Voices from the Front Lines: An Analysis of Physicians’ Reflective Narratives about Flaws with the ‘System’

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals (NEJM, JAMA, CMAJ, Annals IM) between January 2015 and December 2017 (n?=?282). By consensus, we identified those that addressed system flaws (n?=?87). Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity.

     

Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent–Child Relationships Compensate?

Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent–child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n?=?1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual’s classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent–child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent–child relationships. This highlights the importance of considering the quality of friendships and parent–child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.

     

The heterogeneous processes of cheating: Attention evidence from two eye tracking experiments

Dishonesty erodes society. Although much is known about dishonesty, the process leading up to the decision of whether to be honest or dishonest is often assumed to be homogenous and is not well understood. In this paper, we take a more nuanced approach and explore more closely the process of deciding whether to cheat or be honest when an opportunity to cheat arises. We do this in two laboratory eye tracking experiments. In our first experiment (n = 193), we identify heterogeneity in the decision to cheat. Some decisions on whether to cheat or be honest exhibit relatively little variation and appear to be oriented towards cheating (or honesty) with apparently little consideration of the alternative, whereas other decisions seem to be characterized by a higher degree of consideration for both decision alternatives. Our second experiment (n = 299) demonstrates that a gaze dependent intervention in the choices process is able to affect the behavioral outcomes.     

Cross‐national comparisons of attitudes towards suicide and suicidal persons in university students from 12 countries

This paper reports the results of a comparative investigation of attitudes to suicide and suicidal persons in 5,572 university students from 12 countries. Participants filled out two scales measuring attitudes towards suicide and suicidal persons, a measure of psychological distress together with the questions about suicidal behavior. Results showed that the highest suicide acceptance scores were observed in Austrian, UK, Japanese and Saudi Arabian samples and the lowest scores were noted in Tunisian, Turkish, Iranian and Palestinian samples. While the highest social acceptance scores for a suicidal friend were noted in Turkish, US, Italian and Tunisian samples, the lowest scores were seen in Japanese, Saudi Arabian, Palestinian and Jordanian samples. Compared to participants with a suicidal past, those who were never suicidal displayed more internal barriers against suicidal behavior. Men were more accepting of suicide than women but women were more willing to help an imagined suicidal peer. Participants with accepting attitudes towards suicide but rejecting attitudes towards suicidal persons reported more suicidal behavior and psychological distress, and were more often from high suicide rate countries and samples than their counterparts. They are considered to be caught in a fatal trap in which most predominant feelings of suicidality such as hopelessness or helplessness are likely to occur. We conclude that in some societies such as Japan and Saudi Arabia it might be difficult for suicidal individuals to activate and make use of social support systems.     

Is ontological revisionism uncharitable?

Some philosophers (‘nihilists’) deny the existence of composite material objects. Other philosophers (‘universalists’) hold that whenever there are some things, they compose something. The purpose of this paper is to scrutinize an objection to these revisionary views: the objection that nihilism and universalism are both unacceptably uncharitable because each of them implies that a great deal of what we ordinarily believe is false. Our main business is to show how nihilism and universalism can be defended against the objection. A secondary point is that universalism is harder to defend than nihilism.     

Mobilizing cause supporters through group‐based interaction

Collective action expresses group‐based identities, formed by supporters seeking to further particular social causes. While the development of groups linked to action necessitates interaction among supporters, little research has examined how these groups form. Utilizing responses of supporters who participated in 1 of 29 action‐planning sessions, this research presents an initial attempt to identify the ingredients important to this process. It shows that to the extent that the actions agreed on in the course of group interactions were seen as capable of making a difference (action efficacy), and worthy of public expression (action voice), supporters’ group‐based identification was enhanced. This in turn increased their willingness to engage in collective action. Practical implications and avenues for future research to understand the mobilization process are discussed.     

Concepts as Semantic Pointers: A Framework and Computational Model

The reconciliation of theories of concepts based on prototypes, exemplars, and theory‐like structures is a longstanding problem in cognitive science. In response to this problem, researchers have recently tended to adopt either hybrid theories that combine various kinds of representational structure, or eliminative theories that replace concepts with a more finely grained taxonomy of mental representations. In this paper, we describe an alternative approach involving a single class of mental representations called “semantic pointers.” Semantic pointers are symbol‐like representations that result from the compression and recursive binding of perceptual, lexical, and motor representations, effectively integrating traditional connectionist and symbolic approaches. We present a computational model using semantic pointers that replicates experimental data from categorization studies involving each prior paradigm. We argue that a framework involving semantic pointers can provide a unified account of conceptual phenomena, and we compare our framework to existing alternatives in accounting for the scope, content, recursive combination, and neural implementation of concepts.     

What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model

Objective: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care.

Design: Longitudinal observational study in adults with type 2 diabetes.

Main outcome measures: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling.

Results: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern’s effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion’s effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time.

Conclusions: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.     

The Impact of Decision Timing on the Effectiveness of Leaders’ Apologies to Repair Followers’ Trust in the Aftermath of Leader Failure

Purpose

The aim of the present research was to investigate how a negative decision outcome generated by a leader in a hasty, timely, or delayed manner impacts upon the need for, and the effectiveness of apologies to restore followers’ trust.

Design/Methodology/Approach

Data were collected using five studies in which the effects of timing of an incorrect decision on the trust repair process were investigated.

Findings

In the aftermath of a leader’s failure, followers experienced a delayed incorrect decision as a more severe transgression than a hasty or a timely incorrect decision. This effect was mediated by procedural fairness concerns (Study 1). The present findings also revealed an interesting paradox. Specifically, in the delayed condition followers expressed the highest need for an apology (Studies 2 and 3), but at the same time expected an apology to be less effective for enhancing trustworthiness than in the timely and the hasty condition (Study 3). Moreover, we also showed that the actual provision of an apology was effective for restoring both trustworthiness (Study 4) and trust (Studies 4 and 5) in the timely and the hasty condition, but ineffective in the delayed condition.

Implications

The present research shows that when the outcome of a decision is uncertain, it is better to make a decision (too) soon rather than (too) late.

Originality/Value

Despite the ubiquity of timing errors in daily life, our studies are the first to focus on the role of timeliness of decisions in the trust repair process.

     

Characteristics of Children in Foster Care,Family-Style Group Care,and Residential Care: A Scoping Review

When risky child and family circumstances cannot be resolved at home, (temporary) 24-h out-of-home placement of the child may be an alternative strategy. To identify specific placement risks and needs, care professionals must have information about the child and his or her family, care history, and social-cultural characteristics at admission to out-of-home care. However, to date information on case characteristics and particular their similarities and differences across the three main types of out-of-home settings (namely foster care, family-style group care, and residential care) is largely lacking. This review compiles and compares characteristics of school-aged children of average intelligence and their families at the time of each child’s admission to one of the three care modalities. A scoping review technique that provides a broad search strategy and ensures sufficient coverage of the available literature is used. Based on the 36 studies included, there is consensus that the majority of normally intelligent children in care demonstrate severe developmental and behavioral problems. However, the severeness as well as the kinds of defining characteristics present differ among the children in foster care, family-style group care, and residential care. The review also identifies several existing knowledge gaps regarding relevant risk factors. Future research is recommended to fill these gaps and determine the developmental pathway in relation to children’s risks and needs at admission. This will contribute to the development of an evidence-based risks and needs assessment tool that will enable care professionals to make informed referrals to a specific type of out-of-home care when such a placement is required.