Report Urges ‘Cultural Shift’ as Hockey Coaches Defy Concussion Specialists

By JEFF Z. KLEIN
The New York Times
Originally Published: November 30, 2012

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The entire article is here.

Witness

One Case at a Time Blog

observations from an anesthesiologist and mother of two

Originally published January 2012

 

The anesthesia scheduling office accidentally placed me in an operating room tomorrow with a patient who is a Jehovah’s Witness. It was a paperwork slip-up; I am new and someone forgot to put my name on the “never” list. There are three options for anesthesiologists at my hospital: You will provide anesthesia for Jehovah’s Witnesses

1. For all operations
2. Only for operations that are not expected to involve great blood loss
3. Never

Of course, all anesthesiologists agree to care for Jehovah’s Witnesses who have a life-threatening emergency if we are the only one available.

I had chosen number three: never. I called the scheduling office and they apologized and switched me to a different operating room.

My lack of faith in any nameable higher being is so firm that I can not reconcile it with what Jehovah’s Witnesses would ask me to do. Their practice comes, of course, from the bible. According to watchtower.org, the official website of the Jehovah’s Witnesses, the belief that “Taking blood into body through mouth or veins violates God's laws” comes from three biblical passages: Gen. 9:3, 4; Lev. 17:14; Acts 15:28, 29.

 

(cut)

 

I am morally incapable of letting someone bleed to death. In my operating room, when I am delivering anesthesia, I am responsible completely for that person’s life. This responsibility weighs heavily on me until each patient is safely out of the operating room. I welcome the weight. I care for each person deeply.

 

The entire blog post is here.

 

Thanks to Ed Zuckerman for this information.

Psychologist surrenders license over custody evaluation

Psychiatric Crimes Database
Published on November 29, 2012

On July 20, 2012, psychologist Charlotte Higgins-Lee surrendered her license to practice to the Oregon Board of Psychologist Examiners According to the Board’s document, in late 2010, Higgins-Lee received a referral to conducted a psychological evaluation of a father and his nine-year-old daughter and to testify in a January 2011 hearing concerning custody and parenting time. Though the custody matter concerned the father, daughter and father’s ex-spouse (the daughter’s mother), Higgins-Lee did not interview the mother (though she interviewed the father, daughter and others). Nonetheless, she concluded that the father should have sole custody and that “more information should be obtained on the mother’s alcohol use/abuse and violence,” among other statements critical of the mother, whom she had never met or interviewed. The Board proposed a reprimand, civil fine of $7,500 and requirement to practice under supervision for a minimum of six months. However, Higgins-Lee later agreed to a new stipulated agreement to surrender her license to the Board.

The board order is here.

Arizona studies envision telemedicine on smartphones

By: Lorri Allen
Cronkite News Service
Originally published: Nov 21, 2012


Until now, telemedicine has largely involved capital-intensive studios and cameras isolated to one area of a hospital. But the Mayo Clinic and a University of Arizona center dedicated to telemedicine are pioneering work aimed at moving care to smartphones.

That means practicing medicine in remote and underserved communities will become cheaper, quicker and more effective, according to Dr. Bart Demaerschalk, a neurologist at Mayo Clinic Hospital.

"What we're attempting to do is to make it even easier for the clinical specialist to insert themselves in a virtual manner for the patient in the remote environment," he said. "A mobile device should fulfill that goal."

Dr. Ronald Weinstein, director of the Arizona Telemedicine Program, sees it as a natural progression.

"Telemedicine is rapidly evolving into being next-generation or even a generation beyond by going to mobile health or e-health, and the concept du jour is that the smartphone is the telemedicine workstation," he said.

That's happening at Benson Hospital, where health care workers use Skype on iPads to save time.

"It's very low-cost and it's to facilitate communication between our ER docs and admissions," said John Roberts, information technology director.

The entire story is here.

Vignette 20: Has the Psychologist Done too Much?

Dr. Plenty lives and practices psychology in a rural area.  She began to provide psychotherapy to Mr. DiMencha, a 52-year-old, who suffered with depression.  After six sessions, Mr. DiMencha suffered a significant concussion while at work.  His impairment is noticeable by Dr. Plenty without any type of testing.  He struggles with understanding concepts and becomes tangential during the next two sessions.

Mr. DiMencha’s co-worker, Janet, helped him find an attorney so that his rights are protected.  Dr. Plenty had Mr. DiMencha sign a release to talk with the attorney as well as Janet.  From a phone call with the attorney, Workers Compensation wants to work out a settlement. However, the attorney has little awareness about how impaired Mr. DiMencha is.  The patient has never met the attorney face-to-face, just by email and phone contacts.

Mr. DiMencha demonstrates a variety of cognitive deficits.  He needs assistance and monitoring with daily tasks, such as home care, shopping, transportation, understanding the settlement process, reading his mail, and paying his bills. He will likely need to go into an assisted living facility. His family lives at a distance and provides minimal help. Workers Compensation refuses to pay for the case management services of an independent social worker. Attempts to find social service agencies able to help him have not been successful. Mr. DiMencha doesn't appear to understand his legal rights or the settlement process.

Prior to providing extra-therapy support, Dr. Plenty had Mr. DiMencha sign a document explaining her fees for the additional services.  She is not sure that he completely understands what is happening or her version of informed consent for the additional services.  The psychologist has been doing much of the case management work, e.g. locating a long-time friend who is willing to help him at home, referring him to a neuropsychologist for testing, engaging in lengthy discussions with his primary care physician and neurologist, participating in multiple conversations with the attorney, and trying to find a guardian or power of attorney.

In the midst of all of this activity, the psychologist contacts you for an ethics consultation.

What are the potential ethical issues with this case?

What are the competing ethical principles?

Is Dr. Plenty acting beyond the limits of her competency?

Is she practicing outside of her scope of her license?

What problems may occur as a function of Dr. Plenty engaging in a multiple relationship role in Mr. DiMencha’s care?

What suggestions would you make to Dr. Plenty?

The Psych Approach

By DAVID BROOKS
The New York Times
Originally Published: September 27, 2012

Here are some excerpts:


Tough’s book is part of what you might call the psychologizing of domestic policy. In the past several decades, policy makers have focused on the material and bureaucratic things that correlate to school failure, like poor neighborhoods, bad nutrition, schools that are too big or too small. But, more recently, attention has shifted to the psychological reactions that impede learning — the ones that flow from insecure relationships, constant movement and economic anxiety.

Attention has shifted toward the psychological for several reasons. First, it’s become increasingly clear that social and emotional deficits can trump material or even intellectual progress. Schools in the Knowledge Is Power Program, or KIPP, are among the best college prep academies for disadvantaged kids. But, in its first survey a few years ago, KIPP discovered that three-quarters of its graduates were not making it through college. It wasn’t the students with the lower high school grades that were dropping out most. It was the ones with the weakest resilience and social skills. It was the pessimists.

Second, over the past few years, an array of psychological researchers have taught us that motivation, self-control and resilience are together as important as raw I.Q. and are probably more malleable.

Finally, pop culture has been far out front of policy makers in showing how social dysfunction can ruin lives. You can turn on an episode of “Here Comes Honey Boo Boo,” about a train wreck working-class family. You can turn on “Alaska State Troopers” and see trailer parks filled with drugged-up basket cases. You can listen to rappers like Tyler, The Creator whose songs are angry howls from fatherless men.

The entire article is here.

Gay Conversion Therapy Law Temporarily Blocked By Federal Judge

By LISA LEFF
The Huffington Post
Originally published December 4, 2012


A federal judge on Monday temporarily blocked California from enforcing a first-of-its-kind law that bars licensed psychotherapists from working to change the sexual orientations of gay minors, but he limited the scope of his order to just the three providers who have appealed to him to overturn the measure.

U.S. District Court Judge William Shubb made a decision just hours after a hearing on the issue, ruling that the First Amendment rights of psychiatrists, psychologists and other mental health professionals who engage in "reparative" or "conversion" therapy outweigh concern that the practice poses a danger to young people.

"Even if SB 1172 is characterized as primarily aimed at regulating conduct, it also extends to forms of (conversion therapy) that utilize speech and, at a minimum, regulates conduct that has an incidental effect on speech," Shubb wrote.

The judge also disputed the California Legislature's finding that trying to change young people's sexual orientation puts them at risk for suicide or depression, saying it was based on "questionable and scientifically incomplete studies."

The law, which was passed by the Legislature and signed by Gov. Jerry Brown in October, states that therapists and counselors who use "sexual orientation change efforts" on clients under 18 would be engaging in unprofessional conduct and subject to discipline by state licensing boards. It is set to take effect on Jan. 1.

The entire story is here.

Human Enhancements at Work Pose Ethical Dilemmas

By Kate Holland
Reuters Health Information
Originally published November 8, 2012


Retinal implants to help pilots see at night, stimulant drugs to keep surgeons alert and steady handed, cognitive enhancers to focus the minds of executives for a big speech or presentation.

Medical and scientific advances are bringing human enhancements into work but with them, according to a report by British experts, come not only the potential to help society and boost productivity, but also a range of ethical dilemmas.

"We're not talking science fiction here, we're talking about advances that could impact significantly on the way we work...in the near future," said Genevra Richardson, a professor of law at Kings College London and one of the authors of the report.

The report was published after a joint workshop involving four major British scientific institutions which looked at emerging technologies like cognitive enhancing drugs, bionic limbs and retinal implants that have the potential to change workplaces dramatically in future.

Richardson said while such developments may benefit society in important ways, such as by boosting workforce productivity, their use also had "significant policy implications" to be considered by governments, employers, workers and trades unions.

The entire article is here.

DSM-5 Wins APA Board Approval

By John Gever, Senior Editor
MedPage Today
Originally published December 1, 2012

The American Psychiatric Association's board of trustees has approved the fifth edition of its influential diagnostic manual, dubbed DSM-5, the group announced Saturday.

The board vote is the last step before the manual is formally released at the APA's annual meeting next May. The association's Diagnostic and Statistical Manual of Mental Disorders was last revised in 1994; that edition is known colloquially as DSM-IV.

According to an APA statement, changes include an end to the system of "axes" used to class diagnoses into broad groups, and an associated restructuring of diagnostic groups to bring disorders thought to be biologically related under the same headings.

Also, many of the diagnostic criteria will now include so-called dimensional assessments to indicate severity of symptoms.

Specific language in DSM-5 was not immediately released, and probably won't be until the formal unveiling in May. Detailed criteria that had been published on the APA's DSM5.org website for public review and comment have now been removed.

However, the statement released Saturday indicated that the manual will include many of the most controversial of the proposed changes from DSM-IV.

The entire article is here.