Ami Schattner
JAMA Intern Med. Published online April 04, 2016.
doi:10.1001/jamainternmed.2016.0610
Here is an excerpt:
[The physician-patient relationship] requires full commitment providing information, empathy, and bonding obligatory for patient-centeredness, patient satisfaction, trust, and adherence which translate into "hard" health outcomes. Because clinical care is strongly dependent on this human interaction, it is also susceptible to inherent biases (mostly unintentional) that are one major cause of variation in care. In this context, providers' reactions to certain patients may involve negative feelings adversely affecting the degree of effort invested in their care, diagnostic accuracy, treatment decisions, and level of communication, empathy and support. Stigmatized patients may get different (less than optimal) care, just as "nice" patients may be preferred and receive better care. Instead of empathy and bonding, which have a positive impact on outcomes, censure, absent compassion, diminished bonding, and poor support toward patients who caused their own wretched state are likely, as well as actual variation in care, all compromising patient outcomes. For example, poor provider's empathy and bonding on the part of the clinician was linked to low patient adherence and may be associated with actual discrimination and rationing.
The article is here.
Monday, April 25, 2016
The Strict Liability Standard and Clinical Supervision
Paul D. Polychronis & Steven G. Brown
Professional Psychology: Research and Practice, Vol 47(2), Apr 2016, 139-146.
Abstract
Clinical supervision is essential to both the training of new psychologists and the viability of professional psychology. It is also a high-risk endeavor for clinical supervisors because of regulations in many states that impose a strict liability standard on supervisors for supervisees’ conduct. Applied in the context of tort law, the concept of strict liability makes supervisors responsible for supervisees’ actions without having to establish that a given supervisor was negligent or careless. Consequently, in jurisdictions where the strict liability standard is used, it is virtually inevitable that clinical supervisors will be named in civil suits over a supervisee’s actions regardless of whether a supervisor has been appropriately conscientious. In cases of supervisee misconduct, regulations in 27 of 51 jurisdictions (the 50 states plus the District of Columbia) generally hold clinical supervisors fully responsible for supervisees’ actions in a professional realm regardless of the nature of the supervisees’ misbehavior. Some examples are provided of language from these state regulations. The implications of this current reality are discussed. Altering the regulatory approach to clinical supervision is explored to reduce risk to clinical supervisors that is beyond their reasonable control. Recommendations for conducting clinical supervision and corresponding risk-management practices are suggested to assist clinicians in protecting themselves if practicing in a jurisdiction that uses the strict liability standard in regulations governing clinical supervision.
The article is here.
Professional Psychology: Research and Practice, Vol 47(2), Apr 2016, 139-146.
Clinical supervision is essential to both the training of new psychologists and the viability of professional psychology. It is also a high-risk endeavor for clinical supervisors because of regulations in many states that impose a strict liability standard on supervisors for supervisees’ conduct. Applied in the context of tort law, the concept of strict liability makes supervisors responsible for supervisees’ actions without having to establish that a given supervisor was negligent or careless. Consequently, in jurisdictions where the strict liability standard is used, it is virtually inevitable that clinical supervisors will be named in civil suits over a supervisee’s actions regardless of whether a supervisor has been appropriately conscientious. In cases of supervisee misconduct, regulations in 27 of 51 jurisdictions (the 50 states plus the District of Columbia) generally hold clinical supervisors fully responsible for supervisees’ actions in a professional realm regardless of the nature of the supervisees’ misbehavior. Some examples are provided of language from these state regulations. The implications of this current reality are discussed. Altering the regulatory approach to clinical supervision is explored to reduce risk to clinical supervisors that is beyond their reasonable control. Recommendations for conducting clinical supervision and corresponding risk-management practices are suggested to assist clinicians in protecting themselves if practicing in a jurisdiction that uses the strict liability standard in regulations governing clinical supervision.
The article is here.
Sunday, April 24, 2016
Why Is It So Hard for Us to Admit Our Mistakes?
Karen Firestone
Harvard Business Review
Originally posted March 28, 2016
Advice for how to gracefully handle mistakes often emphasizes 1) taking responsibility for the error, 2) presenting a plan for the remedy, and then 3) fixing what was wrong. Although these directions sound simple, they can be extremely difficult to execute in real life. No one finds it easy to own up to a mistake — particularly a costly one.
(cut)
Many people are afraid of appearing incompetent in front of our colleagues and bosses. But what we sometimes don’t realize is that it is worse to be viewed as a coward incapable of owning up to mistakes or accepting criticism. Rather than saying, “The plate dropped,” it is good practice to say, “I dropped the plate” — especially if that is exactly what happened. The best executives and investors “drop plates” all the time; without doing so, they would lack experience and a healthy understanding of risk.
The article is here.
Harvard Business Review
Originally posted March 28, 2016
Advice for how to gracefully handle mistakes often emphasizes 1) taking responsibility for the error, 2) presenting a plan for the remedy, and then 3) fixing what was wrong. Although these directions sound simple, they can be extremely difficult to execute in real life. No one finds it easy to own up to a mistake — particularly a costly one.
(cut)
Many people are afraid of appearing incompetent in front of our colleagues and bosses. But what we sometimes don’t realize is that it is worse to be viewed as a coward incapable of owning up to mistakes or accepting criticism. Rather than saying, “The plate dropped,” it is good practice to say, “I dropped the plate” — especially if that is exactly what happened. The best executives and investors “drop plates” all the time; without doing so, they would lack experience and a healthy understanding of risk.
The article is here.
Saturday, April 23, 2016
Computer creates high-tech Rembrandt counterfeit
Michael Franco
Gizmag
Originally posted April 6, 2016
In conversations about artificial intelligence and the time when machines will be able to functions as well as — or better than — human beings, it's often said that one thing computers will never be able to do is create art and music the way we do. Well, that argument just lost a bit of steam thanks to a project that's been carried out by Microsoft and ING. Working with the Technical University of Delft and two museums in the Netherlands, the project, called "Next Rembrandt," used algorithms and a 3D printer to create a brand-new Rembrandt painting that looks like it could easily have been delivered by Dutch Master's own hand about 350 years ago.
The article and video are here.
Gizmag
Originally posted April 6, 2016
In conversations about artificial intelligence and the time when machines will be able to functions as well as — or better than — human beings, it's often said that one thing computers will never be able to do is create art and music the way we do. Well, that argument just lost a bit of steam thanks to a project that's been carried out by Microsoft and ING. Working with the Technical University of Delft and two museums in the Netherlands, the project, called "Next Rembrandt," used algorithms and a 3D printer to create a brand-new Rembrandt painting that looks like it could easily have been delivered by Dutch Master's own hand about 350 years ago.
The article and video are here.
Friday, April 22, 2016
The Ethics of Sexual Objectification: Autonomy and Consent
Patricia Marino
Inquiry: An Interdisciplinary Journal of Philosophy
Volume 51, Issue 4, 2008
Abstract
It is now a platitude that sexual objectification is wrong. As is often pointed out, however, some objectification seems morally permissible and even quite appealing—as when lovers are so inflamed by passion that they temporarily fail to attend to the complexity and humanity of their partners. Some, such as Nussbaum, have argued that what renders objectification benign is the right sort of relationship between the participants; symmetry, mutuality, and intimacy render objectification less troubling. On this line of thought, pornography, prostitution, and some kinds of casual sex are inherently morally suspect. I argue against this view: what matters is simply respect for autonomy, and whether the objectification is consensual. Intimacy, I explain, can make objectification more morally worrisome rather than less, and symmetry and mutuality are not relevant. The proper political and social context, however, is crucial, since only in its presence can consent be genuine. I defend the consent account against the objection that there is something paradoxical in consenting to objectification, and I conclude that given the right background conditions, there is nothing wrong with anonymous, one‐sided, or just‐for‐pleasure kinds of sexual objectification.
The article is here.
Inquiry: An Interdisciplinary Journal of Philosophy
Volume 51, Issue 4, 2008
Abstract
It is now a platitude that sexual objectification is wrong. As is often pointed out, however, some objectification seems morally permissible and even quite appealing—as when lovers are so inflamed by passion that they temporarily fail to attend to the complexity and humanity of their partners. Some, such as Nussbaum, have argued that what renders objectification benign is the right sort of relationship between the participants; symmetry, mutuality, and intimacy render objectification less troubling. On this line of thought, pornography, prostitution, and some kinds of casual sex are inherently morally suspect. I argue against this view: what matters is simply respect for autonomy, and whether the objectification is consensual. Intimacy, I explain, can make objectification more morally worrisome rather than less, and symmetry and mutuality are not relevant. The proper political and social context, however, is crucial, since only in its presence can consent be genuine. I defend the consent account against the objection that there is something paradoxical in consenting to objectification, and I conclude that given the right background conditions, there is nothing wrong with anonymous, one‐sided, or just‐for‐pleasure kinds of sexual objectification.
The article is here.
Review: Eric Fair’s ‘Consequence,’ a Memoir by a Former Abu Ghraib Interrogator
By Michiko Kakutani
New York Times Book Review
Originally published April 4, 2016
Here is an excerpt:
Of the Abu Ghraib torture photos broadcast by “60 Minutes” in April 2004, Mr. Fair writes: “Some of the activities in the photographs are familiar to me. Others are not. But I am not shocked. Neither is anyone else who served at Abu Ghraib. Instead, we are shocked by the performance of the men who stand behind microphones and say things like ‘bad apples’ and ‘Animal House’ on night shift.’”
In 2007, Mr. Fair says, he confessed everything to a lawyer from the Department of Justice and two agents from the Army’s Criminal Investigation Command, providing pictures, letters, names, firsthand accounts, locations and techniques. He was not prosecuted. “We tortured people the right way,” he writes, “following the right procedures, and used the approved techniques.”
Mr. Fair, however, became increasingly racked by guilt. He begins having nightmares. Nightmares in which “someone I know begins to shrink,” becoming so small “they slip through my fingers and disappear onto the floor.” Nightmares in which “there’s a large pool of blood on the floor” that moves as if it’s alive, nipping at his feet.
The book review is here.
New York Times Book Review
Originally published April 4, 2016
Here is an excerpt:
Of the Abu Ghraib torture photos broadcast by “60 Minutes” in April 2004, Mr. Fair writes: “Some of the activities in the photographs are familiar to me. Others are not. But I am not shocked. Neither is anyone else who served at Abu Ghraib. Instead, we are shocked by the performance of the men who stand behind microphones and say things like ‘bad apples’ and ‘Animal House’ on night shift.’”
In 2007, Mr. Fair says, he confessed everything to a lawyer from the Department of Justice and two agents from the Army’s Criminal Investigation Command, providing pictures, letters, names, firsthand accounts, locations and techniques. He was not prosecuted. “We tortured people the right way,” he writes, “following the right procedures, and used the approved techniques.”
Mr. Fair, however, became increasingly racked by guilt. He begins having nightmares. Nightmares in which “someone I know begins to shrink,” becoming so small “they slip through my fingers and disappear onto the floor.” Nightmares in which “there’s a large pool of blood on the floor” that moves as if it’s alive, nipping at his feet.
The book review is here.
Thursday, April 21, 2016
A question of basic morality on legal defense for juveniles
By The Los Angeles Times Editorial Board
Originally published April 4, 2016
Here are two excerpts:
But the public defender often has a conflict of interest. Consider, for example, when two people are accused of stealing a bike. Each might blame the other for the crime, so they can't have the same lawyer. One gets the public defender. For many years, the second one got a private lawyer from a county-approved panel, who was paid by the hour and — county officials argued — had too little incentive to keep costs down.
(cut)
The fee, which has inched up over the years, has yielded results that should have been predictable. More juvenile defendants represented by those flat-fee panel lawyers get sentenced to “camps” — juvenile jails — than their counterparts represented by the public defender. That means a higher cost to taxpayers, who foot the bill for each of those jailed teenagers, even though the outcomes (criminal recidivism, homelessness, employment) are far better for those whose sentences are served in community and school settings.
The full text is here.
Originally published April 4, 2016
Here are two excerpts:
But the public defender often has a conflict of interest. Consider, for example, when two people are accused of stealing a bike. Each might blame the other for the crime, so they can't have the same lawyer. One gets the public defender. For many years, the second one got a private lawyer from a county-approved panel, who was paid by the hour and — county officials argued — had too little incentive to keep costs down.
(cut)
The fee, which has inched up over the years, has yielded results that should have been predictable. More juvenile defendants represented by those flat-fee panel lawyers get sentenced to “camps” — juvenile jails — than their counterparts represented by the public defender. That means a higher cost to taxpayers, who foot the bill for each of those jailed teenagers, even though the outcomes (criminal recidivism, homelessness, employment) are far better for those whose sentences are served in community and school settings.
The full text is here.
The Science of Choosing Wisely — Overcoming the Therapeutic Illusion
David Casarett
New England Journal of Medicine 2016; 374:1203-1205
March 31, 2016
DOI: 10.1056/NEJMp1516803
Here are two excerpts:
The success of such efforts, however, may be limited by the tendency of human beings to overestimate the effects of their actions. Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the “illusion of control.” In medicine, it may be called the “therapeutic illusion” (a label first applied in 1978 to “the unjustified enthusiasm for treatment on the part of both patients and doctors”). When physicians believe that their actions or tools are more effective than they actually are, the results can be unnecessary and costly care. Therefore, I think that efforts to promote more rational decision making will need to address this illusion directly.
(cut)
The outcome of virtually all medical decisions is at least partly outside the physician’s control, and random chance can encourage physicians to embrace mistaken beliefs about causality. For instance, joint lavage is overused for relief of osteoarthritis-related knee pain, despite a recommendation against it from the American Academy of Orthopedic Surgery. Knee pain tends to wax and wane, so many patients report improvement in symptoms after lavage, and it’s natural to conclude that the intervention was effective.
The article is here.
New England Journal of Medicine 2016; 374:1203-1205
March 31, 2016
DOI: 10.1056/NEJMp1516803
Here are two excerpts:
The success of such efforts, however, may be limited by the tendency of human beings to overestimate the effects of their actions. Psychologists call this phenomenon, which is based on our tendency to infer causality where none exists, the “illusion of control.” In medicine, it may be called the “therapeutic illusion” (a label first applied in 1978 to “the unjustified enthusiasm for treatment on the part of both patients and doctors”). When physicians believe that their actions or tools are more effective than they actually are, the results can be unnecessary and costly care. Therefore, I think that efforts to promote more rational decision making will need to address this illusion directly.
(cut)
The outcome of virtually all medical decisions is at least partly outside the physician’s control, and random chance can encourage physicians to embrace mistaken beliefs about causality. For instance, joint lavage is overused for relief of osteoarthritis-related knee pain, despite a recommendation against it from the American Academy of Orthopedic Surgery. Knee pain tends to wax and wane, so many patients report improvement in symptoms after lavage, and it’s natural to conclude that the intervention was effective.
The article is here.
Wednesday, April 20, 2016
Is health profiling morally permissible?
Kasper Lippert-Rasmussen
J Med Ethics doi:10.1136/medethics-2015-103360
R. Scott Braithwaite, Elizabeth R. Stevens and Arthur Caplan argue that some risk stratifications—that is, “employing patient characteristics to reduce the uncertainty that a future event will occur”—amount to profiling and, thus, invidious discrimination. These are forms of risk stratification “in which there is concern that ethical harms exceed likely or proven benefits for a group, and in the case of health care, involves any differential treatment in response to a personal characteristic that may cause an unwanted consequence for that person or for other persons with that characteristic”. Braithwaite et al recognise the potential benefits of (increasingly fine-grained) risk stratification: “It can make the provision of therapies safer…[and] improve diagnostic accuracy… Additionally, it can promote the efficient utilization of resources”. However, risk stratification also involves ‘ethical harms’, which must be weighed against the benefits, that is, it can (1) stigmatise groups; (2) violate privacy; (3) increase distributive injustice, for example, by making an already unjustly disadvantaged group suffer further disadvantages relative to a ‘counterfactual situation of no risk stratification’; and (4) imperil autonomy.
The article is here.
J Med Ethics doi:10.1136/medethics-2015-103360
R. Scott Braithwaite, Elizabeth R. Stevens and Arthur Caplan argue that some risk stratifications—that is, “employing patient characteristics to reduce the uncertainty that a future event will occur”—amount to profiling and, thus, invidious discrimination. These are forms of risk stratification “in which there is concern that ethical harms exceed likely or proven benefits for a group, and in the case of health care, involves any differential treatment in response to a personal characteristic that may cause an unwanted consequence for that person or for other persons with that characteristic”. Braithwaite et al recognise the potential benefits of (increasingly fine-grained) risk stratification: “It can make the provision of therapies safer…[and] improve diagnostic accuracy… Additionally, it can promote the efficient utilization of resources”. However, risk stratification also involves ‘ethical harms’, which must be weighed against the benefits, that is, it can (1) stigmatise groups; (2) violate privacy; (3) increase distributive injustice, for example, by making an already unjustly disadvantaged group suffer further disadvantages relative to a ‘counterfactual situation of no risk stratification’; and (4) imperil autonomy.
The article is here.
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