When Is It Okay to Date a Patient?

By Shelly Reese
Medscape Ethics Report 2012
Originally published November 15, 2012


Introduction

To the besotted poet, love is intoxicating, exasperating, invigorating. To the doctor -- if the would-be paramour is a patient -- it's also unethical.

But physician responses to Medscape's 2012 ethics survey clearly indicate that many physicians aren't willing to condemn every romance. When asked, "Is it ever acceptable to become involved a romantic or sexual relationship with a patient?" more than two thirds (68%) of the 24,000 doctors who responded resoundingly say "no."

In contrast, nearly one third are more nuanced in their view. Only a tiny minority (1%) give romance with current patients a green light, but a sizable share (22%) say that a romantic relationship with a former patient may be acceptable, as long as at least 6 months have passed since the professional relationship was terminated. Another 9% say the ethics depend on the situation.

Whereas the American Medical Association (AMA) clearly states that sexual contact that is concurrent with the doctor/patient relationship constitutes sexual misconduct, it takes a fuzzier position on relationships that might develop later. The AMA notes that the prior doctor/patient relationship may unduly influence the patient and that such a relationship is unethical if the doctor "uses or exploits trust, knowledge, emotions or influence derived from the previous professional relationship."

Ethicists, such as Dr. Richard Martinez, director of forensic psychiatry services at Denver Health Medical Center and the author of several articles on ethical decision-making and the patient/physician relationship, says the AMA was wise to leave a little wiggle room in its opinion.

"Relationships are complicated," he says. "Every ethical dilemma has to be evaluated and considered on a case-by-case basis."

The entire story is here.

Thanks to Gary Schoener for this information.

Dealing With Doctors Who Take Only Cash

By PAUL SULLIVAN
The New York Times
Originally published: November 23, 2012

Here is an excerpt:

The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife’s diet. Within two days, our baby was sleeping through the night and we were all feeling better.

The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.

A couple of weeks later, our insurance company said it wouldn’t pay anything. Here’s how the company figured it: First, it said a fair price for our doctor’s fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.

While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.

Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?

The entire story is here.

Hanging Suicides Up in United States

By Steven Reinberg
HealthDay Reporter
Originally published November 20, 2012

A surge in hanging deaths among middle-aged adults appears to be responsible for the notable increase in U.S. suicides between 2000 and 2010, a new study finds.


Hangings accounted for 26 percent of suicides in 2010, up from 19 percent at the start of the decade. Among those aged 45 to 59, suicide by hanging increased 104 percent in that time period, according to the report documenting changing suicide patterns.

Overall, 16 percent more Americans took their own lives in 2010 than in 2000. That's equivalent to 12.1 suicides per 100,000 people compared to 10.4 per 100,000 previously.

"It is important that the huge increase in suicide by hanging be recognized," said lead researcher Susan Baker, founding director of the Johns Hopkins Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The entire story is here.

Online Patient Access to Records May Boost Visits

By John Gever, Senior Editor
MedPage Today
Published: November 20, 2012


Patients with access to their physicians' electronic health record systems had more office visits, hospital admissions, and emergency room encounters than those without such access, researchers said.

Participants in a Kaiser Permanente program giving them access to their electronic records, including a secure email system for communicating with clinicians, showed significant increases in nearly all measures of healthcare utilization, relative to the period before they joined the program, Ted E. Palen, MD, PhD, MSPH, of Kaiser Permanente Colorado in Denver, and colleagues reported in the Nov. 20 issue of the Journal of the American Medical Association.

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In an accompanying editorial, two researchers at Brigham and Women's Hospital in Boston noted that the study findings stood in contrast to Kaiser investigations in other regions, which had found reductions in utilization associated with so-called patient portals to electronic health records.

The entire story is here.

Medicare Is Faulted on Shift to Electronic Records

By REED ABELSON
The New York Times
Originally Published: November 29, 2012

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

The entire article is here.

MaleSurvivor Conference Examines Sexual Abuse in Sports

By Eric V. Copage
The New York Times
Originally published November 18, 2012

Here are some excerpts:

A dour procession of stories about sexual misconduct by coaches toward their male charges has come to light in recent months. Jerry Sandusky, a former assistant football coach at Penn State, was sentenced in October to 30 to 60 years in prison on 45 counts of child molesting. Sugar Ray Leonard wrote in his autobiography last year that he was sexually molested by an Olympic boxing coach. The N.H.L. players Theo Fleury and Sheldon Kennedy were sexually abused as teenagers by their hockey coach Graham James.
      

The prevalence of sexual abuse among all boys 17 and under has been variously estimated to be as low as 5 percent and as high as 16 percent. For some of the millions of children who participate in sports nationwide, and their parents, sexual assault in a sports context has its own dynamic.

      

“Sports is a place where parents send their boys to learn skills, to learn how to be teammates and how to work together — to make boys stronger and healthier,” said Dr. Howard Fradkin, author of “Joining Forces,” a book about how men can heal from sexual abuse. “It’s the place where we send our boys to grow up. The betrayal that occurs when abuse occurs in sports is damaging because it destroys the whole intent of what they started out to do.”

 

The entire story is here.

Maine West High School Sued For Student Hazing, Sodomy 'Sanctioned By Coaches'

The Huffington Post
Originally published November 20, 2012

The family of a Illinois high school freshman is suing the Maine Township High School District 207, claiming that Maine West High School officials sanctioned hazing of the unnamed teen as part of a years-long ritual at the school.

The unidentified mother appeared at a news conference Monday wearing a baseball cap and sunglasses alongside attorney Antonio Romanucci.

"I thought my son would be safe at school," she said, according to WLS-TV. "You think when you drop off your son, it's a safe place to be. But I feel like the coaches should have kept him safe on the soccer field, and they didn't do that."

The mother adds that the acts -- and the school's failure to respond -- breaks Illinois state anti-bullying laws.

The lawsuit claims that the 14-year-old and at least two other boys were sexually assaulted during soccer practice in September -- during school hours and condoned by coaches. The complaint alleges that teammates shoved the three boys to the ground and beat them. The older players then held them down, pulled down their pants and underwear and sodomized them.



The entire story is here.

The Role of Health Professionals in Detainee Interrogation

A teenager tortured at Guantanamo, and the stalled legislation to ensure clinicians "first, do no harm"

By Santiago Wills
The Atlantic
Originally published November 11, 2012

Here is one excerpt:

In the aftermath of the wars in Iraq and Afghanistan, ever since leaked reports and testimonies -- including that of alleged 9/11 mastermind Khalid Sheikh Mohammed, currently on trial in Guantanamo -- were published in 2004, the issue has attracted the attention of the media, health organizations, and political activists. Psychologists and doctors have clashed with their peers and with the Department of Defense over the role that health professionals should play in interrogations, given their oath to "do no harm." The Senate Judiciary Committee and numerous military investigations have confirmed that physicians and clinicians played a significant role during so-called enhanced interrogations, either through reverse engineering of the Survival, Evasion, Resistance, Escape (SERE) program, or through monitoring and assisting in CIA black sites and prisons like Bagram and Guantanamo.

Recently, that conflict reached politicians in Albany, New York. This year, State Senator Thomas Duane and Assembly Member Richard Gottfried sponsored a unique piece of legislation that establishes sanctions (including license removal) for state-licensed health professionals who participate in torture or improper treatment of prisoners.

"The bill presents an opportunity to fill a gap in state law on the regulation of health professionals that desperately needs to be filled," Leonard Rubenstein, the former president of Physicians for Human Rights -- an independent organization that fights human rights violations all around the world -- said in a public forum. "Almost everyone agrees that the idea that health professionals can participate in abuse of detainees and prisoners is indefensible. If that is the case, it is also indefensible to exclude such acts from state law on licensing and regulation of health professionals."

The entire story is here.

Physician Suicide Linked to Work Stress

By Crystal Phend, Senior Staff Writer
MedPage Today
Originally published November 14, 2012

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

The entire story is here.

The original article is here.

Here is the conclusion from the abstract:

Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.