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 Social Security. Show all posts
Showing posts with label Social Security. Show all posts

Monday, September 9, 2013

Vignette 28: Another Point of View

A psychologist who completes evaluations for the Bureau of Disability Determination (BDD) calls you for a consultation.

Earlier in the day, the psychologist evaluated a 48-year-old male with a history of chronic pain.  The only documentation received from BDD was a list of medications, which included an antidepressant and a prescription sleep aid.

The disability applicant arrived late for the evaluation, reporting that his pain prevented him from being on time.  He shuffled his feet, walked in a hunched manner, used a cane, shifted in his seat frequently, and groaned throughout the evaluation.  He described rather significant cognitive and vegetative symptoms of depression.  He began to cry softly at one point when discussing the negative consequences of chronic pain.  When asked about outpatient psychological treatment, the disability applicant explained he did not know that psychotherapy could help, and he would be anxious to try therapy.

At the end of the evaluation, the patient left, shuffling and making muffled groans as he left the office and the waiting room.  When the psychologist returned to his office, he remembered a lunch date for which he was late.  As he was leaving the office building, the psychologist saw the disability applicant in the parking lot laughing with another person.  He twirled his cane with one hand.  He stood upright and seemed genuinely happy.  When the disability applicant met the psychologist’s gaze, the applicant immediately hunched over, grabbed his back, groaned loudly, and used the cane to steady himself.  The psychologist hopped in his car for lunch without any discussion with the applicant.

Knowing that BDD evaluations are used within a legal context (in that lawyers, other psychologists, and administrative law judges will see this report), the psychologist asks the following questions:

1. What are the psychologist's ethical duties to the BDD?

2. What are the psychologist's ethical duties to the applicant?

3. Is the psychologist permitted to use any of his observations outside of the office as part of his report? If so, why?  If not, why not?

4. If so, should it be included as an addendum or as part of the body of the report?

5. In either case, how do these observations influence the psychologist’s rating of truthfulness or veracity during the evaluation?

6. Does the psychologist have any obligation to clarify what happened in the parking lot with the disability applicant by phone?

7. If not, how should the psychologist respond if the disability applicant calls him to discuss the evaluation or the interaction in the parking lot?

8. Is it appropriate to use the term “malingering” in the report, given that there is such a small sample of behavior?

Sunday, November 25, 2012

Move Over Economists: We Need a Council of Psychological Advisers

Much of governing involves predicting behavior or getting people to change it. Lawyers and economists need some help with both.

By Barry Schwartz
The Atlantic
Originally published

Though President Obama won reelection decisively, he won't have much time to celebrate. Many of the nation's problems -- stimulating employment, reducing the deficit, controlling health-care costs, and improving the quality of education -- are very serious, and some of them must be addressed with great urgency. And none of these problems can be addressed simply by waving a magic government wand. To a significant degree, they all involve understanding what motivates current practices -- of business-people, financiers, doctors, patients, teachers, students -- and what levers we may be able to use to change those practices.

Historically, when the need has arisen to change behavior, political leaders have turned to economists. That's one reason why presidents have a Council of Economic Advisers. When economists speak, presidents listen. And when economists have the president's ear, all their whispers are predicated on a set of assumptions about human behavior. Whether it's increasing GDP, reducing unemployment, sustaining Social Security, making sure people are financially prepared for retirement, or stabilizing the financial sector, economists commonly hold certain beliefs. They will for example argue that people are motivated by self-interest and are rational calculators of their interests, and that the most effective way to get people to change the way they behave is by creating the right material incentives.

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There is also growing evidence, some of it provided by psychologists Carol Dweck and Angela Duckworth, that the focus on beefing up the cognitive components of education that has dominated reform for the last 30 years may be misplaced. More important may be efforts to cultivate motivation and character (Paul Tough's remarkable new book, How Children Succeed, provides a vivid summary of this work). The importance of character and motivation suggests that the drill-and-test model of education that has become so common may actually be not just ineffective, but counterproductive.

The entire story is here.