By Annie Lowrey
The New York Times
Originally published April 23, 2013
On a stormy evening this spring, nurses at Dr. Gary Stuck’s family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort — combined with dozens more like it — is starting to make a difference: across the city, doctors are providing less, but not worse, health care.
For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.
This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown over the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington’s long-term deficit problems and ease the strain on family budgets.
The entire story is here.
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
Tuesday, April 30, 2013
U.S. Spurns California Move for Greater Say on Prisons
By Norimitsu Onishi
The New York Times
Originally published April 5, 2013
A federal judge on Friday rejected California’s motion to regain control of mental health care in its prisons, ruling that the quality of care failed to meet standards required by the Constitution. The move dealt a blow to Gov. Jerry Brown’s broader efforts to bring the prisons back under the state’s authority.
In a ruling handed down about 90 days after the state first argued that enough improvements had been made to mental health care after 18 years of outside control, Judge Lawrence K. Karlton of United States District Court in Sacramento wrote that there were “ongoing constitutional violations” and that court oversight “remains necessary to remedy those violations.”
In a statement, Deborah Hoffman, a spokeswoman for the California Department of Corrections and Rehabilitation, said that the judge had not given enough weight to experts and evidence showing that mental health care in the prisons was “a model for the nation.” She said that the state will appeal.
The entire story is here.
The New York Times
Originally published April 5, 2013
A federal judge on Friday rejected California’s motion to regain control of mental health care in its prisons, ruling that the quality of care failed to meet standards required by the Constitution. The move dealt a blow to Gov. Jerry Brown’s broader efforts to bring the prisons back under the state’s authority.
In a ruling handed down about 90 days after the state first argued that enough improvements had been made to mental health care after 18 years of outside control, Judge Lawrence K. Karlton of United States District Court in Sacramento wrote that there were “ongoing constitutional violations” and that court oversight “remains necessary to remedy those violations.”
In a statement, Deborah Hoffman, a spokeswoman for the California Department of Corrections and Rehabilitation, said that the judge had not given enough weight to experts and evidence showing that mental health care in the prisons was “a model for the nation.” She said that the state will appeal.
The entire story is here.
Monday, April 29, 2013
Jodi Arias Trial - Teachable Moments
Dr. Samuels's Testimony on his evaluation of Jodi Arias. Witness for the Defense
Dr. DeMarte's Testimony on her evaluation of Jodi Arias. Witness for the Prosecution.
The YouTube video can be found here.
There are quite a few teachable moments in both of these videos.
Thanks to Gary Schoener for these links.
Dr. DeMarte's Testimony on her evaluation of Jodi Arias. Witness for the Prosecution.
The YouTube video can be found here.
There are quite a few teachable moments in both of these videos.
Thanks to Gary Schoener for these links.
Sunday, April 28, 2013
College admission questions rarely identify criminal behavior
University of Colorado
Press Release
April 16, 2013
A new study shows that neither criminal background checks nor pre-admission screening questions accurately predict students likely to commit crime on college campuses.
"In an effort to reduce campus crime, more than half of all American colleges ask applicants about their criminal histories or require criminal background checks," said study author Carol Runyan , Ph.D., MPH, and professor of epidemiology at the Colorado School of Public Health. "But there is no real evidence to show this reduces campus crime."
Colleges across the U.S. ramped up background checks after the 2007 Virginia Tech massacre which killed 32 people and wounded another 17.
Yet Runyan found that only 3.3 percent of college seniors who engaged in misconduct actually reported precollege criminal histories during the admissions process. And just 8.5 percent of applicants with a criminal history were charged with misconduct during college.
The study surveyed 6,972 students at a large southern university. It found that students with criminal records prior to college were more likely to commit crimes once admitted but the screening process rarely identified them.
"We didn't look at cheating or minor alcohol offences," Runyan said. "We focused on significant offences like assault, robbery, property crimes, driving under the influence of alcohol, marijuana use and other drug-related crimes."
While colleges are generally safe environments, students can be both perpetrators and victims of crimes that pose risks to the entire campus community, Runyan said.
She noted that earlier studies had reported that up to 14 percent of all college men admitted to some kind of sexual assault or coercion while 30 percent of university males and 22 percent of females said they had driven under the influence of alcohol in the last year. Also, 19 percent of students reported illicit drug use.
Still, the screening questions have proven a weak tool in identifying would-be campus criminals, Runyan said.
Runyan's findings indicate that students who engage in criminal activity during college are more likely to have engaged in misconduct prior to college, whether they admit it on their applications or not. However, she said current screening questions on the college application often fail to detect which students will engage in misconduct during college. And most of those who have records before college don't seem to continue the behaviors in college.
Even if the screenings could identify likely troublemakers, Runyan said, colleges would have to decide whether to admit the students given that the odds of them committing a crime on campus would still be low. And much of the reported precollege crime involves marijuana use and is not violent.
Another complication is possible discrimination. Students from more affluent backgrounds, who tend to be white, can often pay to have their early criminal records expunged while others, including many minorities, can't afford it.
"Based on our work, I cannot say with confidence that colleges should stop asking about criminal backgrounds, but I would use caution in thinking that this is the best strategy to address crime on campus," said Runyan who directs the University of Colorado's Pediatric Injury Prevention, Education and Research Program. "We need to ensure a safe and supportive environment for all students rather than limiting college access for students who may need extra help."
The study was recently published in the journal Injury Prevention and will be presented by Runyan at a conference in June.
Press Release
April 16, 2013
A new study shows that neither criminal background checks nor pre-admission screening questions accurately predict students likely to commit crime on college campuses.
"In an effort to reduce campus crime, more than half of all American colleges ask applicants about their criminal histories or require criminal background checks," said study author Carol Runyan , Ph.D., MPH, and professor of epidemiology at the Colorado School of Public Health. "But there is no real evidence to show this reduces campus crime."
Colleges across the U.S. ramped up background checks after the 2007 Virginia Tech massacre which killed 32 people and wounded another 17.
Yet Runyan found that only 3.3 percent of college seniors who engaged in misconduct actually reported precollege criminal histories during the admissions process. And just 8.5 percent of applicants with a criminal history were charged with misconduct during college.
The study surveyed 6,972 students at a large southern university. It found that students with criminal records prior to college were more likely to commit crimes once admitted but the screening process rarely identified them.
"We didn't look at cheating or minor alcohol offences," Runyan said. "We focused on significant offences like assault, robbery, property crimes, driving under the influence of alcohol, marijuana use and other drug-related crimes."
While colleges are generally safe environments, students can be both perpetrators and victims of crimes that pose risks to the entire campus community, Runyan said.
She noted that earlier studies had reported that up to 14 percent of all college men admitted to some kind of sexual assault or coercion while 30 percent of university males and 22 percent of females said they had driven under the influence of alcohol in the last year. Also, 19 percent of students reported illicit drug use.
Still, the screening questions have proven a weak tool in identifying would-be campus criminals, Runyan said.
Runyan's findings indicate that students who engage in criminal activity during college are more likely to have engaged in misconduct prior to college, whether they admit it on their applications or not. However, she said current screening questions on the college application often fail to detect which students will engage in misconduct during college. And most of those who have records before college don't seem to continue the behaviors in college.
Even if the screenings could identify likely troublemakers, Runyan said, colleges would have to decide whether to admit the students given that the odds of them committing a crime on campus would still be low. And much of the reported precollege crime involves marijuana use and is not violent.
Another complication is possible discrimination. Students from more affluent backgrounds, who tend to be white, can often pay to have their early criminal records expunged while others, including many minorities, can't afford it.
"Based on our work, I cannot say with confidence that colleges should stop asking about criminal backgrounds, but I would use caution in thinking that this is the best strategy to address crime on campus," said Runyan who directs the University of Colorado's Pediatric Injury Prevention, Education and Research Program. "We need to ensure a safe and supportive environment for all students rather than limiting college access for students who may need extra help."
The study was recently published in the journal Injury Prevention and will be presented by Runyan at a conference in June.
Saturday, April 27, 2013
New Zealand legalizes same-sex marriage
By The Associated Press
Originally published April 17, 2013
Lawmakers voted 77 to 44 in favour of the gay-marriage bill on its third and final reading.
People watching from the public gallery and some lawmakers immediately broke into song after the result was announced, singing the New Zealand love song Pokarekare Ana in the indigenous Maori language.
"For us, we can now feel equal to everyone else," said Tania Penafiel Bermudez, a bank teller who said she already considers herself married to partner Sonja Fry but now can get a certificate to prove it. "This means we can feel safe and fair and right in calling each other wife and wife."
The entire article is here.
Originally published April 17, 2013
Lawmakers voted 77 to 44 in favour of the gay-marriage bill on its third and final reading.
People watching from the public gallery and some lawmakers immediately broke into song after the result was announced, singing the New Zealand love song Pokarekare Ana in the indigenous Maori language.
"For us, we can now feel equal to everyone else," said Tania Penafiel Bermudez, a bank teller who said she already considers herself married to partner Sonja Fry but now can get a certificate to prove it. "This means we can feel safe and fair and right in calling each other wife and wife."
The entire article is here.
Boy Scouts propose to lift ban on gays as youth members, keep it for adult leaders
By DAVID CRARY
Associated Press
Originally posted April 20, 2013
Searching for compromise on a divisive issue, the Boy Scouts of America is proposing to partially lift its long-standing exclusion of gays — allowing them as youth members but continuing to bar them as adult leaders.
The proposal, unveiled Friday after weeks of private leadership deliberations, will be submitted to the roughly 1,400 voting members of the BSA's National Council during the week of May 20 at a meeting in Texas.
The key part of the resolution says no youth may be denied membership in the Scouts "on the basis of sexual orientation or preference alone." A ban would continue on leadership roles for adults who are openly gay or lesbian.
Gay-rights groups, which had demanded a complete lifting of the ban, criticized the proposal as inadequate.
"Until every parent and young person have the same opportunity to serve, the Boy Scouts will continue to see a decline in both membership and donations," said Rich Ferraro, a spokesman for the gay-rights watchdog group GLAAD.
Chad Griffin, president of the Human Rights Campaign, said the BSA was too timid.
The entire story is here.
Associated Press
Originally posted April 20, 2013
Searching for compromise on a divisive issue, the Boy Scouts of America is proposing to partially lift its long-standing exclusion of gays — allowing them as youth members but continuing to bar them as adult leaders.
The proposal, unveiled Friday after weeks of private leadership deliberations, will be submitted to the roughly 1,400 voting members of the BSA's National Council during the week of May 20 at a meeting in Texas.
The key part of the resolution says no youth may be denied membership in the Scouts "on the basis of sexual orientation or preference alone." A ban would continue on leadership roles for adults who are openly gay or lesbian.
Gay-rights groups, which had demanded a complete lifting of the ban, criticized the proposal as inadequate.
"Until every parent and young person have the same opportunity to serve, the Boy Scouts will continue to see a decline in both membership and donations," said Rich Ferraro, a spokesman for the gay-rights watchdog group GLAAD.
Chad Griffin, president of the Human Rights Campaign, said the BSA was too timid.
The entire story is here.
Friday, April 26, 2013
Online Medical Professionalism: Patient and Public Relationships
Policy Statement From the American College of Physicians and the Federation of State Medical Boards
Ann Intern Med. 16 April 2013;158(8):620-627
Abstract
User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient–physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and 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.
Because of the creation and use of information online and the widespread use of the Internet and Web 2.0 platforms, physicians and others are increasingly required to consider how best to protect patient interests and apply principles of professionalism to new settings. As new technologies and practices, such as social networking, are embraced, it is paramount to maintain the privacy and confidentiality of patient information, demonstrate respect for patients, ensure trust in physicians and in the medical profession, and establish appropriate boundaries. To protect patients and the public and promote quality health care, it is critical to strike the proper balance to harness opportunities while being aware of inherent challenges in using technology. But as others have pointed out, “Connectivity need not come at the expense of professionalism”.
Organizational statements addressing these issues are starting to appear, but they may not provide specific guidance to deal with and anticipate concerns. Innovations often bring benefits, but rapid introduction of technology sometimes outpaces existing policies, laws, and guidelines. This article provides a framework for analyzing medical ethics and professionalism issues in online postings and interactions, including the use of electronic resources for clinical or direct patient care involving patient information outside of the electronic health record, and the nonclinical or personal use of these media. It presents the implications of online activities for patients, physicians, the profession, and society and contains recommendations that address online communication with patients, the use of social media sites to gather and share information about patients, physician-produced blogs, physician posting of personal information that patients can access, and communications among colleagues about patient care.
Ann Intern Med. 16 April 2013;158(8):620-627
Abstract
User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient–physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and 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.
Because of the creation and use of information online and the widespread use of the Internet and Web 2.0 platforms, physicians and others are increasingly required to consider how best to protect patient interests and apply principles of professionalism to new settings. As new technologies and practices, such as social networking, are embraced, it is paramount to maintain the privacy and confidentiality of patient information, demonstrate respect for patients, ensure trust in physicians and in the medical profession, and establish appropriate boundaries. To protect patients and the public and promote quality health care, it is critical to strike the proper balance to harness opportunities while being aware of inherent challenges in using technology. But as others have pointed out, “Connectivity need not come at the expense of professionalism”.
Organizational statements addressing these issues are starting to appear, but they may not provide specific guidance to deal with and anticipate concerns. Innovations often bring benefits, but rapid introduction of technology sometimes outpaces existing policies, laws, and guidelines. This article provides a framework for analyzing medical ethics and professionalism issues in online postings and interactions, including the use of electronic resources for clinical or direct patient care involving patient information outside of the electronic health record, and the nonclinical or personal use of these media. It presents the implications of online activities for patients, physicians, the profession, and society and contains recommendations that address online communication with patients, the use of social media sites to gather and share information about patients, physician-produced blogs, physician posting of personal information that patients can access, and communications among colleagues about patient care.
Thursday, April 25, 2013
Nevada buses hundreds of mentally ill patients to cities around country
By Cynthia Hubert, Phillip Reese, & Jim Sanders
The Sacramento Bee
Originally published April 14, 2013
Over the past five years, Nevada's primary state psychiatric hospital has put hundreds of mentally ill patients on Greyhound buses and sent them to cities and towns across America.
Since July 2008, Rawson-Neal Psychiatric Hospital in Las Vegas has transported more than 1,500 patients to other cities via Greyhound bus, sending at least one person to every state in the continental United States, according to a Bee review of bus receipts kept by Nevada's mental health division.
About a third of those patients were dispatched to California, including more than 200 to Los Angeles County, about 70 to San Diego County and 19 to the city of Sacramento.
In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012. During that same period, the hospital has dispersed those patients to an ever-increasing number of states.
(cut)
It also is cheaper, he noted. Southern Nevada Adult Mental Health Services spent a total of $205,000 putting patients on Greyhound buses during the past five years, according to The Bee analysis. The state hospital admits about 4,000 patients a year to its inpatient unit, and inpatient care runs around $500 per day per client, Ghertner said.
The entire story is here.
The Sacramento Bee
Originally published April 14, 2013
Over the past five years, Nevada's primary state psychiatric hospital has put hundreds of mentally ill patients on Greyhound buses and sent them to cities and towns across America.
Since July 2008, Rawson-Neal Psychiatric Hospital in Las Vegas has transported more than 1,500 patients to other cities via Greyhound bus, sending at least one person to every state in the continental United States, according to a Bee review of bus receipts kept by Nevada's mental health division.
About a third of those patients were dispatched to California, including more than 200 to Los Angeles County, about 70 to San Diego County and 19 to the city of Sacramento.
In recent years, as Nevada has slashed funding for mental health services, the number of mentally ill patients being bused out of southern Nevada has steadily risen, growing 66 percent from 2009 to 2012. During that same period, the hospital has dispersed those patients to an ever-increasing number of states.
(cut)
It also is cheaper, he noted. Southern Nevada Adult Mental Health Services spent a total of $205,000 putting patients on Greyhound buses during the past five years, according to The Bee analysis. The state hospital admits about 4,000 patients a year to its inpatient unit, and inpatient care runs around $500 per day per client, Ghertner said.
The entire story is here.
Wednesday, April 24, 2013
Diagnosis: Human
By Ted Gup
The New York Times Op-Ed
Originally published on April 2, 2013
Here are some excerpts:
The New York Times Op-Ed
Originally published on April 2, 2013
Here are some excerpts:
No one made him take the heroin and alcohol, and yet I cannot help but hold myself and others to account. I had unknowingly colluded with a system that devalues talking therapy and rushes to medicate, inadvertently sending a message that self-medication, too, is perfectly acceptable.
My son was no angel (though he was to us) and he was known to trade in Adderall, to create a submarket in the drug among his classmates who were themselves all too eager to get their hands on it. What he did cannot be excused, but it should be understood. What he did was to create a market that perfectly mirrored the society in which he grew up, a culture where Big Pharma itself prospers from the off-label uses of drugs, often not tested in children and not approved for the many uses to which they are put.
And so a generation of students, raised in an environment that encourages medication, are emulating the professionals by using drugs in the classroom as performance enhancers.
And we wonder why it is that they use drugs with such abandon. As all parents learn — at times to their chagrin — our children go to school not only in the classroom but also at home, and the culture they construct for themselves as teenagers and young adults is but a tiny village imitating that to which they were introduced as children.
The issue of permissive drug use and over-diagnosis goes well beyond hyperactivity. In May, the American Psychiatric Association will publish its D.S.M. 5, the Diagnostic and Statistical Manual of Mental Disorders. It is called the bible of the profession. Its latest iteration, like those before, is not merely a window on the profession but on the culture it serves, both reflecting and shaping societal norms. (For instance, until the 1970s, it categorized homosexuality as a mental illness.)
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