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 professionalism. Show all posts
Showing posts with label professionalism. Show all posts

Thursday, September 10, 2020

Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter

Zulman DM, Haverfield MC, Shaw JG, et al.
JAMA. 2020;323(1):70–81.
doi:10.1001/jama.2019.19003

Key Points

Question  What are the most promising practices to foster physician presence and connection with patients?

Findings  This mixed-methods study identified 5 practices that may enhance physician presence and meaningful connection with patients in the clinical encounter: (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.

Meaning  For busy clinicians with multiple demands and distractions, 5 recommended practices have the potential to facilitate meaningful interactions with patients.

Abstract
Importance  Time constraints, technology, and administrative demands of modern medicine often impede the human connection that is central to clinical care, contributing to physician and patient dissatisfaction.

Objective  To identify evidence and narrative-based practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.

Evidence Review  Preliminary practices were derived through a systematic literature review (fromJanuary 1997 to August 2017, with a subsequent bridge search to September 2019) of effective interpersonal interventions; observations of primary care encounters in 3 diverse clinics (n = 27 encounters); and qualitative interviews with physicians (n = 10), patients (n = 27), and nonmedical professionals whose occupations involve intense interpersonal interactions (eg, firefighter, chaplain, social worker; n = 30). After evidence synthesis, promising practices were reviewed in a 3-round modified Delphi process by a panel of 14 researchers, clinicians, patients, caregivers, and health system leaders. Panelists rated each practice using 9-point Likert scales (−4 to +4) that reflected the potential effect on patient and clinician experience and feasibility of implementation; after the third round, panelists selected their “top 5” practices from among those with median ratings of at least +2 for all 3 criteria. Finalrecommendations incorporate elements from all highly rated practices and emphasize the practices with the greatest number of panelist votes.

Findings  The systematic literature review (n = 73 studies) and qualitative research activities yielded 31 preliminary practices. Following evidence synthesis, 13 distinct practices were reviewed by the Delphi panel, 8 of which met criteria for inclusion and were combined into a final set of 5 recommendations: (1) prepare with intention (take a moment to prepare and focus before greeting a patient); (2) listen intently and completely (sit down, lean forward, avoid interruptions); (3) agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda); (4) connect with the patient’s story (consider life circumstances that influence the patient’s health; acknowledge positive efforts; celebrate successes); and (5) explore emotional cues (notice, name, and validate the patient’s emotions).

Conclusions and Relevance  This mixed-methods study identified 5 practices that have the potential to enhance physician presence and meaningful connection with patients in the clinical encounter. Evaluation and validation of the outcomes associated with implementing the 5 practices is needed, along with system-level interventions to create a supportive environment for implementation.

Thursday, August 6, 2020

Five tips for transitioning your practice to telehealth

Five tips for transitioning your practice to telehealthRebecca Clay
American Psychological Association
Originally posted 19 June 20

When COVID-19 forced Boston private practitioner Luana Bessa, PhD, to take her practice Bela Luz Health online in March, she was worried about whether she could still have deep, meaningful connections with patients through a screen.

To her surprise, Bessa’s intimacy with patients increased instead of diminished. While she is still mindful of maintaining the therapeutic “frame,” it can be easier for everyday life to intrude on that frame while working virtually. But that’s OK, says Bessa. “I’ve had clients tell me, ‘It makes you more human when I see your cat jump on your lap,’” she laughs. “It has really enriched my relationships with some clients.”

Bessa and others recommend several ways to ensure that the transition to telehealth is a positive experience for both you and your patients.

Protect your practice’s financial health

Make sure your practice will be viable so that you continue serving patients over the long haul. If you have an office sitting idle, for example, see if your landlord will renegotiate or suspend lease payments, suggests Kimberly Y. Campbell, PhD, of Campbell Psychological Services, LLC, in Silver Spring, Maryland. Also renegotiate agreements with other vendors, such as parking lot owners, cleaning services, and the like.

And since patients can’t just hand you or your receptionist a credit card, you’ll need to set up an alternate payment system. Campbell turned to a credit card processing company called Clover. Other practitioners use the payment system that’s part of their electronic health record system. Natasha Holmes, PsyD, uses SimplePractice to handle payment for her Boston practice And Still We Rise, LLC. Although there’s a fee for processing payments, an integrated program makes payment as easy as clicking a button after a patient’s session and watching the payment show up at your bank the next day.

The info is here.

Friday, July 3, 2020

American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:
  1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
  2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
  3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
  4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
  5. Monitoring the implementation of tasks 1-4.

Friday, August 23, 2019

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

Nathan K. Gamble and Michael Pruski
The New Bioethics
DOI: 10.1080/20502877.2019.1649871

Abstract

A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Saturday, November 10, 2018

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction

Maria Panagioti, Keith Geraghty, Judith Johnson
JAMA Intern Med. 2018;178(10):1317-1330.
doi:10.1001/jamainternmed.2018.3713

Abstract

Objective  To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.

Data Sources  MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.

Study Selection  Quantitative observational studies.

Data Extraction and Synthesis  Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.

Main Outcomes and Measures  The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.

Results  Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).

Conclusions and Relevance  This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Tuesday, November 6, 2018

Bringing back professionalism in the practice of law is key

Samuel C. Stretton
The Legal Intelligencer
Originally published October 4, 2018

Here is an excerpt:

All lawyers ought to review the Pennsylvania Rules of Civility. Although these rules do not have disciplinary consequences, they set forth the aspirations all lawyers should achieve in the legal profession. Perhaps lawyers have to understand what it means to be a professional. To have the privilege of being admitted to practice law in a state is a wonderful opportunity. The lawyer being admitted becomes part of the legal profession which has a long and historic presence. The legal profession can take great credit for the evolving law and for the democratic institutions which populate this country. Lawyers through vigorous advocacy and through much involvement in the community and in the political offices have help to create a society by law where fairness and justice are the ideals. Once admitted to practice, each and every lawyer becomes part of this wonderful profession and has a duty to uphold the ideals not only in terms of representing clients as vigorously and as honestly as they can, but also in terms of insuring involvement in the community and in society. Each generation of lawyers help to reinterpret the constitution and make it a living document to adjust to the modern problems of every generation. It is a wonderful and great honor to be part of this profession and perhaps one of the greatest privileges any lawyer can have. This privilege allows a lawyer to participate fully in the third branch of public. This privilege allows a lawyer to become part of the public life of their community and of the country in terms of representation and in terms of legal and judicial changes.

The information is here.

Monday, June 26, 2017

What’s the Point of Professional Ethical Codes?

Iain Brassington
BMJ Blogs
June 13, 2017

Here is an excerpt:

They can’t be meant as a particularly useful tool for solving deep moral dilemmas: they’re much too blunt for that, often presuppose too much, and tend to bend to suit the law.  To think that because the relevant professional code enjoins x it follows that x is permissible or right smacks of a simple appeal to authority, and this flies in the face of what it is to be a moral agent in the first place.  But what a professional code of ethics may do is to provide a certain kind of Bolamesque legal defence: if your having done φ attracts a claim that it’s negligent or unreasonable or something like that, being able to point out that your professional body endorses φ-ing will help you out.  But professional ethics, and what counts as professional discipline, stretches way beyond that.  For example, instances of workplace bullying can be matters of great professional and ethical import, but it’s not at all obvious that the law should be involved.

There’s a range of reasons why someone’s behaviour might be of professional ethical concern.  Perhaps the most obvious is a concern for public protection.  If someone has been found to have behaved in a way that endangers third parties, then the profession may well want to intervene.

The blog post is here.

Friday, July 3, 2015

AMA is finally taking a stand on quacks like Dr. Oz

By Julia Belluz
Vox.com
Originally posted June 13, 2015

Medical students and residents frustrated with bogus advice from doctors on TV have, for more than a year, been asking the American Medical Association to clamp down and "defend the integrity of the profession."

Now the AMA is finally taking a stand on quack MDs who spread pseudoscience in the media.

"This is a turning point where the AMA is willing to go out in public and actively defend the profession," Benjamin Mazer, a medical student at the University of Rochester who was involved in crafting the resolution, said. "This is one of the most proactive steps that the AMA has taken [on mass media issues]."

The entire story is here.

Sunday, February 16, 2014

The Workplace and Social Networking - Got Boundaries?

By Kate Anthony
Online Institute
Originally published January 23, 2014

Negotiating the boundaries between our professional and personal lives is increasingly a part of our work as therapists. If you use social media sites such as Twitter, Facebook and LinkedIn you are probably aware of the sometimes inappropriate statuses or updates people post.  Even if you are not a user of them, you will likely have seen the media reports about an staff’s Facebooks posts made while off sick coming back to haunt them, or ill-advised crude tweets resulting in an employee instantly losing their job despite having deleted it within 14 seconds of posting (see example here).

The entire article is here.

Wednesday, October 23, 2013

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Lawrence P. Casalino, M.D., Ph.D.
October 9, 2013 DOI: 10.1056/NEJMp1310974

Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry. Physicians practicing in higher-income areas are less likely to accept new Medicaid patients. Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.

The entire story is here.

Thanks to Gary Schoener for this information.

Saturday, August 24, 2013

The Concept of “Conduct Unbecoming” as Applied to a Physician’s Extra-Medical Behavior

By THOMAS G. GUTHEIL, M.D., HOWARD E. BOOK, M.D., and ARCHIE BRODSKY, B.A.
Journal of Psychiatry & Law 39/Summer 2011

An approach analogous to the military concept of “conduct unbecoming an officer” is increasingly evident in the attempted management of physicians’ personal behavior by medical licensing entities—even when such behavior bears little or no relation to medical practice. This article surveys the genesis
of this approach, the social and professional forces that have encouraged attempts to regulate extra-medical activities, and the current status of pertinent guild rules and other professional guidelines. Two reported case examples are reviewed with critical commentary.

The entire article is here.

Thanks to Gary Schoener for this information.

Saturday, June 18, 2011

Does your office appearance matter?


From research.news.osu

People may judge the quality and qualifications of psychotherapists simply by what their offices look like, a new study suggests.

After only viewing photos of offices, study participants gave higher marks to psychotherapists whose offices were neat and orderly, decorated with soft touches like pillows and throw rugs, and which featured personal touches like diplomas and framed photos.

"People seem to agree on what the office of a good therapist would look like and, especially, what it wouldn't look like," said Jack Nasar, co-author of the study and professor of city and regional planning at Ohio State University.

"Whether it is through cultural learning or something else, people think they can judge therapists just based on their office environment."

Nasar conducted the study with Ann Sloan Devlin, professor of psychology at Connecticut College.

Their study appears online in the Journal of Counseling Psychology and will appear in a future print edition.

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The entire press release can be found here.