Strategies for private practitioners coping with subpoenas or compelled testimony fro client records or test data.

Psychologists have numerous ethical, professional, and legal obligations regarding the release of client records, test data, and other information in the legal context. The demands of the legal system sometimes conflict with psychologists' ethical obligations to maintain confidentiality of client records, to protect the integrity and security of test materials, and to avoid misuse of assessment techniques and data. This article identifies legal issues that may arise when private practitioners are faced with subpoenas or compelled court testimony for client records or test data and suggests strategies that might be considered in the event such a subpoena or demand is received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies for private practitioners coping with subpoenas or compelled testimony for client records or test data.

Psychologists have numerous ethical, professional, and legal obligations regarding the release of client records, test data, and other information in the legal context. The demands of the legal system sometimes conflict with psychologists' ethical obligations to maintain confidentiality of client records, to protect the integrity and security of test materials, and to avoid misuse of assessment techniques and data. This article identifies legal issues that may arise when private practitioners are faced with subpoenas or compelled court testimony for client records or test data and suggests strategies that might be considered in the event such a subpoena or demand is received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Keeping secrets: the ethical and legal challenges

Blatant examples of breeches of confidentiality are less common in comparison to the daily indiscretions that occur by members of the health care team or support staff. Yet such breeches of confidentiality are rarely identified as ethical or legal problems and therefore remain unaddressed. To uphold their moral and legal obligation to protect private information, nurses must examine the nature of their obligations and devise strategies to create and maintain a culture that holds health care professionals accountable for their actions.     

Legal Risks Faced by Foreign Architectural, Engineering, and Construction Firms in China

The extensive opportunities in China’s construction industry are expected to attract many foreign architectural, engineering, and construction (AEC) firms to her shores. However, these foreign firms may face many legal risks and obstacles, mainly because of the differences in culture and operating environment from their home countries. This study investigates the legal risks that foreign AEC firms encounter when operating in China, and how these risks are managed. Data were collected from 21 foreign (non-Chinese) AEC professionals who have extensive experience in China. Legal risks faced by foreign AEC firms in China include: difficulty in complying with the innumerable laws and regulations at the central, provincial, and local levels of the government; keeping up with new laws and regulations that are constantly being enacted; seeming reluctance of Chinese business associates to enter into binding contracts; and lack of sanctity of contracts and contractual obligations not being carried out fully, leading to disputes. Based on the research findings, a framework for managing legal risks is proposed for use by industry practitioners. The framework recommends to practitioners several measures to manage the legal risks. These include relationship-based strategies like establishing close relationships with the Chinese government officials and Chinese business associates and careful selection of Chinese business partners. It is recommended that foreign AEC professionals adopt the mindset that in China, the contact is to be continuously negotiated and reinterpreted. To achieve this, industry practitioners should provide a substantial contingency sum. It is also important to emplace permanent staff in China so that they can understand the local environment and monitor the changes taking place there.     

Managed care: rationing without justice, but not unjustly

Three ethical criticisms of managed care are often voiced: (1) by "skimming the cream" of the patient population, managed care organizations fail to discharge their obligations to improve access, or at least, to not worsen it; (2) managed care organizations engage in rationing, thereby depriving patients of care to which they are entitled; and (3) by pressuring physicians to ration care, managed care organizations interfere with physicians' fulfillment of their fiduciary obligations to provide the best care for each patient. This article argues that each of these criticisms is misconceived. The first rests on the false assumption that the health care system includes a workable division of responsibility regarding access that assigns obligations concerning access to managed care organizations. The second and third criticisms wrongly assume that we in the United States have taken the first step toward assuring equitable access to care for all, articulating a standard for what counts as an "adequate level of care" to which all are entitled. These three misguided criticisms obscure the most fundamental ethical flaw of managed care: the fact that it operates in an institutional setting within which no connection can be made between the activity of rationing and the basic requirements of justice.     

Risk management with the suicidal patient: Lessons from case law.

Suicide continues to account for a comparatively large proportion of all lawsuits filed against mental health professionals. However, despite the prominence of suicide in mental health malpractice litigation, clinicians must resist resorting to defensive clinical practices in an attempt to shield themselves from potential lawsuits. By using accepted tenets of suicide management as a starting point, the author aims in this article to inform and educate practitioners about clinical malpractice from a legal, as well as a clinical, point of view. Hence, this article aims to demystify relevant case law for practitioners by offering informative, real life examples of how therapeutic practice is interpreted in the courtroom, as well as examples of how juries and judges typically view the treatment decisions clinicians routinely make regarding their suicidal patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The association between prenatal sella turcica morphology and notochordal remnants in the dorsum sellae

This report examines the relation between state variations in the regulation of nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs), and the employment of these nonphysician providers (NPPs) by community health centers (CHCs). Data for this report came from a 1991-92 survey of CHCs assessing the employment of NPPs, and secondary available data. The dependent variables examined were the numbers of NPPs currently employed by CHCs. Independent variables included 1992 practice environment scores, CHC location, number of CHC physicians, and NPP-to-population ratios. The number of NPs and PAs employed by CHCs was significantly associated with practice environment for these practitioners. NPP-to-population ratios and the number of CHC physicians are also significantly associated with NPP employment by CHCs. State decision makers may reduce legislative and regulatory barriers to practice as a way to improve the practice environment for nonphysician primary care providers, particularly NPs and PAs. Thus, community health centers can employ adequate number of NPPs to fulfill their mission of serving the poor and underserved population.     

Age-related changes in cardiac physiology. Can they be postponed or treated by drugs?

In this paper preliminary findings from the first stage of an English National Board (ENB) commissioned study investigating the educational needs of community practitioners in relation to their responsibilities for student learning are presented. A national postal survey of all educational centres offering nurse and/or midwifery education was undertaken in the latter half of 1993. Information was collected regarding the nature and planning of the community practice components of courses. The main methods of support for practitioners included the provision of the ENB 998/997 courses and liaison meetings between educational centres and community practice areas. Practitioners were often required to both supervise and assess students on practice placements, the length of these placements varying enormously. For those centres offering the mental health and learning disability branches of the Diploma in Higher Education in Nursing Studies (Project 2000), a significant proportion lacked teachers with specialist community qualifications. The investigation took place at a time of great upheaval, with 42% of centres reporting that they were in the process of amalgamation. The findings demonstrate that community nurses and midwives undoubtedly contribute to the education of nurse and midwife students and consequently have educational needs which must be addressed if they are to continue to supervise students.     

Legal standards, expertise, and experts in the resolution of contested child custody cases.

The authors critically evaluate the roles of forensic practitioners and psychological researchers in determinations of the best-interest-of-the-child standard (BICS) in child custody disputes. The authors examine (a) the existing empirical research on the adjustment of children of divorce, (b) the current forensic practice of mental health practitioners, (c) the standardized forensic assessment instruments available, and (d) the ethical dilemmas faced by mental health practitioners who work in this area. On the basis of their analysis, the authors argue that current evidence does not support most of the "expert testimony" proffered by mental health practitioners to the court. As a consequence, they posit that the BICS does not reflect either the needs of the legal system or the expertise of the psychological profession, and that the least detrimental alternative to the child standard more accurately meets the needs of both fields. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General practitioners' perceptions of private health screening: too much paper, anxiety, and reassurance

There is no evidence to support the practice of screening consultations that include general physical examinations and batteries of tests; however, many patients may choose, or be sent by their employers, to have private full health screening (FHS). General practitioners (GPs) are routinely sent the results of these screening examinations and are expected to deal with any subsequent care required. GPs recognize some positive aspects of FHS, but in our survey there was a groundswell of dislike for these examinations because of uncertainty about patient benefit (raised anxiety or false assurance) and a potential to irritate the GP. The implications for workload were minimal but resented. GPs would welcome a precise summary of significant findings and for the screening doctor to take greater responsibility for follow-up.     

Russian family practice training program: a single step on a long journey

SETTING: The outcome of tuberculosis treatment is often not assessed in low-incidence countries such as Switzerland. In economically developed countries, private practitioners do not have the final responsibility for ensuring the completion of adequate tuberculosis treatment, and public health officers have little or no legal means of intervening if they are not specifically requested to do so. Furthermore, the reluctance of private practitioners to follow official guidelines may be an obstacle to the implementation of a regular surveillance policy. OBJECTIVE: To assess the results of treatment in patients with culture-positive pulmonary tuberculosis and to identify the risk factors for non-adherence to treatment. DESIGN: Retrospective study of all cases notified between 1988 and 1992 in Vaud County, and mainly treated by independent practitioners. RESULTS: Among 133 patients notified with culture-positive pulmonary tuberculosis, complete information about treatment outcome was available for 120. Treatment success (cure or completed adequate treatment) was observed in 84 patients (70%), 17 died (14%) and 19 (16%) were considered as defaulters. The default rate was higher among immigrants, alcoholics, intravenous drug users and male patients. Among non-adherent patients, 4/19 (21%) relapsed within 3 years, compared with 3/84 (4%) among adherent patients. CONCLUSION: The outcome of treatment in this group of patients does not correspond to the expected standards: the treatment completion rate was too low, and the default rate was too high. Better education of medical staff and health-care workers, use of directly-observed treatment, and regular surveillance of treatment outcome will be necessary to improve the results.     

Behavioral "Medicine" and the Collaboration Model of Knapp and Vandecreek.

Knapp and Vandecreek's (1981) article provided a helpful outline of some ethical and legal considerations of the health psychologist. Their recommendations regarding "physician collaboration" (p. 679) in the psychological management of physiological health concerns lead to practical problems that require further ethical and legal inquiry. Some concerns arising from efforts to apply the collaboration model are considered here: interaction with physicians who are minimally sophisticated about the psychological aspects of illness; collaboration with physicians who routinely equate patient's health psychology concerns only with emotional disorder and consign these individuals to the psychologist; and whether health psychologists can select an accurate diagnosis for conditions that are not psychological in nature. Health psychologists may ultimately resolve these issues as the professional identity of behavioral "medicine" and its practitioners develops. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for prostate cancer in asymptomatic men: clinical, legal, and ethical implications

PURPOSE/OBJECTIVES: To describe the opposing recommendations of the major medical organizations related to screening for prostate cancer and to explore the impact of these opposing recommendations on advanced practice nurses (APNs) who are in a position to decide who gets screened and when. DATA SOURCES: Published medical, legal, and economic articles, published legal verdicts and settlements, case law, and news reports. DATA SYNTHESIS: The national recommendations for screening for prostate cancer are conflicting and have legal, economic, and ethical implications for healthcare practitioners. Both the current early diagnostic tests, age- and race-based prostate specific antigen ranges, and the resultant treatment have significant problems and further contribute to the national controversy about whether to screen asymptomatic men. Lack of coverage for early detection of prostate cancer by many managed-care plans and Medicare also contribute to the dilemma practitioners face. However, electing not to screen "at-risk" men may subject APNs to charges of negligence or other legal theories. CONCLUSIONS: Present recommendations by the leading national medical, cancer, and policy organizations related to prostate cancer screening are contradictory. Adding to this national quagmire is the lack of financial support from Medicare and most health maintenance organization plans to pay for early detection of prostate cancer. These conflicting recommendations place APNs in a legally and ethically precarious position. APNs and nurses with patient education responsibilities should individualize decision-making and counsel their asymptomatic patients who may be at risk for prostate cancer about the benefits and complications of screening. IMPLICATIONS FOR NURSING PRACTICE: Considering the multiple implications of the decision to screen for prostate cancer, counseling patients who may be at risk for the disease and involving them and their spouses may be the best approach in deciding whether to screen for prostate cancer in asymptomatic men.     

Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists

OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.     

Review of Documenting psychotherapy: Essentials for mental health practitioners.

Reviews the book, Documenting psychotherapy: Essentials for mental health practitioners by Mary E. Moline, George T. Williams, and Kenneth M. Austin (see record 1997-36283-000). Despite the newness of the field, writing about treatment documentation is already a daunting task. Psychotherapy documentation is controlled by both state law and by ethics codes of the various disciplines involved in treatment. Thus, it is not surprising that Documenting Psychotherapy is an uneven book, with significant gaps in the text. The book is divided into four parts, plus a large number of appendices. Each chapter contains brief summaries of selected court cases that highlight the chapter issues. In the first part, Moline et al. cover the importance of record-keeping, giving good arguments in favor of keeping comprehensive records. They address issues of confidentiality in this part as well. Part II outlines what information should go into the record. Part III addresses safety issues and Part IV addresses miscellaneous issues, including treatment of minors, client access to records, and retention of records. Overall, Moline et al. have made a good attempt at an overwhelming project, but they fell victim to the volume of material in the field. Their book gives a good overview of ethical and legal issues in record-keeping, and may be helpful to inexperienced practitioners. Their interpretation of specific legal issues is very good and very clear. However, for those practitioners who are facing specific questions about how to document psychotherapy, how to respond to requests for information, or how to deal with legal issues, this book cannot replace a clear knowledge of one's state and discipline regulations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child custody resolution: A study of social science involvement and impact.

To explore the use of mental health professional expertise in the legal system, legal professionals' sources of social science information, and the legal profession's perspectives on the appropriate roles of mental health professionals in the process, we solicited information from attorneys and judges on (a) the extent to which they actively seek the involvement of mental health professionals in child custody cases, (b) the factors that influence such involvement, and (c) the degree to which these attitudes and practices are influenced by social science data or theory. Among the most striking features of these results was the report by the overwhelming majority of legal professionals that they did not consider either social science data or mental health professionals' involvement or recommendations in child custody cases as critical to their practice of family law. Specifically, mental health participation was rarely solicited, and when it was, this decision rested primarily on the paradigmatic regularities of the legal system or practical needs of the case rather than on a view that such involvement was central to the client's or child's mental health. The implications of these findings for collaboration between the mental health and legal disciplines in the area of family policy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling and therapy on the Internet.

Rapid development of Internet technology has allowed a growing number of individuals and corporations to offer consumers, health care services, or "eHealth," including counseling and therapy. Almost no information exists about such individuals, due in part to difficulties in conducting research over the Internet. An Internet survey solicited backgrounds, communication technologies, and clinical interventions from individual behavioral eHealth care practitioners. Results are discussed regarding legal, ethical, and professional issues related to use of different Internet technologies. Psychologists are urged to give proper attention to empirical research, language, and current standards of practice before attempting to deliver counseling or psychotherapy over the Internet. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

National survey of ethical practices across rural and urban communities.

This study examines ethical dilemmas and problems that are encountered by psychologists across rural and urban communities. A survey instrument was created on the basis of previous surveys of ethical practices. A national sample of 1,000 psychologists stratified into urban and nonurban practitioners was surveyed; 447 usable surveys were returned. Data analysis revealed significant differences between small town/rural and urban/suburban groups for several ethical categories. Notably, small town/rural psychologists are more likely to encounter several types of multiple relationships than their urban counterparts. Small town/rural practitioners are also more likely to be highly visible, or well-known, in their communities. Qualitatively, respondents described their struggles with dual relationships, and several offered suggestions to cope with boundary issues. These findings suggest the need to study the practice of psychology in rural communities in more depth, to study the impact of rural characteristics on clients and practitioners, and to create a conceptual model of best practices for rural practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)