By Paul Burcher
Bioethics Blog
Originally posted November 11, 2015
Here is an excerpt:
This case exemplifies the ambiguity around “informed consent.” The nurse was referring to a document, a signed piece of paper; I was referencing a conversation, a process involving sharing information and answering questions. From a legal perspective, informed consent would seem to represent the document, whereas from an ethical perspective it is the process, not the paper that embodies informed consent. Of course, ultimately, both have a role to play, and in the case of a significant procedure it is best to have both sides of this informed consent coin documented. But what I would like to suggest is that the signed document represents an artifact—a physical symbol that two parties agree that the real nature of informed consent has been fulfilled. The piece of paper is derivative, and a signed document that lacks the ethical underpinning of a complete and valid consent discussion is meaningless. A lawyer would probably give a slightly different answer, but this is an ethics blog, not a discussion of medical malpractice.
So if the signed document is not an essential aspect of informed consent, but rather evidence of the process that has supposed to have had occurred, what then represents the essential elements of informed consent? The standard answer is really not bad: all relevant information regarding the procedure, its risks, and alternatives have been discussed, and the patient’s questions have been answered. But the devil is always in the details, and in this case the detail of importance is how we define relevant.
The entire blog post is here.
Showing posts with label Risk Management. Show all posts
Showing posts with label Risk Management. Show all posts
Wednesday, December 2, 2015
Sunday, May 17, 2015
Deceased clients and their wills
When a treating psychologist receives a bequest, what ethical considerations come into play?
By Stephen Behnke, JD, PhD, MDiv
The Monitor on Psychology
May 2015, Vol 46, No. 5
Print version: page 72
Here is an excerpt:
Most risk managers — people who work for insurance carriers, for example, whose primary goal is to lower a psychologist's exposure to risk — will advise the psychologist to decline the property. This advice makes good sense. The situation invites a claim that the psychologist exercised undue influence over the client, which is a relevant legal standard for overturning the bequest. The likelihood that a claim of undue influence will be made against the psychologist rises exponentially if the client had heirs, or potential beneficiaries of the estate who are found. If a complaint is made to an ethics committee or licensing board, the psychologist will bear the burden of demonstrating that there has been no exploitation:
The entire article is here.
By Stephen Behnke, JD, PhD, MDiv
The Monitor on Psychology
May 2015, Vol 46, No. 5
Print version: page 72
Here is an excerpt:
Most risk managers — people who work for insurance carriers, for example, whose primary goal is to lower a psychologist's exposure to risk — will advise the psychologist to decline the property. This advice makes good sense. The situation invites a claim that the psychologist exercised undue influence over the client, which is a relevant legal standard for overturning the bequest. The likelihood that a claim of undue influence will be made against the psychologist rises exponentially if the client had heirs, or potential beneficiaries of the estate who are found. If a complaint is made to an ethics committee or licensing board, the psychologist will bear the burden of demonstrating that there has been no exploitation:
The entire article is here.
Tuesday, April 14, 2015
The Ethics of Physicians’ Web Searches for Patients’ Information
Nicholas Genes and Jacob Appel
The Journal of Clinical Ethics
Volume 26, Number 1, Spring 2015
When physicians search the web for personal information about their patients, others have argued that this undermines patients’ trust, and the physician-patient relationship in general. We add that this practice also places other relationships at risk, and could jeopardize a physician’s career.
Yet there are also reports of web searches that have unambiguously helped in the care of patients, suggesting circumstances in which a routine search of the web could be beneficial. We advance the notion that, just as nonverbal cues and unsolicited information can be useful in clinical decision making, so too can online information from patients. As electronic records grow more voluminous and span more types of data, searching these resources will become a clinical skill, to be used judiciously and with care—just as evaluating the literature is, today.
But to proscribe web searches of patients’ information altogether is as nonsensical as disregarding findings from physical exams—instead, what’s needed are guidelines for when to look and how to evaluate what’s uncovered, online.
The entire article is here.
The Journal of Clinical Ethics
Volume 26, Number 1, Spring 2015
When physicians search the web for personal information about their patients, others have argued that this undermines patients’ trust, and the physician-patient relationship in general. We add that this practice also places other relationships at risk, and could jeopardize a physician’s career.
Yet there are also reports of web searches that have unambiguously helped in the care of patients, suggesting circumstances in which a routine search of the web could be beneficial. We advance the notion that, just as nonverbal cues and unsolicited information can be useful in clinical decision making, so too can online information from patients. As electronic records grow more voluminous and span more types of data, searching these resources will become a clinical skill, to be used judiciously and with care—just as evaluating the literature is, today.
But to proscribe web searches of patients’ information altogether is as nonsensical as disregarding findings from physical exams—instead, what’s needed are guidelines for when to look and how to evaluate what’s uncovered, online.
The entire article is here.
Friday, February 6, 2015
Insights for Writing a Code of Ethics or Conduct
Risk management, strategy, and analysis from Deloitte
via The Wall Street Journal
The heart of an organization is often expressed in its code of ethics or code of conduct. It tells the world what really matters to an organization and what it is all about. Companies that follow both the letter and the spirit of the law by taking a “value-based” approach to ethics and compliance may have a distinct advantage in the marketplace. Give the average employee a legalistic “thou shall not….” code, and a negative response is almost guaranteed. Give employees a document that states clearly and concisely the organization’s expectations, outlines acceptable behaviors and presents viable options for asking questions and voicing concerns, and the likelihood is much greater that they will meet those expectations and exhibit the desired behaviors. Make the contents of the code equally applicable to, and understood by, everyone in the organization—at all levels, across all business units and spanning the geographies—and you have a key ingredient for a code that becomes ingrained in the corporate culture, with all of the benefits.
The entire article is here.
via The Wall Street Journal
The heart of an organization is often expressed in its code of ethics or code of conduct. It tells the world what really matters to an organization and what it is all about. Companies that follow both the letter and the spirit of the law by taking a “value-based” approach to ethics and compliance may have a distinct advantage in the marketplace. Give the average employee a legalistic “thou shall not….” code, and a negative response is almost guaranteed. Give employees a document that states clearly and concisely the organization’s expectations, outlines acceptable behaviors and presents viable options for asking questions and voicing concerns, and the likelihood is much greater that they will meet those expectations and exhibit the desired behaviors. Make the contents of the code equally applicable to, and understood by, everyone in the organization—at all levels, across all business units and spanning the geographies—and you have a key ingredient for a code that becomes ingrained in the corporate culture, with all of the benefits.
The entire article is here.
Wednesday, September 24, 2014
8 Malpractice Dangers in Your EHR
By Neil Chesanow
MedScape
Originally published August 26, 2014
Many physicians are so concerned about being sued for malpractice that they routinely order unnecessary tests and procedures to practice defensive medicine. And yet, when it comes to legal risks in using their electronic health records (EHRs), their concern is often nonexistent, experts assert.
Many doctors use their EHRs in nonstandard ways, without considering how this may affect them in a liability suit. Or they gloss over other aspects of using an EHR.
"Every aspect of EHR selection, implementation, and use may be examined in the course of medical malpractice discovery to uncover the source of the incident, or undermine the records that are being presented in defense of the malpractice claim," warns Ronald B. Sterling, CPA, MBA, an EHR expert in Silver Spring, Maryland, and author of Keys to EMR Success.
"Anything could be a malpractice issue," Sterling says, "from the product itself, to the way it was set up, to how you've been using it."
Are your EHR practices setting you up for a rude awakening should a patient sue you for malpractice? Let's take a look.
The entire article is here.
MedScape
Originally published August 26, 2014
Many physicians are so concerned about being sued for malpractice that they routinely order unnecessary tests and procedures to practice defensive medicine. And yet, when it comes to legal risks in using their electronic health records (EHRs), their concern is often nonexistent, experts assert.
Many doctors use their EHRs in nonstandard ways, without considering how this may affect them in a liability suit. Or they gloss over other aspects of using an EHR.
"Every aspect of EHR selection, implementation, and use may be examined in the course of medical malpractice discovery to uncover the source of the incident, or undermine the records that are being presented in defense of the malpractice claim," warns Ronald B. Sterling, CPA, MBA, an EHR expert in Silver Spring, Maryland, and author of Keys to EMR Success.
"Anything could be a malpractice issue," Sterling says, "from the product itself, to the way it was set up, to how you've been using it."
Are your EHR practices setting you up for a rude awakening should a patient sue you for malpractice? Let's take a look.
The entire article is here.
Monday, May 12, 2014
Episode 8: The Dark Side of Ethics - False Risk Management Strategies
In this episode, John talks with Dr. Sam Knapp, Psychologist and Ethics Educator, about false risk management strategies. Using the acculturation model as a guide, Sam and John discuss how some psychologists have learned false risk management strategies. They discuss the possible erroneous rationale for these strategies. John and Sam provide good clinical and ethical reasons as how these strategies can actually hinder high quality of services. They also discuss ethics education in general and why learning about ethics codes do not necessarily enhance ethical practice.
At the end of the workshop the participants will be able to:
Find this podcast in iTunes
Click here to purchase 1 APA-approved Continuing Education credit
Or listen directly here.
Resources
Podcast slides can be found here.
Knapp, Samuel; Handelsman, Mitchell M.; Gottlieb, Michael C.; VandeCreek, Leon D. The dark side of professional ethics. Professional Psychology: Research and Practice, Vol 44(6), Dec 2013, 371-377.
American Psychological Association's Ethical Principles of Psychologists and Code of Conduct
Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36, 59-65.
No Suicide Contracts: An Effective Strategy?
John Gavazzi
At the end of the workshop the participants will be able to:
- Explain the concept of a false risk management strategy,
- Identify two false risk management strategies,
- Outline how false risk management strategies hinder high quality psychological care.
Find this podcast in iTunes
Click here to purchase 1 APA-approved Continuing Education credit
Or listen directly here.
Resources
Podcast slides can be found here.
Knapp, Samuel; Handelsman, Mitchell M.; Gottlieb, Michael C.; VandeCreek, Leon D. The dark side of professional ethics. Professional Psychology: Research and Practice, Vol 44(6), Dec 2013, 371-377.
American Psychological Association's Ethical Principles of Psychologists and Code of Conduct
Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36, 59-65.
No Suicide Contracts: An Effective Strategy?
John Gavazzi
Thursday, February 13, 2014
Managing Risk When Contemplating Multiple Relationships
By Jeffrey Younggren and Michael C. Gottlieb
Professional Psychology: Research and Practice, Vol 35(3), Jun 2004, 255-260.
Abstract
Entering into dual relationships with psychotherapy patients has been a topic of significant controversy in professional psychology. Although these types of extratherapeutic alliances have generally been considered to be unethical conduct, some authors recently have supported their development as both ethical and, in some cases, even therapeutic (A. Lazarus & O. Zur, 2002). In this article, the authors briefly review the general literature regarding dual relationships and offer the reader guidelines in applying an ethically based, risk-managed, decision-making model that could be helpful when a practitioner is considering entering into such relationships or when such relationships inadvertently develop.
The entire article is here, behind a paywall.
The authors ask many great questions from a risk management perspective.
Professional Psychology: Research and Practice, Vol 35(3), Jun 2004, 255-260.
Abstract
Entering into dual relationships with psychotherapy patients has been a topic of significant controversy in professional psychology. Although these types of extratherapeutic alliances have generally been considered to be unethical conduct, some authors recently have supported their development as both ethical and, in some cases, even therapeutic (A. Lazarus & O. Zur, 2002). In this article, the authors briefly review the general literature regarding dual relationships and offer the reader guidelines in applying an ethically based, risk-managed, decision-making model that could be helpful when a practitioner is considering entering into such relationships or when such relationships inadvertently develop.
The entire article is here, behind a paywall.
The authors ask many great questions from a risk management perspective.
Monday, June 24, 2013
In Bed with our Clients: Should Psychotherapists Play Matchmaker or is this Plain Old Erotic Transference?
By Keely Kolmes, PsyD.
http://drkkolmes.com
Last January, there was an opinion piece in the New York Times, written by Richard Friedman on whether therapists should play Cupid for clients, basically performing as a matchmaker, setting them up on dates. The article focused primarily on the fantasies that some clinicians have about wanting to do this and the potential issues that could come up regarding transference. It did not speak directly to erotic transference, but I think this is a key component of such a question.
Following the article, HuffPost Live did a segment on which I was one of four guests interviewed about our points of view on the issue. As expected, the show included diverse opinions and even had the one clinician, Terah Harrison, who has expanded her practice to include matching services.
Another clinician, Dr. Lazarus, argued passionately that we are "uniquely well positioned" to make such matchmaking recommendations to our clients. Jeff Sumber agreed it was unethical but he admitted to having such strong fantasies about fixing up his clients that he'd deliberately scheduled people in hopes they might meet. (I imagine his clients are now wondering as they arrive for therapy if the person leaving is someone he has chosen for them?)
Guess which role I played on this segment? Yes, I was the conservative fuddy-duddy talking ethics, dual relationships, and risk management.
The entire story is here.
http://drkkolmes.com
Last January, there was an opinion piece in the New York Times, written by Richard Friedman on whether therapists should play Cupid for clients, basically performing as a matchmaker, setting them up on dates. The article focused primarily on the fantasies that some clinicians have about wanting to do this and the potential issues that could come up regarding transference. It did not speak directly to erotic transference, but I think this is a key component of such a question.
Following the article, HuffPost Live did a segment on which I was one of four guests interviewed about our points of view on the issue. As expected, the show included diverse opinions and even had the one clinician, Terah Harrison, who has expanded her practice to include matching services.
Another clinician, Dr. Lazarus, argued passionately that we are "uniquely well positioned" to make such matchmaking recommendations to our clients. Jeff Sumber agreed it was unethical but he admitted to having such strong fantasies about fixing up his clients that he'd deliberately scheduled people in hopes they might meet. (I imagine his clients are now wondering as they arrive for therapy if the person leaving is someone he has chosen for them?)
Guess which role I played on this segment? Yes, I was the conservative fuddy-duddy talking ethics, dual relationships, and risk management.
The entire story is here.
Tuesday, May 28, 2013
Learning From Litigation
By Joanna C. Schwartz
The New York Times - Op Ed
Originally published May 16, 2013
MUCH of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error.
Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. But many believe that a major barrier to doing so is the medical malpractice tort system: the threat of being sued is believed to prevent the kind of transparency necessary to identify and learn from errors when they occur.
New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.
I recently surveyed more than 400 people responsible for hospital risk management, claims management and quality improvement in health care centers around the country, in cooperation with the American Society of Health Care Risk Managers, and I interviewed dozens more.
The entire story is here.
The New York Times - Op Ed
Originally published May 16, 2013
MUCH of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error.
Experts agree that the best way to reduce medical error is to gather and analyze information about past errors with an eye toward improving future care. But many believe that a major barrier to doing so is the medical malpractice tort system: the threat of being sued is believed to prevent the kind of transparency necessary to identify and learn from errors when they occur.
New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.
I recently surveyed more than 400 people responsible for hospital risk management, claims management and quality improvement in health care centers around the country, in cooperation with the American Society of Health Care Risk Managers, and I interviewed dozens more.
The entire story 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
Saturday, October 20, 2012
Sports in the Board Room
By Allie Grasgreen
Inside Higher Ed
Originally published October 10, 2012
The very morning that the man whose actions brought down top administrators at Pennsylvania State University was being condemned to at least 30 years in prison for child abuse, critics of big-time collegiate athletics gathered here were discussing the role -- or lack thereof -- of university governing boards in sports programs.
In documenting the many failings revealed by the abuse scandal at Penn State, the report by Louis J. Freeh documented the faults of the university's former president, Graham Spanier -- among them, neglecting to adequately alert the 32-member Board of Trustees about red flags regarding former assistant football coach Jerry Sandusky.
But equally or even more so at fault, the report said, was the board itself, whose trustees failed to ask questions of Spanier or themselves, such as whether they should conduct an internal investigation. They lacked the necessary structures even to make sure they got the information they needed to properly assess and address potential risks, the report said.
And so officials from the Association of Governing Boards of Universities and Colleges recognized the “crisis” at Penn State and role the board played in it, as they presented the findings of a new survey and report on board responsibilities for intercollegiate athletics here Wednesday at a meeting of the Knight Commission on Intercollegiate Athletics.
The entire story is here.
Inside Higher Ed
Originally published October 10, 2012
The very morning that the man whose actions brought down top administrators at Pennsylvania State University was being condemned to at least 30 years in prison for child abuse, critics of big-time collegiate athletics gathered here were discussing the role -- or lack thereof -- of university governing boards in sports programs.
In documenting the many failings revealed by the abuse scandal at Penn State, the report by Louis J. Freeh documented the faults of the university's former president, Graham Spanier -- among them, neglecting to adequately alert the 32-member Board of Trustees about red flags regarding former assistant football coach Jerry Sandusky.
But equally or even more so at fault, the report said, was the board itself, whose trustees failed to ask questions of Spanier or themselves, such as whether they should conduct an internal investigation. They lacked the necessary structures even to make sure they got the information they needed to properly assess and address potential risks, the report said.
And so officials from the Association of Governing Boards of Universities and Colleges recognized the “crisis” at Penn State and role the board played in it, as they presented the findings of a new survey and report on board responsibilities for intercollegiate athletics here Wednesday at a meeting of the Knight Commission on Intercollegiate Athletics.
The entire story is here.
Wednesday, October 5, 2011
Data breach exposes 4.9 million Tricare patients
By Sig Christenson
San Antonio Express-News
One of the Pentagon's largest contractors said late Wednesday it had discovered a data breach affecting as many as 4.9 million patients who have received care from military facilities in San Antonio since 1992.Science Applications International Corp. said the breach involved backup computer tapes from an electronic health care record. Some of the information included Social Security numbers, addresses, phone numbers and private health information for patients in 10 states.
A statement posted on the Defense Department's Tricare health system website said no credit card or bank account information was on the backup tapes.
Tricare covers military retirees as well as active-duty troops and their dependents.
“The risk of harm to patients is judged to be low despite the data elements involved since retrieving the data on the tapes would require knowledge of and access to specific hardware and software and knowledge of the system and data structure,” the website statement said.
Vernon Guidry, a spokesman for SAIC, a McLean, Va.-based scientific, engineering and technology applications firm, could not say when the data from the backup tapes was compromised.
The statement on Tricare's website, however, said the tapes contained information on patients visiting San Antonio military hospitals and clinics or had tests analyzed here from 1992 through Sept. 7. The San Antonio Military Medical Center, formerly BAMC, was apparently unaware of the breach.
The tapes held data on people living throughout Tricare's southern region, which includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and Texas with the exception of El Paso.
The entire story can be read here.
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