
Social Science & Medicine
Available online 25 May 2020, 113008

Abstract

Doctors are generally thought of as very intelligent and capable. This perception has upsides—doctors are afforded respect and esteem—but it may also have downsides, such as neglecting the mental and physical health of physicians. Two studies examine how Americans “typecast” doctors as Godlike “thinkers” who help others, rather than as vulnerable “feelers” who might themselves need help.

Highlights

• Americans view doctors as godlike and invulnerable.

• Doctors are seen as more agentic than other working professionals.

• Doctors are seen as able to ignore mental and physical health problems.

• Moral typecasting in medicine leads people to neglect doctors' suffering.

From the Discussion

Indeed, doctors are seen as equal to God in their capacity to think, exert self-control, remember details, and plan for the future (see Figure 1). Past work reveals that people typecast those who help others both high in agency and low in experience—which makes them invulnerable to injury and insult, and relatively incapable of suffering (K. Gray & Wegner, 2009). Our results confirm the existence of moral typecasting in medicine: compared to other working adults, people see doctors as less sensitive to pain, fear, embarrassment, and hunger (see Figure 2). We further find that these perceptions of super-human doctors extend outside of work and into global perceptions of physicians’ traits and abilities. This work adds to other research arguing that people do not want to acknowledge the feelings of healthcare providers, because this would make providers less capable of serving our health-related goals (Schroeder & Fishbach, 2015).

A pdf of the research is here.

Monday, July 20, 2020

Physicians united: Here’s why pulling out of WHO is a big mistake

Andis Robeznieks
American Medical Association
Originally published 8 July 20

Here is an excerpt:

The joint statement builds on a previous response from the AMA made back in May after the administration announced its intention to withdraw from the WHO.

Withdrawal served “no logical purpose,” made finding a solution to the pandemic more challenging and could have harmful repercussions in worldwide efforts to develop a vaccine and effective COVID-19 treatments, then-AMA President Patrice A. Harris, MD, MA, said at the time.

Defeating COVID-19 “requires the entire world working together,” Dr. Harris added.

In April, Dr. Harris said withdrawing from the WHO would be “a dangerous step in the wrong direction, and noted that “fighting a global pandemic requires international cooperation “

“Cutting funding to the WHO—rather than focusing on solutions—is a dangerous move at a precarious moment for the world,” she added

The message regarding the need for a unified international effort was echoed in the statement from the physician leaders.

"As our nation and the rest of the world face a global health pandemic, a worldwide, coordinated response is more vital than ever,” they said. “This dangerous withdrawal not only impacts the global response against COVID-19, but also undermines efforts to address other major public health threats.”

The info is here.

Friday, April 24, 2020

COVID-19 Is Making Moral Injury to Physicians Much Worse

Wendy Dean
Medscape.com
Originally published 1 April 20

Here is an excerpt:

Moral injury is also coming to the forefront as physicians consider rationing scarce resources with too little guidance. Which surgeries truly justify use of increasingly scarce PPE? A cardiac valve replacement? A lumpectomy? Repairing a torn ligament?

Each denial has profound impact on both the patients whose surgeries are delayed and the clinicians who decide their fates. Yet worse decisions may await clinicians. If, for example, New York City needs an additional 30,000 ventilators but receives only 500, physicians will be responsible for deciding which 29,500 patients will not be ventilated, virtually assuring their demise.

How will physicians make those decisions? How will they cope? The situation of finite resources will force an immediate pivot to assessing patients according to not only their individual needs but also to society's need for that patient's contribution. It will be a wrenching restructuring.

Here are the essential principles for mitigating the impact of moral injury in the context of COVID-19. (They are the same as recommendations in the time before COVID-19.)

1. Value physicians

a. Physicians are putting everything on the line. They're walking into a wildfire of a pandemic, wearing pajamas, with a peashooter in their holster. That takes a monumental amount of courage and deserves profound respect.

The info is here.

Monday, February 24, 2020

Physician Burnout Is Widespread, Especially Among Those in Midcareer

Brianna Abbott
The Wall Street Journal
Originally posted 15 Jan 20

Burnout is particularly pervasive among health-care workers, such as physicians or nurses, researchers say. Risk for burnout among physicians is significantly greater than that of general U.S. working adults, and physicians also report being less satisfied with their work-life balance, according to a 2019 study published in Mayo Clinic Proceedings.

Overall, 42% of the physicians in the new survey, across 29 specialties, reported feeling some sense of burnout, down slightly from 46% in 2015.

The report, published on Wednesday by medical-information platform Medscape, breaks down the generational differences in burnout and how doctors cope with the symptoms that are widespread throughout the profession.

“There are a lot more similarities than differences, and what that highlights is that burnout in medicine right now is really an entire-profession problem,” said Colin West, a professor of medicine at the Mayo Clinic who researches physician well-being. “There’s really no age group, career stage, gender or specialty that’s immune from these issues.”

In recent years, hospitals, health systems and advocacy groups have tried to curb the problem by starting wellness programs, hiring chief wellness officers or attempting to reduce administrative tasks for nurses and physicians.

Still, high rates of burnout persist among the medical community, from medical-school students to seasoned professionals, and more than two-thirds of all physicians surveyed in the Medscape report said that burnout had an impact on their personal relationships.

Nearly one in five physicians also reported that they are depressed, with the highest rate, 18%, reported by Gen Xers.

The info is here.

Tuesday, February 18, 2020

Can an Evidence-Based Approach Improve the Patient-Physician Relationship?

A. S. Cifu, A. Lembo, & A. M. Davis
JAMA. 2020;323(1):31-32.
doi:10.1001/jama.2019.19427

Here is an excerpt:

Through these steps, the research team identified potentially useful clinical approaches that were perceived to contribute to physician “presence,” defined by the authors as a purposeful practice of “awareness, focus, and attention with the intent to understand and connect with patients.”

These practices were rated by patients and clinicians on their likely effects and feasibility in practice. A Delphi process was used to condense 13 preliminary practices into 5 final recommendations, which were (1) prepare with intention, (2) listen intently and completely, (3) agree on what matters most, (4) connect with the patient’s story, and (5) explore emotional cues. Each of these practices is complex, and the authors provide detailed explanations, including narrative examples and links to outcomes, that are summarized in the article and included in more detail in the online supplemental material.

If implemented in practice, these 5 practices suggested by Zulman and colleagues are likely to enhance patient-physician relationships, which ideally could help improve physician satisfaction and well-being, reduce physician frustration, improve clinical outcomes, and reduce health care costs.

Importantly, the authors also call for system-level interventions to create an environment for the implementation of these practices.

Although the patient-physician interaction is at the core of most physicians’ activities and has led to an entire genre of literature and television programs, very little is actually known about what makes for an effective relationship.

The info is here.

Wednesday, January 22, 2020

Association Between Physician Depressive Symptoms and Medical Errors

Pereira-Lima K, Mata DA, & others
JAMA Netw Open. 2019; 2(11):e1916097

Abstract

Importance  Depression is highly prevalent among physicians and has been associated with increased risk of medical errors. However, questions regarding the magnitude and temporal direction of these associations remain open in recent literature.

Objective  To provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors.

Conclusions and Relevance  Results of this study suggest that physicians with a positive screening for depressive symptoms are at higher risk for medical errors. Further research is needed to evaluate whether interventions to reduce physician depressive symptoms could play a role in mitigating medical errors and thus improving physician well-being and patient care.

From the Discussion

Studies have recommended the addition of physician well-being to the Triple Aim of enhancing the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. Results of the present study endorse the Quadruple Aim movement by demonstrating not only that medical errors are associated with physician health but also that physician depressive symptoms are associated with subsequent errors. Given that few physicians with depression seek treatment and that recent evidence has pointed to the lack of organizational interventions aimed at reducing physician depressive symptoms, our findings underscore the need for institutional policies to remove barriers to the delivery of evidence-based treatment to physicians with depression.

https://doi.org/10.1001/jamanetworkopen.2019.16097

Tuesday, October 15, 2019

Why not common morality?

Rhodes R 
Journal of Medical Ethics 
Published Online First: 11 September 2019. 
doi: 10.1136/medethics-2019-105621

Abstract

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics.

Friday, October 11, 2019

Dying is a Moral Event. NJ Law Caught Up With Morality

T. Patrick Hill
Star-Ledge Guest Column
Originally posted September 9, 2019

New Jersey’s Medical-Aid-in-Dying legislation authorizes physicians to issue a prescription to end the lives of their patients who have been diagnosed with a terminal illness, are expected to die within six months, and have requested their physicians to help them do so. While the legislation does not require physicians to issue the prescription, it does require them to transfer a patient’s medical records to another physician who has agreed to prescribe the lethal medication.

(cut)

The Medical Aid in Dying Act goes even further, concluding that its passage serves the public’s interests, even as it endorses the “right of a qualified terminally ill patient …to obtain medication that the patient may choose to self-administer in order to bring about the patient’s humane and dignified death.”

The info is here.

Friday, September 27, 2019

Empathy choice in physicians and non-physicians

Daryl Cameron and Michael Inzlicht
PsyArXiv
Originally created on September 11, 2019

Abstract

Empathy in medical care has been one of the focal points in the debate over the bright and dark sides of empathy. Whereas physician empathy is sometimes considered necessary for better physician-patient interactions, and is often desired by patients, it also has been described as a potential risk for exhaustion among physicians who must cope with their professional demands of confronting acute and chronic suffering. The present study compared physicians against demographically matched non-physicians on a novel behavioral assessment of empathy, in which they choose between empathizing or remaining detached from suffering targets over a series of trials. Results revealed no statistical differences between physicians and non-physicians in their empathy avoidance, though physicians were descriptively more likely to choose empathy. Additionally, both groups were likely to perceive empathy as cognitively challenging, and perceived cognitive costs of empathy associated with empathy avoidance. Across groups, there were also no statistically significant differences in self-reported trait empathy measures and empathy-related motivations and beliefs. Overall, these results suggest that physicians and non-physicians were more similar than different in terms of their empathic choices and in their assessments of the costs and benefits of empathy for others.

Conclusion:

In summary, do physicians choose empathy, and should they do so?  We find that physicians do not how a clear preference to approach or avoid empathy.  Nevertheless, they do perceive empathy to be cognitively taxing, entailing effort, aversiveness, and feelings of inefficacy, and these perceptions associated with reduced empathy choice.  Physicians who derived more satisfaction and less burnout from helping were more likely to choose empathy, and so too if they believed that empathy is good, and useful, for medical practice.  More generally, in the current work, physicians did not show statistically meaningful differences from demographically matched controls in trait empathy, empathy regulation behavior, motivations to approach or avoid empathy, or beliefs about empathy’s use for medicine.  Although it has often been suggested that physicians exhibit different levels of empathy due to the demands of medical care, the current results suggest that physicians are much like everyone else, sensitive to the relevant costs and benefits of empathizing.

The research is here.

Monday, September 23, 2019

Ohio medical board knew late doctor was sexually assaulting his male patients, but did not remove his license, report says

Image result for richard strauss ohio state
Richard Strauss
Laura Ly
CNN.com
Originally posted August 30, 2019

Dr. Richard Strauss is believed to have sexually abused at least 177 students at Ohio State University when he worked there between 1978 and 1998. A new investigation has found that the State Medical Board of Ohio knew about the abuse by the late doctor but did nothing.

A new investigation by a working group established by Ohio Gov. Mike DeWine found that the state medical board investigated allegations of sexual misconduct against Strauss in 1996.

The board found credible evidence of sexual misconduct by Strauss and revealed that Strauss had been "performing inappropriate genital exams on male students for years," but no one with knowledge of the case worked to remove his medical license or notify law enforcement, DeWine announced at a press conference Friday.

The investigation revealed that an attorney with the medical board did intend to proceed with a case against Strauss, but for some reason never followed through. That attorney, as well as others involved with the 1996 investigation, are now deceased and cannot be questioned about their conduct, DeWine said.

"We'll likely never know exactly why the case was ultimately ignored by the medical board," DeWine said Friday.

The allegations against Strauss — who died by suicide in 2005 — emerged last year after former Ohio State athletes came forward to claim the doctor had sexually abused them under the guise of a medical examination.

The info is here.

Thursday, September 19, 2019

Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?

Spiegel P, Kass N, Rubenstein L.
JAMA. Published online August 30, 2019.
doi:10.1001/jama.2019.12567

The modern successor to the Hippocratic oath, called the Declaration of Geneva, was updated and approved by the World Medical Association in 2017. The pledge states that “The health and well-being of my patient will be my first consideration” and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.” Can a physician work in US immigration detention facilities while upholding this pledge?

There is a humanitarian emergency at the US-Mexico border where migrants, including families, adults, or unaccompanied children, are detained and processed by the Department of Homeland Security’s (DHS) Customs and Border Patrol and are held in overcrowded and unsanitary conditions with insufficient medical care.2 Children (persons <18 years), without their parents or guardians, are often being detained in these detention facilities beyond the 72 hours allowed under federal law. Adults and children with a parent or legal guardian are then transferred from Customs and Border Patrol facilities to DHS’ Immigration and Customs Enforcement facilities, which are also overcrowded and where existing standards for conditions of confinement are often not met. Unaccompanied minors are transferred from Customs and Border Patrol detention facilities to Health and Human Services (HHS) facilities run by the Office of Refugee Resettlement (ORR). The majority of these unaccompanied children are then released to the care of community sponsors, while others stay, sometimes for months.

Children should not be detained for immigration reasons at all, according to numerous professional associations, including the American Academy of Pediatrics.3 Detention of children has been associated with increased physical and psychological illness, including posttraumatic stress disorder, as well as developmental delay and subsequent problems in school.

Given the psychological and physical harm to children who are detained, the United Nations Committee on the Rights of the Child stated that the detention of a child “cannot be justified solely on the basis of the child being unaccompanied or separated, or on their migratory or residence status, or lack thereof,” and should in any event only be used “…as a measure of last resort and for the shortest appropriate period of time.”6 The United States is the only country not to have ratified the convention on the Rights of the Child, but the international standard is so widely recognized that it should still apply. Children held in immigration detention should be released into settings where they are safe, protected, and can thrive.

The info is here.

Monday, September 16, 2019

Sex misconduct claims up 62% against California doctors

Vandana Ravikumar
USAToday.com
Originally posted August 12, 2019

The number of complaints against California physicians for sexual misconduct has risen by 62% since the fall of 2017, according to a Los Angeles Times investigation.

The investigation, published Monday, found that the rise in complaints coincides with the beginning of the #MeToo movement, which encouraged victims of sexual misconduct or assault to speak out about their experiences. Though complaints of sexual misconduct against physicians are small in number, they are among the fastest growing types of allegations.

Recent high-profile incidents of sexual misconduct involving medical professionals were also a catalyst, the Times reported. Those cases include the abuses of Larry Nassar, a former USA Gymnastics doctor who was sentenced in 2018 for 40-175 years in prison for molesting hundreds of young athletes.

That same year, hundreds of women accused former University of Southern California gynecologist George Tyndall of inappropriate behavior. Tyndall, who worked at the university for nearly three decades, was recently charged for sexually assaulting 16 women.

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