The doctor-patient relationship in the post-managed care era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a "post-managed care era," where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

Resource scarcity and outcome conflict in time-sharing performance

The efficacy of the resource-scarcity and outcome-conflict views in explaining dual-task interference was examined. A discrete—continuous task pair was purposely chosen to allow fine-grained analysis of time-shared performance. The relative priority of the dual task was manipulated by a secondary task technique to test for performance tradeoff that would be indicative of resource allocation. The temporal predictability of the discrete stimuli was manipulated to examine possible strategic avoidance of interference. The moment-by-moment data did not reveal any evidence for a switching strategy. It was concluded that the intricate interference patterns could be more easily interpreted within the resource framework than within the outcome-conflict framework.     

What we must Accomplish in the coming Decades

Abstract. In order to survive as a species and grow in complexity, humanity must adopt a new image of what it means to be human, rediscover a reward system beyond the merely material, and see that young people find joy in challenges and in cooperating with others.     

The stress of coming out

To conclude, (1) although homosexuality has been recognized for hundreds of years, we still do not understand it completely. (2) This paper places emphasis on the process of individuation and gender-identity that takes place very early in childhood as the cause of homosexuality. (3) If the process is not completed properly, the individual's gender-identity will deviate from that of the vast majority of people. Homosexuality is, therefore, considered by me as a deviation from, rather than a variation of, human sexuality. (4) The degree of neurosis or psychosis associated with homosexuality or heterosexuality is not causal in nature, although the two are intimately intertwined. (5) The stress of coming out varies a great deal in intensity and depends on the degree of integration of the individual and the support given to him by his friends, associates, and family. (6) Although the last decade has brought about a greater acceptance of homosexuality than ever before, sufficient prejudice, ignorance, and fear remain to keep many homosexuals "in the closet." (7) Even today the disclosure of one's homosexuality threatens the individual with the loss of so many important aspects of his life, such as his job, his friends, and even his family, that there is little wonder that coming out of the closet poses such problems for so many homosexuals.     

Research in the high-stakes era

The federal No Child Left Behind Act (NCLB; 2001), mandating standardized testing in public schools, provides researchers with unprecedented opportunities for scientific comparison. At the same time, the climate of high-stakes testing encouraged by the law merits empirical scrutiny from psychologists across an array of specialties. If researchers wish to advance policy through psychological science, they must take care to construct research designs that are meaningful to policymakers and professionals in other disciplines. The present study used data from 1,450 Virginia schools to provide a model of scientifically grounded research that is also informed by current legal and political contexts. Results indicate that student poverty and geography are associated with differential access to highly qualified teachers, and that differential access to qualified teachers is uniquely associated with performance on high-stakes achievement tests. Psychologists, with their unique training, are encouraged to take a more active role in using NCLB data.     

Integration: A coming of age

Integration is one of the most prevalent contemporary themes in the field of family therapy. This discussion proposes a process-based model of integration which transcends theoretical content. A brief review of integrative efforts in the field of marriage and family therapy is followed by an exploration of issues related to theoretical content. A model for understanding the personal process of integration is developed which articulates a five stage process of integration. Finally, after a brief character development to illustrate the different stages, some initial implications for a process-based model of integration are explored.David J. Moultrup, MSW, LICSW, is in private practice in Arlington, Massachusetts.     

智能时代的工程心理学

智能技术为智能时代的工程心理学研究和应用提供了新的机遇。为此, 系统提出了智能时代工程心理学的工作框架。该工作框架包括工程心理学研究和应用的对象、核心问题空间、学科理念、研究重点、应用范围、方法等。智能时代的人机关系呈现出一种新的形式: 人机组队式的人机合作关系。“以人为中心的人工智能”应该是智能时代工程心理学的学科理念。针对智能技术, 近期工程心理学研究者开始开展围绕新型人机关系的理论框架和基本问题、人机组队中的心理结构和决策控制、人机交互等方面的研究工作。为有效支持智能系统的研发, 概括总结了一些工程心理学新方法和提升的方法。最后, 针对当前工程心理学所面对的一些挑战提出了具体的建议。     

Rethinking professional ethics in the cost-sharing era

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions--an "aspirational ethic" that exhorts physicians to treat all patients the same regardless of their ability to pay, and an "agency ethic" that calls on physicians to be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay.     

Diffusion of entitlement: An inhibitory effect of scarcity on consumption

Four studies demonstrated that increasing a desirable commodity's scarcity (i.e., decreasing its supply or increasing demand for it) can inhibit people from claiming the commodity for themselves, thereby delaying its consumption. In Study 1, participants were slower to claim a commodity when its supply was limited versus unlimited. In Study 2, participants expressed more disapproval of someone who took the last commodity compared to the second-last commodity. Participants in Study 3 anticipated that increased demand for a commodity would make them less likely to claim it despite wanting it more. Study 4 showed that the more participants there were who could claim a commodity, the longer it went unclaimed. The inhibitory effect of scarcity was mediated by diminished entitlement to the commodity (Study 3), and increasing entitlement reduced the inhibition against taking scarce commodities (Studies 1 and 2). These findings are discussed in the context of individuals' concern with equality.