Physicians Talking With Their Partners About Patients

Morris NP, & Eshel N.
JAMA. Published online August 16, 2019.
doi:10.1001/jama.2019.12293

Maintaining patient privacy is a fundamental responsibility for physicians. However, physicians often share their lives with partners or spouses. A 2018 survey of 15 069 physicians found that 85% were currently married or living with a partner, and when physicians come home from work, their partners might reasonably ask about their day. Physicians are supposed to keep patient information private in almost all circumstances, but are these realistic expectations for physicians and their partners? Might this expectation preclude potential benefits of these conversations?

In many cases, physician disclosure of clinical information to partners may violate patients’ trust. Patient privacy is so integral to the physician role that the Hippocratic oath notes, “And whatsoever I shall see or hear in the course of my profession...if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.” Whether over routine health care matters, such as blood pressure measurements; or potentially sensitive topics, such as end-of-life decisions, concerns of abuse, or substance use, patients expect their interactions with physicians to be kept in the strictest confidence. No hospital or clinic provides patients with the disclaimer, “Your private health information may be shared over the dinner table.” If a patient learned that his physician shared information about his medical encounters without permission, the patient may be far less likely to trust the physician or participate in ongoing care.

Physicians who share details with their partners about patients may not anticipate the effects of doing so. For instance, a physician’s partner could recognize the patient being discussed, whether from social connections or media coverage. After sharing patient information, physicians lose control of this information, and their partners, who may have less training about medical privacy, could unintentionally reveal sensitive patient information during future conversations.

The info is here.

Can Ethics Be Taught?

Peter Singer
Project Syndicate
Originally published August 7, 2019

Can taking a philosophy class – more specifically, a class in practical ethics – lead students to act more ethically?

Teachers of practical ethics have an obvious interest in the answer to that question. The answer should also matter to students thinking of taking a course in practical ethics. But the question also has broader philosophical significance, because the answer could shed light on the ancient and fundamental question of the role that reason plays in forming our ethical judgments and determining what we do.

Plato, in the Phaedrus, uses the metaphor of a chariot pulled by two horses; one represents rational and moral impulses, the other irrational passions or desires. The role of the charioteer is to make the horses work together as a team. Plato thinks that the soul should be a composite of our passions and our reason, but he also makes it clear that harmony is to be found under the supremacy of reason.

In the eighteenth century, David Hume argued that this picture of a struggle between reason and the passions is misleading. Reason on its own, he thought, cannot influence the will. Reason is, he famously wrote, “the slave of the passions.”

The info is here.

Why Some Christians ‘Love the Meanest Parts’ of Trump

Emma Green
The Atlantic
Originally posted August 18, 2019


Ben Howe is angry at evangelicals. As he describes it, he is angry that they didn’t just vote for Donald Trump in record numbers, but repeatedly provide moral cover for his outrageous failings. He is angry that leaders of the religious right, who long claimed to be the champions of American morality, appear to have gladly traded their values for power. He is angry that Christians claim they support the president because they want to end abortion or protect religious liberty, when supporting Trump suggests that what they really want is a champion who will mock and crush their perceived enemies.

To redeem themselves, Howe believes, evangelicals have to give up their take-no-prisoners culture war.

This is the story Howe, a writer and pundit, tells in his new book, The Immoral Majority—the title aptly riffs on the Moral Majority, the 1980s-era Christian political machine created by the influential pastor Jerry Falwell. Right-wing Christianity is Howe’s native territory: He grew up attending Falwell’s church in Virginia, Thomas Road Baptist Church, down the street from Liberty University, where Howe’s father, a Southern Baptist pastor, taught classes. In other years, Howe’s family attended First Baptist Church in Dallas, which is now pastored by one of Trump’s most vocal supporters, Robert Jeffress. After being raised in the bosom of the religious right, Howe went on to become a filmmaker, a Tea Party activist, and a blogger for the conservative website RedState, where he spent a not insignificant portion of his time trolling progressives. He was later fired from that website, along with other writers, because of his vocally anti-Trump views, he claims. (Rosie Gray wrote about the purge for The Atlantic in the spring of 2018.)

The interview is here.

China approves ethics advisory group after CRISPR-babies scandal

Hepeng Jia
Nature.com
Originally published August 8, 2019

China will establish a national committee to advise the government on research-ethics regulations. The decision comes less than a year after a Chinese scientist sparked an international outcry over claims that he had created the world’s first genome-edited babies.

The country's most powerful policymaking body, the Central Comprehensively Deepening Reforms Commission of the ruling Chinese Communist Party, headed by President Xi Jinping, approved at the end of last month a plan to form the committee. According to Chinese media, it will strengthen the coordination and implementation of a comprehensive and consistent system of ethics governance for science and technology.

The government has released few details on how the committee will work. But Qiu Renzong, a bioethicist at the Chinese Academy of Social Science in Beijing, says it could help to reduce the fragmentation in biomedical ethics regulations across ministries, identifying loopholes in the enforcement of regulations and advise the government on appropriate punishments for those who violate the rules.

The info is here.

DC Physician Indicted for Almost $13M in Medicare Fraud

Ken Terry
MedScape.com
Originally posted August 9, 2019

A physician who has a practice in the District of Columbia has been charged with participation in an alleged $12.7 million healthcare fraud scheme that involved submitting false claims to Medicare for complicated procedures that were never performed, according to a Department of Justice (DOJ) news release.

In an indictment filed July 30 in the District of Columbia, physiatrist Frederick Gooding, MD, aged 68, of Wilmington, Delaware, was charged with 11 counts of healthcare fraud. He was arrested on August 1.

According to the indictment, from January 2015 to August 2018, Gooding participated in a healthcare fraud scheme in which he submitted Medicare claims for injections and aspirations that were not medically necessary, not provided, or both.

Gooding allegedly knew that the injections were not provided. To disguise his scheme, he allegedly falsified medical documents to make it appear as if the purported medical services billed to Medicare were medically necessary.

The info  is here.

Debunking the Stanford Prison Experiment

Thibault Le Texier
PsyArXiv
Originally posted August 8, 2019

Abstract

The Stanford Prison Experiment (SPE) is one of psychology’s most famous studies. It has been criticized on many grounds, and yet a majority of textbook authors have ignored these criticisms in their discussions of the SPE, thereby misleading both students and the general public about the study’s questionable scientific validity. Data collected from a thorough investigation of the SPE archives and interviews with 15 of the participants in the experiment further question the study’s scientific merit. These data are not only supportive of previous criticisms of the SPE, such as the presence of demand characteristics, but provide new criticisms of the SPE based on heretofore unknown information. These new criticisms include the biased and incomplete collection of data, the extent to which the SPE drew on a prison experiment devised and conducted by students in one of Zimbardo’s classes 3 months earlier, the fact that the guards received precise instructions regarding the treatment of the prisoners, the fact that the guards were not told they were subjects, and the fact that participants were almost never completely immersed by the situation. Possible explanations of the inaccurate textbook portrayal and general misperception of the SPE’s scientific validity over the past 5 decades, in spite of its flaws and shortcomings, are discussed.

From the Conclusion:

4) The SPE survived for almost 50 years because no researcher has been through its archives. This was, I must say, one of the most puzzling facts that I discovered during my investigation. The experiment had been criticized by major figures such as Fromm (1973) and Festinger (1980), and the accounts of the experiment have been far from disclosing all of the details of the study; yet no psychologist seems to have wanted to know if the archives what exactly did the archives contain. Is it a lack of curiosity? Is it an excessive respect for the tenured professor of a prestigious university? Is it due to possible access restrictions imposed by Zimbardo? Is it because archival analyses are a time-consuming and work-intensive activity?  Is it due to the belief that no archives had been kept? The answer remains unknown.The recent replication crisis in psychology has shown, however, that psychologists are not indifferent to the functioning of science. This crisis can be seen as a sign of the good health and vigor of the field of psychology, which can correct its errors and improve its methodology (Chambers, 2017, p.171-217). Hopefully, the present study will contribute to psychology’s epistemological self-examination, and expose the SPE for what it was: an incredibly flawed study that should have died an early death.

Study: College Presidents Prioritizing Student Mental Health

Jeremy Bauer-Wolf
InsideHigherEd.com
Originally posted August 12, 2019

With college students reporting problems with anxiety and depression more than ever before, and suicides now a big problem on campuses, university presidents are responding accordingly.

More than 80 percent of top university executives say that mental health is more of a priority on campus than it was three years ago, according to a new report released today by the American Council on Education.

"Student mental health concerns have escalated over the last 10 years," the report states. "We wanted to know how presidents were responding to this increase. To assess short-term changes, we asked presidents to reflect on the last three years on their campus and whether they have observed an increase, decrease, or no change in how they prioritize mental health."

ACE, which represents more than 1,700 college and university presidents, surveyed more than 400 college and university leaders from two- and four-year public and private institutions. About 78 percent of those surveyed were at four-year universities, and the remainder led two-year institutions.

The association found 29 percent of all the presidents surveyed received reports of students with mental health issues once a week or more. About 42 percent of the presidents reported hearing about these problems at least a few times every month. As a result, presidents have allocated more funding to addressing student mental health problems -- 72 percent of the presidents indicated they had spent more money on mental health initiatives than they did three years ago. One unnamed president even reported spending $15 million on a new “comprehensive student well-being building.”

The info is here.

Walking on Eggshells With Trainees in the Clinical Learning Environment—Avoiding the Eggshells Is Not the Answer.

Gold MA, Rosenthal SL, Wainberg ML.
JAMA Pediatr. 
Published online August 05, 2019.
doi:10.1001/jamapediatrics.2019.2501

Here is an excerpt:

Every trainee inevitably will encounter material or experiences that create discomfort. These situations are necessary for growth and faculty should be able to have the freedom in those situations to challenge the trainee’s assumptions.5 However, faculty have expressed concern that in the effort to manage the imbalance of power and protect trainees from the potential of abuse and harassment, we have labeled difficult conversations and discomfort as maltreatment. When faculty feel that the academic institution sides with trainees without considering the faculty member’s perspective and actions, they may feel as if their reputation and hard work as an educator has been challenged or ruined. For example, if a trainee reports a faculty member for creating a “sexually hostile” environment because the faculty has requested that the trainee take explicit sexual histories of adolescents, it may result in the faculty avoiding this type of difficult conversation and lead to a lack of skill development in trainees. Another unintended consequence is that trainees will not gain skills in having difficult conversations with their faculty, and without feedback they may not grow in their clinical expertise. As our workforce becomes increasingly diverse and we care for a range of populations, the likelihood of misunderstandings and the need to talk about sensitive topics and have difficult conversations increases.

There are several ways to create an environment that fosters the ability for trainees and faculty to walk across eggshells without fear. It is important to continue medical school training regarding unconscious bias, cultural sensitivity, and communication skills. This should include helping trainees not only apply these skills with each other and with their patients but also with their faculty. Trainees are likely to have as many unconscious biases toward their faculty as their faculty have toward them. For example, one study found that at one institution, female medical school faculty were given significantly lower teaching evaluations by third-year medical students in all clerkship rotations compared with male medical school faculty. Pediatrics showed the second largest difference, with surgery having the greatest difference.

The info is here.

Trump eyes mental institutions as answer to gun violence

Kevin Freking

Associated Press
Originally published August 30, 2019

Here is an excerpt:

But Trump’s support for new “mental institutions” is drawing pushback from many in the mental health profession who say that approach would do little to reduce mass shootings in the United States and incorrectly associates mental illness with violence.

Paul Gionfriddo, president and chief executive of the advocacy group Mental Health America, said Trump is pursuing a 19th century solution to a 21st century problem.

“Anybody with any sense of history understands they were a complete failure. They were money down the drain,” said Gionfriddo.

The number of state hospital beds that serve the nation’s most seriously ill patients has fallen from more than 550,000 in the 1950s to fewer than 38,000 in the first half of 2016, according to a survey from the Treatment Advocacy Center, which seeks policies to overcome barriers to treatment.

John Snook, the group’s executive director, said Trump’s language “hasn’t been helpful to the broader conversation.” But he said the president has hit on an important problem — a shortage of beds for the serious mentally ill.

“There are headlines every day in almost every newspaper talking about the consequences of not having enough hospital beds, huge numbers of people in jails, homelessness and ridiculously high treatment costs because we’re trying to help people in crisis care,” Snook said.

The info is here.