The Place of Ethical Concerns in Psychology

Ethics plays an important role in psychology from the beginning of the treatment process through rehabilitation. There are many ethical concerns that can arise all of which must be dealt with along the way. These various concerns can also vary from one psychological setting to another. These settings include: hospitals, physical rehabilitation centers and facilities specializing in chronic diseases to name only a few. As the number of psychologists and other professionals working in this field increases, so does the need to focus on areas of ethical concern (Lucignano and Lee). The ethical issues that can arise reach far beyond the medical setting and are present in other situations as well.

Important Ethical concerns include: role delineation, working within the medical model, taking on multiple responsibilities and maintaining confidentiality (Lucignano and Lee). Before any ethical issue can be recognized it must first be clearly defined. Though this article cannot encompass them all, those listed here are commonly encountered and must be dealt with on a regular basis.

The first ethical concern that will be discussed is role delineation. This is a primary concern because it lays the ground work for the responsibilities and expectations of the psychologist; however, there is not a consensus on specifically what constitutes the role of the psychologist in a medical setting. Since many psychologists work in the medical profession, this can present somewhat of a gray area. Instead, diverse terminology has often been used to define this particular role. Terms used include: health psychology, medical psychology, clinical psychology and behavioral medicine. This has presented past arguments over whether or not this lack of clarity in actual definition of terms is more than semantic confusion (Lucignano and Lee). The primary argument here is whether a psychologists’ actions and activities are included under one of these terms that are, for the most part, considered to be unstandardized in this context.

Working within the medical model is another ethical concern that must be considered in the medical field. In these instances, psychologists are usually working on teams that include a physician, social worker, speech pathologist, physical therapist and occupational therapist. Though all teams may not include every role listed above, it is very likely there will be at least two members on each. When this is the case, it is necessary for each person to work within his or her role in order to provide maximum treatment. Ethical awareness is an essential part of providing psychological treatment within the medical model. In a hospital, for instance, unique areas of stress may be present which effect both patients and members of the treatment team (Lucignano and Lee). As a result, there may be difficulties when it comes to the overall decision making process. There may be several causes for this because many people are working to rehabilitate one person. There are several patients so that team may, in effect, be responsible for rehabilitating a wide range of people all of whom are dealing with very different situations. Team members will not always agree on everything and important issues may need to be carefully examined by each team member when it comes to resolving them.

Taking on multiple responsibilities can also bring up ethical issues for psychologists no matter where they work. When treating patients, psychologists take a look at each as an individual and treat each situation accordingly. There are, of course, many responsibilities that come with providing treatment and the solution to a particular need may not always coincide with traditional means and methods of resolution. A psychologist in this type of situation may feel pressured by the many responsibilities he or she must tackle on a daily basis and may be torn between handling a specific one through traditional means or in a way that is unique to the situation. The more administrative duties the psychologist is given, the less time he or she will be able to spend rehabilitating patients. While this may not be an issue that is of top concern, it can arise nonetheless and will need to be dealt with in a way that allows the psychologist to take care of important job-related duties and provide the best treatment possible to all patients.

Maintaining confidentiality is a very important concern. While psychologists don’t have a problem keeping important patient details confined within the facilities with which they are employed, ethical issues can arise when it becomes necessary to discuss certain situations with other professionals. When this occurs, the psychologist involved must decide whether or not the information needs to be passed onto the person requesting it or if a particular piece of information needs to be disseminated to someone else for treatment purposes.

In other situations, a psychologist may be asked for specific information about a current or former patient. While the information in question may be important in the given context, the confidentiality of the patient may be breeched if it is provided. Here the psychologist is faced with a moral dilemma of sorts. He or she knows the information is important and the person requesting it probably should be made aware, but is under a professional obligation to the patient to keep from sharing it. Should this occur, the psychologist can talk to the patient about the situation, informing him or her of the request and why it was made. The final decision of whether or not to provide the information will then be left up to the patient who will be responsible for its dissemination should this be the end result.

When it comes to solving ethical dilemmas, it is important to first understand the code that has been established. When going to work for a particular entity, psychologists will receive information that will instruct them on the various policies and regulations. In order to solve the issues that are bound to arise at one time or another, they will need to assess the individual situations and make a determination on what to do based on the ethical principles that have been set forth. Some dilemmas will be easier to solve than others and will be based around more black and white issues of right and wrong. Other times, distinguishing between right and wrong will not be so easy to do. In some cases, the answer will not lie in a simple context of right and wrong, but instead will be specific to the various factors involved. When this occurs it is often not quite so easy to make the determinations that solve these ethical dilemmas. When this happens, psychologists depend heavily on the ethical principles they have learned as well as the specific policies established by the entities for which they are employed.

One common problem that occurs is in solving particular ethical dilemmas by using the principles when the situation is not completely clear. Sometimes problems arise that call for extensive decision making based on individual factors that cannot be figured into the original ethical principles. Each situation is different and must be treated as such and therefore, will have an individual set of issues that may arise. When this occurs, the psychologist must make a determination based on the specific factors involved while using the ethical principles in a way that will solve the problem without causing an ethical conflict.

Ethics are present for a reason. They are necessary when solving a wide variety of problems that may arise on an individual basis. Though these issue are just that, individual, a uniform code is needed to help psychologists understand and deal with certain types of situations. The place of ethical concerns in psychology applies to psychologists both as researchers and practitioners. Ethics are present in every aspect of psychological practices and must be adhered to in every context. A set of ethical guidelines has been established to aid psychologists in figuring out what to do when these situations arise. All psychologists are bound by these guidelines.

Though ethical guidelines have been established, there is often a debate on whether or not certain issues fall within them and what psychologists should don when they occur. Still, the place of ethics in psychology is not newly found. Aristotle made several important psychological observations concerning the limits beyond which humans cannot control their own behavior, sanity and their capacity for emotional response (Upton). Though these principles have been studied for many years, other issues have arisen specific to new situations and debates. That is why understanding the code of ethics and why it has been established is essential to solving various issues that can, and often do occur.

The code of ethics outlines the responsibilities of the psychologist and establishes what is considered acceptable and unacceptable in regards to the practice of psychology. This code of ethics is multi-dimensional and must be adhered to in order for a psychology to maintain his or her license (Kafka). Since licenses are granted by each individual state of residence, a psychologist working in any particular location is bound by the specific practices established in that place. This practice is defined through roles and obligations a psychologist will possess so there will be consistency within the field. Likewise, the license a psychologist obtains will have meaning to the public who can easily learn what is expected of a professional working in the field.

The main goal is the psychological code of ethics is to insure that all clients and patients are treated in a professional, lawful and respectful manner when seeking treatment (Kafka). Here behaviors are defined that specify how the psychologist will handle the various situations that may arise during the course of treatment for all clients or patients. The ethical code regulates the way in which many behaviors are dealt with and how situations may be resolved. This includes both the private and institutional practice of psychology. This guarantees that anyone who receives service from a psychologist who is adhering to the code of ethics is insured professional, humane treatment that causes no psychological or physical harm. Should the ethical code be breeched for any reason, the situation is investigated and handled accordingly.

The code of ethics is also designed to protect the public from uses and abuses that may result from the mishandling of a particular situation. These protections include: physical, emotional or even financial and cover a wide range of factors related to the practice of psychology. The code contains numerous clauses that clearly specify practices that are considered to be acceptable in regards to billing procedures, file maintenance procedures and even what should occur during appropriate therapy termination. Many aspects include: job handling, office management and client handling. The acceptable versus unacceptable behaviors are defined as well as what actions should be taken if any part of the code is breeched.

The code of ethics directs both the psychologist and client or patient away from conflicts of interest. The existence of dual roles is one conflict that can occur when inappropriate relationships are established between psychologists and those they serve. The ethical code specifies how these situations should be handles and helps both parties in maintaining lawful, socially responsible behavior. This insures the psychologist will be able to treat clients or patients in a positive manner that will promote rehabilitation while clearly drawing the line for those receiving the treatment that clearly defines the appropriate relationship of psychologist and patient. While there may be many arguments surrounding specific situations and what actually constitutes an ethical dilemma, the code is clearly defined and should be closely followed at all times. There are many situations that can certainly present ethical dilemmas, but the code remains in place to help guide psychologists when they must deal with issues that may prove rather difficult. This well-established code not only serves as a guide but also as a way of protecting everyone involved in the treatment process. The ethical code is an important part of the psychological practice because it clearly defines how to deal with important issues that can arise during the course of treatment. This aids psychologists in making important decisions and helps them to better understand the psychological professional as a whole.

Why Do Panic Patients See So Many Doctors?

Panic patients are suddenly hit with a barrage of physical symptoms, “Out of Blue”. When dizziness, heart pounding, shortness of breath, weakness, numbness in the hands and feet and hot cold spells strike without apparent cause, panic sufferer frequently seek medical evaluations (Emergency Room Visits, Family Doctor) to determine the cause. Ballenger (1987) states that 90% of panic sufferers believe they have a physical disorder.

Panic Patients desperately need to know “Why am I feeling this Way?”

When patients present in medical settings with an array of somatic complaints, a thorough medical investigation is undertaken. The panic struck individual waits apprehensively, convinced they will receive a serious medical diagnosis. When the Doctor informs the patient there is no medical cause for these intense bodily sensations, (“Everything is Fine”), the Provider feels he is bringing “Good News” to the patient.

Physician Reassurance Backfires!

Good News from the Doctor’s perspective is Bad News for the patient. The panic sufferer is extremely disappointed. The Doctor did not answer the WhyPanic Question “Why am I feeling this way? No cause for such severe complaints of chest pain and shortness of breath, does not make any sense to the patient. Consistent with my own observations, Pollard and Lewis (1989) report that doctor reassurance for panic symptoms can “actually exacerbate rather than alleviate anxiety. In essence, lack of information, or misinformation, may perpetuate the catastrophic attributions involving impending death or mental instability that are central to this disorder.”

The Doctor Missed Something

Physician reassurance is viewed by the patient as a minimization of the patient’s complaints. Because of the intensity of symptoms, the patient has already concluded something is seriously wrong. Panic patients are seeking a diagnosis and an accurate explanation for the WhyPanic Question. “We can’t find any cause” does not fit with the patient experience. The patient feels that the Doctor may have overlooked a serious medical cause. No cause for severe physical complaints creates more patient ambiguity and uncertainty. The patient begins to worry more about what COULD be causing them to feel this way and may look for a more thorough Doctor and investigation to finally pin down the answer to the WhyPanic Question. A case of doctor doubt can develop and the patient catches “online disease” and the “read and catch syndrome.” You look up your symptoms online and discover possible related symptoms and diseases and think you could have all of them. Increased worry that panic symptoms represent some life threatening illness can produce additional anxiety symptoms and amplify existing ones. In extreme cases, patients begin to worry that they might have some rare undetected disease that will be discovered upon autopsy!

High Prevalence of Undetected Panic Disorder in Medical Settings

Panic disorder patients congregate in general medical practices, searching for the WhyPanic answer. A growing body of evidence shows very low detection rates for panic disorder in the medical setting. No cause or “? etiology” is a common diagnostic conclusion for panic symptoms in the emergency room, primary care and cardiology practices. Doctors, often feel they have completed the evaluation, when they ruled out medical causes for somatic complaints. Rushed for time and with limited behavioral science training, all too often, they stop short of considering the diagnosis of panic disorder. The patient, convinced the “Doctor missed something”, can go from Doctor to Doctor, Doctor Shopping, until they arrive at an accurate diagnosis. The continued search for the answer to WhyPanic creates very high medical utilization patterns for panic disorder. Sheehan (1982) reports that 70% of panic disorder patients had consulted, at least 10 Doctors before receiving a correct diagnosis. Anthony and Swinson (2000) report that compared to the general population, panic disorder patients “visit physicians seven times more often and missed twice as many work days.”

Patient Perceptions of the Doctor’s Diagnosis for Panic Disorder

Watkins and his associates (1996) asked a selected sample of panic patients who underwent a medical evaluation for panic symptoms

“What diagnosis did you receive?” A sample response was “I was perfectly healthy. It was nothing to worry about. Quit being such a worrier.”

Then, the researchers asked the panic patients “Describe how you felt about hearing the diagnosis.” A sample response was “Scared and confused because I was not 100% convinced I knew what triggered it and I didn’t want it to happen again.”

Early Diagnosis Brief Intervention in the Medical Setting and the Medical Cost Offset Effect

Undiagnosed panic disorder in medical settings leads to high medical utilization, patient dissatisfaction, doctor frustration, increased emotional distress, prolonged suffering, occupational impairment, social isolation and ultimately, patient despair. Anthony and Swinson (2000) reported during the year following a diagnosis of panic disorder, the frequency of visits to medical doctors decreased from a mean of 5.13 to.25 per person. Hospital emergency room visits decreased from 1.23 per person to 0.11 per person.

Integration of Early Diagnosis and Brief CBT for Panic Disorder into Medical Settings could prevent the progression of panic disorder, shorten treatment length, rapidly diminish patient suffering, prevent escalating redundant medical utilization and yield substantial cost savings.

A Pain Management Psychologist – What is My Doctor Thinking?

Does my doctor think that my pain is all in my head?

No! Your doctor knows that your pain is real and very complicated. Regardless of the origin of pain in your body, the pain is recognized and processed in your mind.

What is chronic pain?

Chronic pain is any pain that persists for at least three months in spite of appropriate medical treatment. As you know, pain that persists affects your life in many ways. Others close to you find it difficult to understand how you are suffering and they often offer advice that is not helpful. Relationships get strained and everyone can feel frustrated and helpless. It becomes difficult to be optimistic about the future. Depression is a common by-product of pain, often along with social isolation.

Why a psychologist?

Several reasons. Your pain has likely had a negative impact on many parts of your life. You may feel that those close to you do not understand what you are experiencing, or may be offering advice that is simply not helpful. Many emotional reactions accompany pain, including a feeling of loss of control, helplessness, frustration, anger, tension, and depression to name a few. Unfortunately, these feelings can heighten the intensity of your pain. A clinical psychologist with training in behavioral medicine has the expertise to help you with these feelings as well as to show you how to use your mind (that is, your thoughts and imagination) to reduce and effectively manage your pain.

What will the psychologist do?

You will initially be asked about the history of your pain as well as how you experience your pain on a daily basis. Your psychologist may also want to do brief testing to better understand you and your pain. A treatment program will be developed specifically for you. Techniques may include relaxation, mental imagery, or self-hypnosis. You will be asked to practice these strategies at home to become more proficient in managing your pain.

The field of mind-body medicine has convincingly demonstrated that these approaches are effective in reducing the suffering you are experiencing.

Self-hypnosis? How will this be helpful?

Self-hypnosis allows you to focus your concentration in ways that produce significant pain reduction. If this route is taken, the process will be explained to you in detail. Self-hypnosis does not produce a loss of control, sleep, or cause you to behave in silly ways. If fact, self-hypnosis is almost always experienced as relaxing and restful. You will also find greater control of yourself, particularly in your ability to manage your pain.

Will my doctor be involved?

Your psychologist will work closely with your physician. You will be asked to sign a release so that this communication can happen. You will, of course, be aware of any important information discussed between your psychologist and physician. You will be encouraged to think of your treatment as a team approach with you as an active member.

Most Common Medical Malpractice

Medical malpractice is a big issue nowadays. Doctors, nurses, dentist and other health-related professions studied hard, take qualifying and licensure examinations, and sometimes enrolled themselves in continuing educational programs like master’s or doctorate degree but still they still commit errors. Everyday in our life we commit mistake, that’s normal; but mistake in medical field is a grave threat.

What is really medical malpractice?

Medical malpractice is care that deviates from expected medical community approved practices and results in death or injury to the patient, as defined in Wikipedia. It is clearly stated that it’s a professional negligence which means done by a professional (doctor, nurse, etc.). Why did this happen? Sometimes it’s individualized. There are reasons behind these malpractices like lack of knowledge, behavioral problems, and indistinct job description.

What are the common medical malpractices?

Medication errors. This is the most common type of malpractice. There are so many types of medications; some of them have names that are similar in sound but different classification. Example is omeprazole which is a proton pump inhibitor, metronidazole which is an antibiotic and mebendazole which is an anti-helminthic. Most nurses in this case administer the wrong medication because of the similarity in the sounds of the names of the drugs. Therefore, to prevent this type of malpractice, it is highly recommended to utilize the 10 rights in administering medications.

Misdiagnosis. Misdiagnosis is the failure of the doctor to determine the real condition/status of the patient. This become rampant nowadays because of the increasing number of diseases discovered and the similarity of the symptom a disease condition may present. There were so many cases related to this incident. A wrong diagnosis could be very fatal and costly. You are spending for the treatment regimen the doctor prescribed but instead of cure, it could lead to serious injury. Specialization in the field of medicine and utilization of modern diagnostic facilities however may lower the chance of this kind of medical malpractice.

Surgical Malpractice. Instruments left inside the abdomen of the patient was one the cases of surgical malpractice. Another is wrong incision made to do a nephrectomy, instead of left kidney the right kidney was removed. There was also a case of amputation of the good leg rather than the diseased leg. These incidents had become controversial. This kind of errors was due to miscommunication. There should be a good endorsement done in every department of what the surgical procedure is all about and a good collaboration from all of the health care team.

In medical field, errors must be reduced to the lowest possible number; because here, it’s the life of the patient that is at stake. If you are in a medical field, be sure to be knowledgeable, skillful and competent enough to perform your duty in order to prevent medical malpractice.

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