Lying to insurance companies: the desire to deceive among physicians and the public

This study examines the public's and physicians' willingness to support deception of insurance companies in order to obtain necessary healthcare services and how this support varies based on perceptions of physicians' time pressures. Based on surveys of 700 prospective jurors and 1617 physicians, the public was more than twice as likely as physicians to sanction deception (26%versus 11%) and half as likely to believe that physicians have adequate time to appeal coverage decisions (22%versus 59%). The odds of public support for deception compared to that of physicians rose from 2.48 to 4.64 after controlling for differences in time perception. These findings highlight the ethical challenge facing physicians and patients in balancing patient advocacy with honesty in the setting of limited societal resources.     

Religion and anxiety treatments in primary care patients

Earlier data suggested that religious physicians are less likely to refer to a psychiatrist or psychologist. This follow-up study measures how religious beliefs affect anxiety treatments in primary care. We surveyed US primary care physicians and psychiatrists using a vignette of a patient with anxiety symptoms. Physicians were asked how likely they were to recommend antianxiety medication, see the patient for counseling, refer to a psychiatrist, refer to a psychologist or licensed counselor, encourage meaningful relationships and activities, and encourage involvement in religious community. We experimentally varied symptom severity, whether the patient was Christian or Jewish, and whether she attended religious services. Physician attendance at religious services was assessed in the survey. The response rate was 896 out of 1427 primary care physicians and 312 out of 487 psychiatrists. Religious physicians were more likely to promote religious resources. There was no statistically significant difference between physicians' recommendations for religious and nonreligious patients. There was no statistically significant difference in religious and nonreligious physicians' referrals to a psychologist, licensed counselor, or psychiatrist. Ultimately, we did not find a difference in religious and nonreligious physicians' support for mental health referrals, however, religious physicians were more likely to encourage using religious resources.     

Looks like a liar? Beliefs about native and non-native speakers' deception

We examined whether observers' beliefs about deception were affected by a speaker's language proficiency. Laypersons (N = 105) and police officers (N = 75) indicated which nonverbal and verbal behaviors were predictive of native versus non-native speakers' deception. In addition, they provided their beliefs about these speakers' interrogation experiences. Participants believed that native and non-native speakers would exhibit the same cues to deception. However, they did predict that non-native speakers would likely face several challenges during interrogations (e.g., longer interrogations and difficulties understanding the interrogator's questions). Police officers and laypersons also differed in their beliefs about cues to deception and interrogation experiences.     

Cost containment: Issues of moral conflict and justice for physicians

In response to rapidly rising health care costs in the United States, federal and state governments and private industry are instituting numerous and diverse cost-containment plans. As devices for coping with a scarcity of resources, such plans present serious challenges to physicians' traditional single-minded devotion to patient welfare. Those which contain costs by directly limiting medical options or by controlling physicians' daily clinical decisions can threaten the quality of medical care by allowing economic authorities to make essentially medical judgments. In contrast, other plans coax compliance by arranging incentives, e.g., offering financial rewards for successful cost containment. While they allow for clinical freedom, these plans create conflicts between physicians' fiduciary obligations to their patients and the competing interests of the payers. Such conflicts arise as physicians try to work within governmental or corporate cost containment policies, and also as they attempt to “streamline” clinical efficiency. Throughout, issues of justice emerge as physicians seek to reconcile their own patients' claims upon limited common resources with others' equally legitimate claims.     

Visual Power in Action: Digital Images and the Shaping of Medical Practices

The increasing presence of images in medicine is mostly understood as a visualization of medicine. In this view, physicians and researchers are strongly guided by the visual power of images. Ethnographic fieldwork and interviews with physicians and scientists working in radiology departments and magnetic resonance imaging units however, show that visual power is not always effective. Depending on a situation, physicians and scientists are guided more strongly either by the persuasiveness of an image's visual qualities or its scientific and sociomaterial qualities. Actors trust in images and perceive them as attractive and objective in certain situations, whereas in others they classify images as manipulated representations that are untrustworthy. It is either the visual power or the status of images as scientific and sociomaterial facts that shapes physicians' and researchers' actions. Depending on whether an image is used, for example, to make a diagnosis, to validate a research finding, to communicate with a patient, to prevent litigation, or to improve one's position in the professional field, it is either the visual power or the scientific and sociomaterial characteristics of an image that are more effective in shaping medical practices. Fieldwork and interviews with physicians and scientists show in which situations visual power is relevant (or not) for medical practices.     

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.     

Awareness of Hospital Environment and Organizational Commitment

Abstract

This research examined possible differences between physicians and nurses in their commitment to their hospital and the relationship of their organizational commitment to their awareness of both the internal and the external environments of the organization. Data came from a public hospital in India. Questionnaires were developed for the measurement of the two predictor variables (awareness of the organization's internal environment and awareness of the organization's external environment) and the one predicted variable (organizational commitment). The results indicated significant differences in organizational commitment across hierarchies. The nurses' organizational commitment was predicted by their awareness of internal environment; the physicians' organizational commitment was predicted by their awareness of external environment.     

Ethical considerations surrounding first time procedures: a study and analysis of patient attitudes toward spinal taps by students

A patient is not always told when a student is performing a procedure for the first time. Withholding this information is a form of deception. It is justified on paternalistic grounds (it is in the patient's interest not to know), or on public policy grounds (given the choice, patients would refuse, thus compromising the training of future physicians). Using the spinal tap procedure (lumbar puncture) as a paradigm, 173 patients were surveyed to determine how they felt about first time procedures by medical students, interns, and residents. The patients indicated that they would be willing to be the subject for a student's (52%), intern's (62%), or resident's (66%) first spinal tap. This paper reassesses the ethics of consent for first time procedures based on responses to this survey.     

Achieving activity transitions in physician‐patient encounters.

This article examines how physicians and patients interactionally accomplish the transition from the activity of history taking to that of physical examination. Prior research focuses on participants' reliance on overt verbal resources (e.g., physicians' requests for permission to examine patients or explanations that foreshadow examination). Using the methodology of conversation analysis, this article draws on a corpus of 40 primary‐care encounters to demonstrate that: (a) In addition to verbal behavior, nonverbal behavior is integral to the accomplishment of transitions; and (b) patients' understandings of physicians' verbal and nonverbal behavior as communicating transitions are achieved through situating those behaviors in other contexts of embodied action, talk, activity, and social structure (i.e., the phase structure of encounters). Findings have implications for: (a) the theoretic relationship between verbal and nonverbal behavior in terms of social meaning, (b) what it means to explain transitions and reduce patients' uncertainty, (c) the organization of physician‐patient interaction, and (d) the relationship and interface between macro‐ and microconceptualization of context.     

The Interrater Reliability of Elizur's Hostility Systems and Holt's Aggression Variables: A Meta-Analytical Review

TAT performances of mathematicians, creative writers and physicians were compared by means of Pine's (1960) system for rating amount, integration, and directness of drive expression; and also in terms of expression of affect. Writers were most expressive, followed by mathematicians and then physicians. Mathematicians relied relatively heavily upon use of direct, socialized forms of drive content, while physicians emphasized indirect or disguised forms more than other Ss. These emphases appeared to have defensive and integrative functions, as did the physicians' generally suppressive style. The writers showed no comparable emphases on direct or indirect expression. There were no inter-group differences in overall adjustment Pine's scoring system appears to have considerable potential for comparisons of this kind.     

Is it acceptable for a physician to break confidentiality in the case of sexually transmitted diseases? A mapping of young Kuwaiti's views

IntroductionConfidentiality is essential for the establishment of trust between physicians and their patients.ObjectivesThe circumstances under which it is acceptable to young Kuwaiti for a physician to break confidentiality to protect the spouse of a patient with a sexually transmitted disease (STD) were examined.MethodA sample of 263 young Kuwaiti indicated the acceptability of breaking confidentiality in 48 scenarios that were all possible combinations of five factors: disease severity, time taken by the physician to discuss with the patient, the patient's intent to inform the spouse about the disease, the patient's intent to adopt protective behaviors, and the decision to seek the advice of an expert in infectious diseases before breaking confidentiality.ResultsThrough cluster analysis, four qualitatively different positions were found: Quite never acceptable (6% of the sample, mostly males), Depends on husband's willingness to inform (3%), Depends on husband's protective behavior (29%, mostly females), and Quite always acceptable (32%). The remaining participants did not express any clear view.ConclusionIn Kuwait, students’ trust in the medical profession is, therefore, not likely to be seriously undermined if, from time to time, and in well-specified cases, individual physicians decide to break confidentiality when facing dilemmas of the kind examined in the current study.     

Professional Ethics of Psychologists and Physicians: Mortality,Confidentiality, and Sexuality in Israel

Clinical psychologists' and nonpsychiatric physicians' attitudes and behaviors in sexual and confidentiality boundary violations were examined. The 171 participants' responses were analyzed by profession, sex, and status (student, resident, professional) on semantic differential, boundary violation vignettes, and a version of Pope, Tabachnick, and Keith-Spiegel's (1987) ethical scale. Psychologists rated sexual boundary violation as more unethical than did physicians (p<.001). Rationale (p<.01) and timing (p<.001) influenced ratings. Psychologists reported fewer sexualized behaviors than physicians (p<05). Professional experience (p<.01) and sex (p<.05) were associated with confidence-violating behavior. Overall, 78% of the sample reported attitudes or behaviors associated with boundary violations. The behavior violations were correlated (r=.49). Actual violators rated vignette violators more leniently than did nonviolators (p<.01).     

Fast and frugal versus regression models of human judgement

Following Brunswik (1952), social judgement theorists have long relied on regression models to describe both an individual's judgements and the environment about which such judgements are made. However, social judgement theory is not synonymous with these compensatory, static, structural models. We compared the characterisations of physicians' judgements using a regression model with that of a non-compensatory process model (called fast and frugal). We found that both models fit the data equally well. Both models suggest that physicians use few cues, that they disagree among themselves, and that their stated cue use is discrepant with the models' stated cue use. However, the fast and frugal model is easier to convey to physicians and is also more psychologically plausible. Implications for how social judgement theorists conceptualise the process of vicarious functioning are discussed.     

Motivational cues: The role of perceived senders' self‐control ability in raters' deception judgements

Previous studies have found that senders' personal traits may be used by others to make judgements about the senders' truthfulness. Two studies were conducted to examine whether perceived self‐control ability has an effect on deception judgement. Perceived self‐control was hypothesized to act as a motivational cue that participants would use to assess the sender's motivation to lie, which in turn would influence their deception judgement. Results revealed that when participants assessed the sender as having higher self‐control ability, they would consider the sender to be less motivated to lie in daily life (Study 1), and judge the sender more truthful in a text‐based deception judgement task (Study 2). However, the effect of perceived self‐control ability disappeared in a video‐based task (Study 2), likely due to the multitude of various cues available in audio‐visual stimuli. The theoretical and applied implications of the results are discussed.     

Judgments of damage to public versus private property in Chinese children at different historical times

This study examined children's judgments of damage to public versus private property in China at two historical times. Participants were two cohorts (1980 and 2012) of elementary school children at ages 7, 9, and 11 years. The children were administered paired stories that described a protagonist who damaged public or private property with a good or bad intention. The results showed that children in the 2012 cohort were less likely than their counterparts in the 1980 cohort to judge damage to public property as more culpable than damage to private property. The cohort differences were more evident in older children than in younger children. The results suggest that macro‐level contexts may play an important role in shaping children's judgments.     

Active Versus Passive Euthanasia: An Attributional Analysis1

The present study investigates the way in which observers judged physicians who engaged in various acts of euthanasia. These acts varied over two dimensions: voluntary versus nonvoluntary (on the patient's part) and active versus passive (on the physician's part). Vignettes about a patient who was severely burned in an apartment fire were read by 632 subjects (199 men and 433 women). The vignettes varied the physician's actions and whether the patient requested to die or not. After reading one vignette, participants responded to a 19-item questionnaire to assess the moral evaluation, responsibility, and professional conduct of the physician. The results indicated no significant differences in the perception of the physician involved in voluntary or nonvoluntary euthanasia. The physician was perceived more negatively, held more responsible, and perceived as acting outside the standards of the medical profession in situations of active euthanasia in contrast to passive euthanasia. The data also suggested that the temporal relationship of the physician's behavior to the patient's death affected the perception of the physician's responsibility and professional conduct.     

American Muslim Physician Attitudes Toward Organ Donation

Religious beliefs and values impact Muslim patients' attitudes toward a variety of healthcare decisions, including organ donation. Muslim physician attitudes toward organ donation, however, are less well studied. Utilizing a national survey of physician members of the Islamic Medical Association of North America, relationships between religiosity, patterns of bioethics resource utilization, and sociodemographic characteristics with attitudes toward organ donation were assessed. Of 255 respondents, 251 answered the target question, “in your understanding, does Islamic bioethics and law permit organ donation?.” 177 respondents (70%) answered positively, 30 (12%) negatively, and 46 (18%) did not know. Despite the overwhelming majority of respondents believing organ donation to be permitted by Islamic bioethics and law, fewer than one-third (n = 72, 30%) are registered donors. Several sociodemographic features had a positive association with believing organ donation to be permitted: ethnic descent other than that of South Asian, having immigrated to the USA as an adult, and male sex. When using a logistic regression model controlling for these three variables as potential confounders, the best predictor of Muslim physicians believing organ donation to be permissible was utilization of an Imam as a bioethical resource (odds ratio 5.9, p = 0.02). Religiosity variables were not found to be associated with views on the Islamic permissibility of organ donation. While Muslim American physicians appear to believe there is religious support for organ donation, only a minority sign up to be donors. Greater study is needed to understand how physicians' attitudes regarding donation impact discussions between patients and physicians regarding the possibility of donating and of receiving a transplant.     

Doctors and patients: Partners or adversaries?

The author suggests that an inadequate understanding of the ethical relationship between doctors and patients is at the core of many current health care issues. The doctor-patient relationship is discussed with an emphasis on the expectations of patients and physicians. Three sets of expectations or models of doctor-patient interaction are reviewed and a number of health care issues are explored in this frame-work. It is hypothesized that when doctors and patients have similar expectations they will be partners and that when they differ, they are more likely to be adversaries. Finally it is suggested that unless national health policy is designed to take into account the effect of legislation on physicians' and patients' expectations, dissatisfaction with health care will continue to increase.     

Physicians View Death and Suicide*

ABSTRACT: Comparisons were made between physicians' attitudes toward death and suicide and those of a nonphysician control group. Results of the analysis revealed significant differences that may offer some insights as to why physicians have an elevated suicide rate.