Team Decisions Better for the Weary

by Robert Preidt
MedicineNet.com

Teamwork can help tired people avoid making poor decisions, a new study indicates.

Pilots, doctors and others in demanding professions can make dangerous errors when they're weary. But, fatigued people who work as a team have better problem-solving skills than those who work alone, British researchers report.

They asked 171 army officer cadets, aged 18 to 24, at a weekend training exercise to solve a series of math problems. Some were tested before they began the training session and were rested, while others did the math problems at the end of the weekend when they were exhausted.

Individual cadets who were fatigued did far worse on the tests than those who were rested. However, teams of exhausted cadets did just as well as teams of rested cadets.

The study appears online in the Journal of Experimental Psychology: Applied.

"Teams appear to be more highly motivated to perform well, and team members can compare solutions to reach the best decision when they are fatigued. This appears to allow teams to avoid the inflexible thinking experienced by fatigued individuals," study author Daniel Frings, a senior lecturer in social psychology at London South Bank University, said in a journal news release.

In situations where fatigue is a concern, decisions should be made by teams rather than individuals if possible, the study concluded.

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This research supports the idea that group consultation can be very helpful for tired and overworked psychologists, especially when working with high risk or clinically challenging patients.

Vignette 5: A Tricky Situation

Dr. Smith is a psychologist who has worked with a young woman for about 9 months. The patient presents with a history of rejection and abandonment as well as persons of power misusing her. She recently received an offer to become a sales representative for a pharmaceutical company. The psychologist and patient discussed the type of job she was entering because she may experience rejection from doctors, nurses, and other office personnel.

After her 6 weeks of training, the company assigns her to a regional director that the psychologist knows personally. Along with the initial anxiety of the new job, her territory, and her boss, she reports a fear of failure and other anxiety related symptoms. The psychologist knows her new boss, Mr. Biggy. The psychologist seeks to reassure the patient that he, the psychologist, knows Mr. Biggy on a personal basis and that “he is a really a good guy” that seems bright, friendly, and fair. He indicates that Mr. Biggy is a good “family man”. The patient is reassured, and reported less anxiety. In actuality, Mr. Biggy’s wife is a very close friend of Dr. Smith’s wife. They have dinner as couples several times per year.

Several weeks into going on sales calls, your patient reports that Mr. Biggy is complimenting her on the way she looks and her ability to make the sale. They start spending more time together. However, she begins to feel uncomfortable as she feels like they are spending too much time together. Mr. Biggy starts asking questions that are more personal, forwards her “funny” emails, and texts some inappropriate remarks to her, mainly about her alluring power that helps make sales.

Mr. Biggy and Dr. Smith meet in an unplanned social venue. Mr. Biggy pulls Dr. Smith aside and explains how he has become very attracted to a new sales representative. He thinks that she is young and impressionable. He confides that he would like to have an affair with her.

Dr. Smith politely explains that he feels uncomfortable with them discussing his more personal marital issues. Mr. Biggy indicates that he wants to talk more about his feelings. Dr. Smith suggests a referral to a psychologist, but Mr. Biggy states that he feels more comfortable talking with Dr. Smith. After some other small talk, Dr. Smith leaves to mingle with other friends.

Dr. Smith is now worried about the entire situation.

In hindsight, what triggered some possible difficulties in this situation?

What are the ethical issues involved in this scenario?

How are the client’s emotional and interpersonal issues related to the psychologist’s dilemma?

What are the options for the psychologist for both his relationship with his patient and his relationship with Mr. Biggy?

Fraud in a Labcoat

By Gareth Cook

The Boston Globe

MARC HAUSER has plenty of company when it comes to scientific misconduct.  (See our prior blog post.)

Hauser, you’ll recall, had built a brilliant career at Harvard. He directed a primate lab and published a long list of scientific papers on topics like the cognitive nature of morality, and the similarities between human and animal behavior. He was a popular teacher, and author of the hit book “Moral Minds.’’ And then it turned out that he was taking liberties with his scientific data. One paper was retracted, others were corrected, and, earlier this month, he left the university.

Also this month, federal authorities announced that a cancer researcher at the Boston University School of Medicine was inventing data. Two papers have been retracted. The scientist, and I use the term loosely, was shown the door.

These two cases are part of a remarkable flood of scientific retractions. Between 2001 and 2010, the number of retractions increased more than 15-fold, according to a recent investigation by the Wall Street Journal. There were 22 retractions in 2001, and 339 last year, according to the Journal, over a period of time when the number of publications increased by only 44 percent.

It would seem a grim development, this sudden scourge of epic sloppiness and outright fraud in the halls of science. But it’s actually news we should all welcome: We are not witnessing an explosion of misconduct, but a new openness about it.

There are some forces, including easy access to image manipulation software like Photoshop, that are making it easier to fake results. But the problem has festered for decades, and now, finally, science is beginning to get serious about dealing with it.

The most spectacular recent case of scientific fraud came out of South Korea. In early 2004, researchers there announced that they had cloned a human cell, earning front-page headlines around the world, and tantalizing the public with the prospect of future disease treatments. Invitations to collaborate poured in from top biologists. The South Korean government ensured that the lead scientist, Hwang Woo-suk, had every resource at his disposal. He was a national hero.

The rest of story can be found here.

Nearly 1 in 10 U.S. Kids Diagnosed With ADHD

By Alan Mozes
MedicineNet.com

Over the last decade, an increasing number of American children have been diagnosed with attention-deficit hyperactivity disorder (ADHD), a new government survey reveals.

Researchers from the U.S. Centers for Disease Control and Prevention found that between 2007 and 2009, an average of 9% of children between the ages of 5 and 17 were diagnosed with the disorder. This compared with just under 7% between 1998 and 2000.

The survey also indicated that previously notable racial differences in ADHD incidence rates have narrowed considerably since the turn of the millennium, with prevalence now comparable among whites, blacks and some Hispanic groups.

"We don't have the data to say for certain what explains these patterns, but I would caution against concluding that what we have here is a real increase in the occurrence of this condition," stressed study author Dr. Lara J. Akinbami, a medical officer with the National Center for Health Statistics. The findings appear in an Aug. 18 report from the agency.

"In fact, it would be hard for me to argue that what we see here is a true change in prevalence," Akinbami added. "Instead, I would say that most probably what we found has a lot to do with better access to health care among a broader group of children, and doctors who have become more and more familiar with this condition and now have better tools to screen for it. So, this is probably about better screening, rather than a real increase, and that means we may continue to see this pattern unfold."

According to the National Institutes of Health, ADHD is the most common behavioral disorder among children.

Children with ADHD are apt to have problems staying focused, and often suffer learning and behavioral problems as a result of a tendency to engage in hyperactive and/or impulsive behaviors.

The entire article can be here.

Angela Dean: Winner of the Patricia M. Bricklin Award

The PPA Ethics Committee presents the annual Patricia M. Bricklin Award to a Pennsylvania graduate student who submits the best work product (such as a paper) on ethics.  This year, Angela Dean, a student at Catham University earned the award.  Her professor is Anthony Goreczny, Ph.D.

The award comes with $500 that is funded by the Pennsylvania Psychological Foundation. 

The Ethics Committee invited Ms. Dean to our annual Ethics Educator Conference to be held in October, 2011.  Additionally, Ms. Dean will have a version of her paper published in The Pennsylvania Psychologist.


The title of the paper is Facebook for Psychologists: "Friend"ship Ethics.  It can be reviewed or downloaded from docstoc (below).


FB_Psychological_Ethics -

OCR Data Breach Tally Passes a Milestone

Dom Nicastro for HealthLeaders Media

Covered entities have reported breaches of unsecured protected health information affecting 500 or more individuals to the Office for Civil Rights (OCR) nearly once every other day since the HIPAA privacy and security enforcer began posting the information 18 months ago.

The list, posted on the OCR breach notification website, hit the 300 mark this week. OCR went live with the site in February 2010, recording breaches that date back to September of 2009.

That's about 13 breaches per month dating back to the fall of 2009.

The website is part of the breach notification interim final rule, in effect since September 2009. OCR withdrew the rule a little more than one year ago from the hands of the Office of Management and Budget (OMB), which reviews rules for government agencies. OCR wanted more time to pursue changes to the rule.

The rest of the story can be read here.

HIPAA Auditor Involved in Own Data Breach

Dom Nicastro, for HealthLeaders Media

The company hired by the Office for Civil Rights (OCR) to conduct nationwide HIPAA privacy and security compliance audits was responsible for a breach that includes the loss of an unencrypted flash drive and affects more than 4,500 patient records.

OCR’s request for audit proposals came in February 2011, about eight months after KPMG, LLP, reported its breach to the New Jersey healthcare system.

KPMG, which won OCR’s $9.2 million contract for HITECH-required HIPAA audits in June 2011, told the Saint Barnabas Health Care System of West Orange, NJ, in June 2010 that a KPMG employee lost an unencrypted flash drive that may have contained a list with some patient names and information about their care, Saint Barnabas reported on its website. 

The potential breach affected individuals at two facilities—3,630 patients at Saint Barnabas Medical Center in Livingston, NJ, and 956 patients at Newark Beth Israel Medical Center in Newark, NJ—according to a report on the OCR breach notification website. The website lists entities reporting breaches affecting 500 or more individuals, a HITECH requirement that went live in February 2010.

The flash drive did not include patient addresses, Social Security numbers, personal identification numbers, dates of birth, financial information, or other identifiable information, according to the report on the Saint Barnabas website.

KPMG reported the matter to the New Jersey healthcare system June 29, 2010. KPMG believes the flash drive was misplaced on or about May 10, 2010, according to Saint Barnabas.

When EHRs Meet Malpractice Suits: New Concerns

By Neil Versel InformationWeek

An electronic health record (EHR) is more than just an electronic representation of a paper chart. It is a legal representation of a patient's medical condition and treatment at a given point in time, one that could be admissible in court. And that could present a whole new set of challenges for healthcare organizations.

"There is no guide out there to walk people through all that changes with an EHR," Adam Greene, a Washington, D.C.-based partner in the law firm of Davis Wright Tremaine, said this week at the American Health Information Management Association (AHIMA) Legal EHR Summit in Chicago.

EHRs make patient information more readily accessible to far more people than any paper chart stashed away in a filing room. They also change how and to what extent medical professionals document patient encounters and add in safety-related features such as clinical decision support.

"There are all sorts of liability fears with all these improvements," Greene told InformationWeek Healthcare. The Health Insurance Portability and Accountability Act privacy and security rules require anyone that handles electronic healthcare data to keep an audit log of access to any personally identifiable information, and records have helped organizations catch employees taking unauthorized looks at patient records--sometimes also landing the organizations themselves in hot water.

Indeed, some worry that audit logs can reveal too much. "There are concerns by providers that access reports could be used in malpractice suits," Greene said.

In fact, such reports already are, according to Stacey Cischke, an attorney with Chicago firm Cassiday Schade who teaches a course in legal issues in e-health at Loyola University Chicago. "The scope of traditional discovery is expanded," Cischke said. "More and more courts are finding that metadata and access to the inner workings of the EHR system is relevant and discoverable."

The general public and even plaintiffs' attorneys do not always comprehend how EHRs work, Cischke added. Because there is so much to chart, physicians and nurses are rushed and things get missed. From the patient's perspective, all the doctor should have to do is click and check off boxes in a list, but, according to Cischke, physicians often are "overwhelmed" by time and economic pressures, and skip steps or simply forget to check some boxes. "The metadata will show this," Cischke said.

Cischke said she prepares clinicians for trial by making sure they understand what each piece of metadata means. Knowing when something happened then opens up questions of why the doctor took a certain action.

On the other hand, with an EHR, users can't "fudge" charts as they could with paper, since EHR systems generally won't allow any modifications after a physician signs off on the record of a patient encounter. But plaintiff's attorneys do not always consider this. "It's logistically challenging," Cischke said. It is hard for the layperson to understand individual records, flow sheets, and audit trails.

Thus, Cischke recommended that providers adopt a multidisciplinary approach to identifying potential lawsuits, and promote consistency in how they produce reports and respond to threatened legal action. Both in-house and outside counsel and staff need to learn how the EHR works and how to navigate through electronic records before they find out the hard way, after being sued.

The rest of the story can be round here.

Assisted suicide could be 'legalised' in groundbreaking case

Sarah Boseley, Health Editor

guardian.co.uk

A 46-year-old-man who wants to die after a stroke that left him almost completely paralysed is bringing a groundbreaking legal action that could effectively lead to the legalisation of assisted suicide in the UK.

Martin, as he has agreed to be called to preserve his anonymity and that of his family, was a fit and active man who enjoyed rugby, cars and socialising with friends in the pub before suffering a brainstem stroke three years ago. Now requiring round-the-clock care, his mobility is limited to moving his eyes and small movements of his head. He communicates by staring at letters on a computer screen which the machine recognises and forms into words spoken by a digitised voice.

Martin has been asking to die since six months after the stroke but says he has no one willing to assist him and cannot on his own organise a trip to the Swiss clinic Dignitas, where he could end his life legally. His wife, who chooses to be known as Felicity, says she will be with him if he dies but will not help bring about his death.

Human rights lawyers at the firm Leigh Day in London have taken the first step in an action on Martin's behalf that, if successful, could have massive implications. One possibility is that the case could lead to a court ruling that Martin has the right to help not only from a paid professional to assist him get to Switzerland, but also to the services of a palliative care doctor in the UK to ease his death, should he decide to end his life by refusing food and drink.

Such a ruling would dramatically alter the current options for seriously ill and severely disabled people who wish to end their own lives in the UK. "There would be no more planes to Switzerland," said Richard Stein of Leigh Day. "Why would you bother?"

However, Stein added that beginning this legal action would potentially put the lawyers working on it in legal difficulty, since both they and any doctor or psychiatrist who came to examine Martin for the case could be considered to be assisting his suicide, thus exposing them to potential prosecution or disciplinary action from professional bodies.

The rest of the story and the video can be found here.
A prior post on assisted suicide can be found here.