By Sulome Anderson
The Atlantic
Originally posted January 20, 2015
It’s hard to listen to a psychiatrist who sounds so broken. I expect a mental-health provider to seem healthy, detached. But even over the phone, the weariness in Dr. Brown’s voice is palpable.
“This is what we do when people die,” he says. “Even if they die an expected death, it seems to be human nature to go back over [it]. What should I have said that I didn't, or shouldn’t have said that I did? Could I have done more or did I do too much? This seems to be a part of the grieving process. I think it's especially intense in a situation where you have direct responsibility for helping the person get better.”
Brown lost a patient to suicide last year. She was a long-term client of his, the mother of a large, loving family. Right after a session with him, she went home and killed herself. Two months later, Brown’s son did the same thing.
The entire article is here.
Showing posts with label Treatment Relationship. Show all posts
Showing posts with label Treatment Relationship. Show all posts
Thursday, February 12, 2015
Thursday, December 25, 2014
Effects of biological explanations for mental disorders on clinicians’ empathy
By Matthew S. Lebowitz and Woo-kyoung Ahn
Effects of biological explanations for mental disorders on clinicians’ empathy
PNAS 2014 : 1414058111v1-201414058
Abstract
Mental disorders are increasingly understood in terms of biological mechanisms. We examined how such biological explanations of patients’ symptoms would affect mental health clinicians’ empathy—a crucial component of the relationship between treatment-providers and patients—as well as their clinical judgments and recommendations. In a series of studies, US clinicians read descriptions of potential patients whose symptoms were explained using either biological or psychosocial information. Biological explanations have been thought to make patients appear less accountable for their disorders, which could increase clinicians’ empathy. To the contrary, biological explanations evoked significantly less empathy. These results are consistent with other research and theory that has suggested that biological accounts of psychopathology can exacerbate perceptions of patients as abnormal, distinct from the rest of the population, meriting social exclusion, and even less than fully human. Although the ongoing shift toward biomedical conceptualizations has many benefits, our results reveal unintended negative consequences.
Significance
Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from “normal” people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce clinicians’ empathy. This is alarming because clinicians’ empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.
The entire article is here.
Effects of biological explanations for mental disorders on clinicians’ empathy
PNAS 2014 : 1414058111v1-201414058
Abstract
Mental disorders are increasingly understood in terms of biological mechanisms. We examined how such biological explanations of patients’ symptoms would affect mental health clinicians’ empathy—a crucial component of the relationship between treatment-providers and patients—as well as their clinical judgments and recommendations. In a series of studies, US clinicians read descriptions of potential patients whose symptoms were explained using either biological or psychosocial information. Biological explanations have been thought to make patients appear less accountable for their disorders, which could increase clinicians’ empathy. To the contrary, biological explanations evoked significantly less empathy. These results are consistent with other research and theory that has suggested that biological accounts of psychopathology can exacerbate perceptions of patients as abnormal, distinct from the rest of the population, meriting social exclusion, and even less than fully human. Although the ongoing shift toward biomedical conceptualizations has many benefits, our results reveal unintended negative consequences.
Significance
Mental disorders are increasingly understood biologically. We tested the effects of biological explanations among mental health clinicians, specifically examining their empathy toward patients. Conventional wisdom suggests that biological explanations reduce perceived blameworthiness against those with mental disorders, which could increase empathy. Yet, conceptualizing mental disorders biologically can cast patients as physiologically different from “normal” people and as governed by genetic or neurochemical abnormalities instead of their own human agency, which can engender negative social attitudes and dehumanization. This suggests that biological explanations might actually decrease empathy. Indeed, we find that biological explanations significantly reduce clinicians’ empathy. This is alarming because clinicians’ empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.
The entire article is here.
Tuesday, November 4, 2014
Doctors Tell All—and It’s Bad
By Meghan O'Rourke
The Atlantic
Originally published October 14, 2014
Here is an excerpt:
But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.
To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.
The entire article is here.
The Atlantic
Originally published October 14, 2014
Here is an excerpt:
But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.
To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.
The entire article is here.
Wednesday, July 23, 2014
Examining empathy
By Louise Aronson
The Lancet, Volume 384, Issue 9937, pp 16-17, 5 July 2014
doi:10.1016/S0140-6736(14)61115-6
Here is an excerpt:
Although some of the eleven essays in the collection relate to medicine, the book considers empathy more broadly. “Another person's pain”, Jamison writes, “registers as an experience in the perceiver: empathy as forced symmetry, a bodily echo”. Jamison examines empathy not just across life choices and illness states but also across cultures, geographical borders, gender, and socioeconomic status. She travels, among other places, to Nicaragua where she's hit in the face during a robbery; to Bolivia where a larva emerges from her ankle after a botfly bite; to West Virginia for a visit to an acquaintance in a prison; and to the wilds of Tennessee to watch a particularly sadistic ultra-marathon. Jamison considers all forms of pain—physical, emotional, and psychological; her own and that of others—and often explores topics both literally and metaphorically.
The entire article is here.
The Lancet, Volume 384, Issue 9937, pp 16-17, 5 July 2014
doi:10.1016/S0140-6736(14)61115-6
Here is an excerpt:
Although some of the eleven essays in the collection relate to medicine, the book considers empathy more broadly. “Another person's pain”, Jamison writes, “registers as an experience in the perceiver: empathy as forced symmetry, a bodily echo”. Jamison examines empathy not just across life choices and illness states but also across cultures, geographical borders, gender, and socioeconomic status. She travels, among other places, to Nicaragua where she's hit in the face during a robbery; to Bolivia where a larva emerges from her ankle after a botfly bite; to West Virginia for a visit to an acquaintance in a prison; and to the wilds of Tennessee to watch a particularly sadistic ultra-marathon. Jamison considers all forms of pain—physical, emotional, and psychological; her own and that of others—and often explores topics both literally and metaphorically.
The entire article is here.
Friday, June 13, 2014
Teaching doctors when to stop treatment
By Diane E. Meier
The Washington Post
Originally published May 19, 2014
Here is an excerpt:
For years I had tried to understand why so many of my colleagues persisted in ordering tests, procedures and treatments that seemed to provide no benefit to patients and even risked harming them. I didn’t buy the popular and cynical explanation: Physicians do this for the money. It fails to acknowledge the care and commitment that these same physicians demonstrate toward their patients. Besides, my patient’s oncologist would make no money from the neurosurgery required for the intrathecal chemotherapy procedure.
It seemed that giving more treatment was the only way the oncologist knew to express his care and commitment. To him, stopping treatment was akin to abandoning his patient. And yet the only sense in which she felt abandoned was in her oncologist’s unwillingness to talk with her about what would happen when treatment stopped working.
The entire story is here.
The Washington Post
Originally published May 19, 2014
Here is an excerpt:
For years I had tried to understand why so many of my colleagues persisted in ordering tests, procedures and treatments that seemed to provide no benefit to patients and even risked harming them. I didn’t buy the popular and cynical explanation: Physicians do this for the money. It fails to acknowledge the care and commitment that these same physicians demonstrate toward their patients. Besides, my patient’s oncologist would make no money from the neurosurgery required for the intrathecal chemotherapy procedure.
It seemed that giving more treatment was the only way the oncologist knew to express his care and commitment. To him, stopping treatment was akin to abandoning his patient. And yet the only sense in which she felt abandoned was in her oncologist’s unwillingness to talk with her about what would happen when treatment stopped working.
The entire story is here.
Tuesday, June 10, 2014
When Doctors Treat Patients Like Themselves
By Abigail Zuger
The New York Times
Originally posted May 19, 2014
Here is an excerpt:
Professional training may not remove the interpersonal chemistry that binds us to some and estranges us from others, but it can neutralize these forces somewhat, enough to enable civilized and productive dialogue among all comers. Yet until the day when we deal only in cells, organs and genes and not their human containers, we will, for better or worse, always see ourselves in some patients, our friends and relatives in others, and our patients will likewise instinctively experience doctor as mother or father, buddy or virtual stranger.
Are the ties that bind us for better, medically, or are they for worse? Is health care more effective when patient and doctor are the same — the same sex, class, race, tax bracket, sore feet and cholesterol level? Or does essential objectivity require some differences? When your doctor looks at you and sees a mirrored reflection, is that good for you, or bad?
The entire article is here.
The New York Times
Originally posted May 19, 2014
Here is an excerpt:
Professional training may not remove the interpersonal chemistry that binds us to some and estranges us from others, but it can neutralize these forces somewhat, enough to enable civilized and productive dialogue among all comers. Yet until the day when we deal only in cells, organs and genes and not their human containers, we will, for better or worse, always see ourselves in some patients, our friends and relatives in others, and our patients will likewise instinctively experience doctor as mother or father, buddy or virtual stranger.
Are the ties that bind us for better, medically, or are they for worse? Is health care more effective when patient and doctor are the same — the same sex, class, race, tax bracket, sore feet and cholesterol level? Or does essential objectivity require some differences? When your doctor looks at you and sees a mirrored reflection, is that good for you, or bad?
The entire article is here.
Thursday, May 29, 2014
Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems
By Glyn Elwyn, Christine Dehlendorf, Ronald Epstein, Katy Marrin, James White, and Dominick Frosch
doi: 10.1370/afm.1615
Ann Fam Med May/June 2014 vol. 12 no. 3 270-275
Abstract
Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.
The entire article is here.
doi: 10.1370/afm.1615
Ann Fam Med May/June 2014 vol. 12 no. 3 270-275
Abstract
Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems.
The entire article is here.
Thursday, May 15, 2014
Erotic Feelings Toward the Therapist: A Relational Perspective
By Jenny H. Lotterman
Journal of Clinical Psychology
Volume 70, Issue 2, pages 135–146, February 2014
Abstract
This article focuses on the relational treatment of a male patient presenting with sexual and erotic feelings toward the therapist. The use of relational psychotherapy allowed us to collaborate in viewing our therapeutic relationship as a microcosm of other relationships throughout the patient's life. In this way, the patient came to understand his fears of being close to women, his discomfort with his sexuality, and how these feelings impacted his ongoing romantic and sexual experiences. Use of the therapist's reactions to the patient, including conscious and unconscious feelings and behaviors, aided in the conceptualization of this case. Working under a relational model was especially helpful when ruptures occurred, allowing the patient and therapist to address these moments and move toward repair. The patient was successful in making use of his sexual feelings to understand his feelings and behaviors across contexts.
The entire article is here.
Editor's Note: Psychologists do not talk enough about erotic transference and countertransference in psychotherapy. These emotions happen more frequently than psychologists are willing to admit.
Journal of Clinical Psychology
Volume 70, Issue 2, pages 135–146, February 2014
Abstract
This article focuses on the relational treatment of a male patient presenting with sexual and erotic feelings toward the therapist. The use of relational psychotherapy allowed us to collaborate in viewing our therapeutic relationship as a microcosm of other relationships throughout the patient's life. In this way, the patient came to understand his fears of being close to women, his discomfort with his sexuality, and how these feelings impacted his ongoing romantic and sexual experiences. Use of the therapist's reactions to the patient, including conscious and unconscious feelings and behaviors, aided in the conceptualization of this case. Working under a relational model was especially helpful when ruptures occurred, allowing the patient and therapist to address these moments and move toward repair. The patient was successful in making use of his sexual feelings to understand his feelings and behaviors across contexts.
The entire article is here.
Editor's Note: Psychologists do not talk enough about erotic transference and countertransference in psychotherapy. These emotions happen more frequently than psychologists are willing to admit.
Wednesday, April 30, 2014
Is the Doctor-Patient Relationship Turning Into a Business Partnership?
Reports say patients are increasingly asking doctors for drugs by name, and docs are complying. If they don’t write the script, they risk a low rating on one of many doc-ranking sites.
By Russell Saunders
The Daily Beast
Originally posted April 11, 2014
“The customer is always right.” We all know the saying. It’s a truism in business. Businesses need happy customers. Happy customers keep coming back and they tell their friends. Keeping the customer happy is a businessperson’s number one priority.
Except when the business is a medical practice, and the customer is a patient.
That ever-blurring line between patient and customer is one of the most difficult things to walk in medical practice. On the one hand, people need to keep coming through the door in order to keep it open in the first place, and making sure people have a good experience when they come to you for care is important.
The entire article is here.
By Russell Saunders
The Daily Beast
Originally posted April 11, 2014
“The customer is always right.” We all know the saying. It’s a truism in business. Businesses need happy customers. Happy customers keep coming back and they tell their friends. Keeping the customer happy is a businessperson’s number one priority.
Except when the business is a medical practice, and the customer is a patient.
That ever-blurring line between patient and customer is one of the most difficult things to walk in medical practice. On the one hand, people need to keep coming through the door in order to keep it open in the first place, and making sure people have a good experience when they come to you for care is important.
The entire article is here.
Thursday, April 24, 2014
Study confirms impact of clinician-patient relationship on health outcomes
Meta-analysis finds relationship improvement has beneficial effects similar to some common treatments
Massachusetts General Hospital Press Release
Originally released on April 9, 2014
A meta-analysis of studies that investigated measures designed to improve health professionals' interactions with patients confirms that such efforts can produce health effects just as beneficial as taking a daily aspirin to prevent heart attack. In contrast to previous such reviews, the current report from the Empathy and Relational Science Program at Massachusetts General Hospital (MGH) only included randomized, controlled trials with more reliable results than those included in earlier studies. While it has long been believed that a good patient-clinician relationship can improve health outcomes, objective evidence to support that belief has been hard to come by.
"Although the effect we found was small, this is the first analysis of the combined results of previous studies to show that relationship factors really do make a difference in patients' health outcomes," says Helen Riess, MD, director of the Empathy and Relational Science Program in the MGH Department of Psychiatry, senior author of the report in the open-access journal PLOS ONE.
The entire press release is here.
The entire article is here.
Massachusetts General Hospital Press Release
Originally released on April 9, 2014
A meta-analysis of studies that investigated measures designed to improve health professionals' interactions with patients confirms that such efforts can produce health effects just as beneficial as taking a daily aspirin to prevent heart attack. In contrast to previous such reviews, the current report from the Empathy and Relational Science Program at Massachusetts General Hospital (MGH) only included randomized, controlled trials with more reliable results than those included in earlier studies. While it has long been believed that a good patient-clinician relationship can improve health outcomes, objective evidence to support that belief has been hard to come by.
"Although the effect we found was small, this is the first analysis of the combined results of previous studies to show that relationship factors really do make a difference in patients' health outcomes," says Helen Riess, MD, director of the Empathy and Relational Science Program in the MGH Department of Psychiatry, senior author of the report in the open-access journal PLOS ONE.
The entire press release is here.
The entire article is here.
Monday, April 14, 2014
Episode 6: Ethical Analysis of Vignettes (Number 1)
Dr. Richard F. Small joins John to discuss ethical decision-making, ethics education, and vignette analysis. Rick and John will use information from Episodes 4 and 5 to demonstrate the differences among ethical issues, clinical concerns, legal matters, and risk management. They will utilize the SHAPE decision-making model in conjunction with the acculturation model to demonstrate ways to consider ethical and clinical decision-making. There will be some discussion on risk management and legal issues. They will also discuss possible emotional issues that complicate decision-making skills.
At the end of this podcast, the listener will be able to:
1. Outline the relevant factors if the SHAPE decision-making model,
2. Identify the competing ethical principles in the vignettes, and,
3. Practice integrating personal values with professional ethics.
Find this podcast in iTunes
Click here to purchase 1 APA-approved Continuing Education credit
Listen directly from here
Resources
Episode 4: Ethical Decision-making (Part 1)
Episode 5: Ethical Decision-making (Part 2)
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.
Motivated Moral Reasoning in Psychotherapy
John Gavazzi and Sam Knapp
Nonrational Processes in Ethical Decision-making
Mark Rogerson, Michael C. Gottlieb Mitchell M. Handelsman Samuel Knapp & Jeffrey Younggren
Link to Dr. Small's Practice
At the end of this podcast, the listener will be able to:
1. Outline the relevant factors if the SHAPE decision-making model,
2. Identify the competing ethical principles in the vignettes, and,
3. Practice integrating personal values with professional ethics.
Find this podcast in iTunes
Click here to purchase 1 APA-approved Continuing Education credit
Listen directly from here
Resources
Episode 4: Ethical Decision-making (Part 1)
Episode 5: Ethical Decision-making (Part 2)
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.
Motivated Moral Reasoning in Psychotherapy
John Gavazzi and Sam Knapp
Nonrational Processes in Ethical Decision-making
Mark Rogerson, Michael C. Gottlieb Mitchell M. Handelsman Samuel Knapp & Jeffrey Younggren
Link to Dr. Small's Practice
Monday, March 10, 2014
The Lies That Doctors and Patients Tell
By Sandeep Jauhar
The New York Times
Originally published February 20, 2014
Here is an excerpt:
Physicians sometimes deceive, too. We don’t always reveal when we make mistakes. Too often we order unnecessary tests, to bolster revenue or to protect against lawsuits. We sometimes mislead patients that our therapies have more value, more evidence behind them, than they actually do — whether it was placebo injections from my grandfather’s era, for example, or much of the spinal surgery or angioplasty that’s done today.
Perhaps the most powerful deceptions in medicine are the ones we direct at ourselves — at our patients’ expense. Many physicians still espouse the patriotic (but deeply misconceived) notion that the American medical system is the best in the world. We deny the sickness in our system, and the role we as a profession have played in creating that sickness. We obsessively push ourselves to do more and more tests, scans and treatments for reasons that we sometimes hide from ourselves.
The entire article is here.
The New York Times
Originally published February 20, 2014
Here is an excerpt:
Physicians sometimes deceive, too. We don’t always reveal when we make mistakes. Too often we order unnecessary tests, to bolster revenue or to protect against lawsuits. We sometimes mislead patients that our therapies have more value, more evidence behind them, than they actually do — whether it was placebo injections from my grandfather’s era, for example, or much of the spinal surgery or angioplasty that’s done today.
Perhaps the most powerful deceptions in medicine are the ones we direct at ourselves — at our patients’ expense. Many physicians still espouse the patriotic (but deeply misconceived) notion that the American medical system is the best in the world. We deny the sickness in our system, and the role we as a profession have played in creating that sickness. We obsessively push ourselves to do more and more tests, scans and treatments for reasons that we sometimes hide from ourselves.
The entire article is here.
Tuesday, February 11, 2014
Decline Facebook 'Friend' Appeals from Patients, Groups Say
By David Pittman
Washington Correspondent, MedPage Today
Originally published April 12, 2013, and still relevant today
Physicians should avoid making or accepting "friend" requests through social networking websites with past or current patients, a new policy statement advises.
Instead, doctors should separate their professional and social lives online and direct patients to correct avenues of information if they contact doctors through social networks, according to the policy statement issued jointly on Thursday by the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).
"There's this notion of blurring of our identity, blurring of our persona," David Fleming, MD, chair of ACP's Ethics, Professionalism, and Human Rights Committee, which helped draft the guidelines, said here at the ACP's annual meeting.
The entire article is here.
Washington Correspondent, MedPage Today
Originally published April 12, 2013, and still relevant today
Physicians should avoid making or accepting "friend" requests through social networking websites with past or current patients, a new policy statement advises.
Instead, doctors should separate their professional and social lives online and direct patients to correct avenues of information if they contact doctors through social networks, according to the policy statement issued jointly on Thursday by the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).
"There's this notion of blurring of our identity, blurring of our persona," David Fleming, MD, chair of ACP's Ethics, Professionalism, and Human Rights Committee, which helped draft the guidelines, said here at the ACP's annual meeting.
The entire article is here.
Monday, January 27, 2014
When Doctors ‘Google’ Their Patients
By Haider Javed Warraich
The New York Times - Well Blog
Originally published January 6, 2013
Here is an excerpt:
I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to.
To me, the only legitimate reason to search for a patient’s online footprint is if there is a safety issue. If, for example, a patient appears to be manic or psychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online. Physicians have also investigated patients on the web if they were concerned about suicide risk, or needed to contact the family of an unresponsive patient.
The entire article is here.
The New York Times - Well Blog
Originally published January 6, 2013
Here is an excerpt:
I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to.
To me, the only legitimate reason to search for a patient’s online footprint is if there is a safety issue. If, for example, a patient appears to be manic or psychotic, it might be useful to investigate whether certain claims the patient makes are true. Or, if a doctor suspects a pediatric patient is being abused, it might make sense to look for evidence online. Physicians have also investigated patients on the web if they were concerned about suicide risk, or needed to contact the family of an unresponsive patient.
The entire article is here.
Sunday, January 5, 2014
Doctors and empathy: Teaching Doctor Empathy
A Better NHS
Originally
posted December 20, 2013
Here is an
excerpt:
If at one level
empathy can be demonstrated by a ‘banal social convention’ such as
acknowledging my patient’s suffering, at another, empathy
is inseparable from the moral obligation to care. When we say that
doctors and nurses lack empathy, at one level we might actually mean that they simply
lack basic courtesy and at another deeper level we mean that they don’t
actually care.
Perhaps
etiquette is a thinner version of empathy as ethicist Anna Smajdor, in an
excellent paper about the
limits of empathy in medical education and practice concludes.
She suggests that we should settle for teaching this stripped down version of
empathy. After all, it is clearly in short supply as any patient or health
professional will testify. Kate Granger’s experiences of being a patient
with cancer, led to her powerful call for healthcare professionals to introduce
themselves. #hellomynameis has
made a great and lasting impression.
Thursday, December 12, 2013
Doctors who call patients hypochondriacs are committing malpractice
By Zackary Berger
KevinMD.com
Originally posted on November 25, 2013
There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”
First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them out. I firmly believe that no complaint is illegitimate.
The entire blog post is here.
Thanks to Ed Zuckerman for this information.
KevinMD.com
Originally posted on November 25, 2013
There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”
First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them out. I firmly believe that no complaint is illegitimate.
The entire blog post is here.
Thanks to Ed Zuckerman for this information.
Thursday, November 28, 2013
When Healers Get Too Friendly
By Abigail Zuger
The New York Times - Well
Originally published November 11, 2013
Here is an excerpt:
The incident that it set it off: Dr. Schiff (now 63, an experienced senior clinician) had tangled with an insurer on the phone for two hours before he gave up and handed an impoverished patient $30 to pay for her pain pills. A resident observed the transaction and turned him in. But Dr. Schiff is a proud repeat offender, whose past infractions include helping patients get jobs, giving them jobs himself, offering them rides home, extending the occasional dinner invitation and, yes, once handing over a computer.
He was told physicians should stay away from “random acts of kindness” — an activity that may sound harmless but is quite distinct from the practice of medicine, and has its risks. Patients might get too familiar, expect too much.
The entire story is here.
The New York Times - Well
Originally published November 11, 2013
Here is an excerpt:
The incident that it set it off: Dr. Schiff (now 63, an experienced senior clinician) had tangled with an insurer on the phone for two hours before he gave up and handed an impoverished patient $30 to pay for her pain pills. A resident observed the transaction and turned him in. But Dr. Schiff is a proud repeat offender, whose past infractions include helping patients get jobs, giving them jobs himself, offering them rides home, extending the occasional dinner invitation and, yes, once handing over a computer.
He was told physicians should stay away from “random acts of kindness” — an activity that may sound harmless but is quite distinct from the practice of medicine, and has its risks. Patients might get too familiar, expect too much.
The entire story is here.
Sunday, June 9, 2013
Blurring the lines of ethics when doctors use social media
By Wes Fisher
Dr.KevinMD Blog
Originally posted on May 28, 2013
The position paper from the American College of Physicians and the Federation of State Medical Boards, is a humbling reminder of the challenges that today’s physicians face when entering the online space.
Their recommendations for online medical professionalism, written by ethics committees for the two organizations, “provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies” — no small amount of territory to summarize.
But given the tenure of their document, I should probably hang up this blog right now. After all, why risk being vulnerable in the online world? While well-meaning on one hand, we should appreciate that physicians have officially been put on notice on how to behave online.
To be fair, I agree with most of what they say. All the things about patient confidentiality are appropriate. All the things about respect for persons, better still.
But to me, the part of the document that wanders off into the “influence of social media on the patient-physician relationship” and the influence of social media on the “public perception of physician behaviors,” is more difficult to gauge in its benefit or detriment to the public discourse.
The entire article is here.
Dr.KevinMD Blog
Originally posted on May 28, 2013
The position paper from the American College of Physicians and the Federation of State Medical Boards, is a humbling reminder of the challenges that today’s physicians face when entering the online space.
Their recommendations for online medical professionalism, written by ethics committees for the two organizations, “provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies” — no small amount of territory to summarize.
But given the tenure of their document, I should probably hang up this blog right now. After all, why risk being vulnerable in the online world? While well-meaning on one hand, we should appreciate that physicians have officially been put on notice on how to behave online.
To be fair, I agree with most of what they say. All the things about patient confidentiality are appropriate. All the things about respect for persons, better still.
But to me, the part of the document that wanders off into the “influence of social media on the patient-physician relationship” and the influence of social media on the “public perception of physician behaviors,” is more difficult to gauge in its benefit or detriment to the public discourse.
The entire article is here.
Sunday, September 9, 2012
James Holmes' psychiatrist went to cops with concerns about a patient
By John Ingold and Jeremy P. Meyer
denverpost.com
Originally published August 30, 2012
Here are some excerpts:
On the day she last saw James Holmes, University of Colorado psychiatrist Lynne Fenton went to a campus police officer with concerns about a patient.
Fenton testified Thursday during a hearing in Holmes' murder case that she had no contact with Holmes after June 11. That same day, Fenton said, she contacted Officer Lynn Whitten about a patient. Fenton did not identify the patient, citing the confidentiality issues that were the focus of Thursday's hearing.
"I was trying to gather information for myself," Fenton said.
(cut)
The purpose of the hearing was for prosecutors and defense attorneys to debate whether a notebook Holmes mailed to Fenton the day before the July 20 rampage, which also left 58 injured, is a confidential communication between a doctor and a patient. The defense says it is. Prosecutors believe they should be able to look at it.
The hearing ended Thursday unfinished, and the issue will be taken up again Sept. 20.
The entire story is here.
Thanks to Gary Schoener for this story.
denverpost.com
Originally published August 30, 2012
Here are some excerpts:
On the day she last saw James Holmes, University of Colorado psychiatrist Lynne Fenton went to a campus police officer with concerns about a patient.
Fenton testified Thursday during a hearing in Holmes' murder case that she had no contact with Holmes after June 11. That same day, Fenton said, she contacted Officer Lynn Whitten about a patient. Fenton did not identify the patient, citing the confidentiality issues that were the focus of Thursday's hearing.
"I was trying to gather information for myself," Fenton said.
(cut)
The purpose of the hearing was for prosecutors and defense attorneys to debate whether a notebook Holmes mailed to Fenton the day before the July 20 rampage, which also left 58 injured, is a confidential communication between a doctor and a patient. The defense says it is. Prosecutors believe they should be able to look at it.
The hearing ended Thursday unfinished, and the issue will be taken up again Sept. 20.
The entire story is here.
Thanks to Gary Schoener for this story.
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