Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.     

Best Practices in the Multidisciplinary Assessment of Emotional Disturbances: A Primer for Counselors

Emotional and behavioral difficulties often interfere with children's acquisition of academic, career, and social skills. Counselors assume an important role in the mandated multidisciplinary evaluation of children with emotional disturbance (ED), but the field lacks a standard battery of assessment procedures for working with children who have ED. The authors review the current issues related to students with ED, describe instruments and procedures used to assess ED, and discuss the counselor's role in the assessment process.     

Child sexual abuse, early family risk, and childhood parentification: pathways to current psychosocial adjustment.

In this study, the authors examined the role of parentification (children assuming adult-like roles in the family) as it relates to family risk (parental psychopathology, parental illness, and domestic violence), child sexual abuse (CSA), and psychosocial adjustment in 499 college women. Structural equation modeling was used to test a model of direct, indirect, and mediational pathways through which CSA, family risk, and parentification contributed to later psychosocial maladjustment. Results indicate that CSA and family risk independently and directly predicted higher levels of maladjustment, but only family risk positively predicted parentification in childhood. Parentification was unexpectedly related to less maladjustment. Parentification failed to mediate the relation between early family risk and maladjustment. Findings suggest that family risk factors may contribute to parentification and that parentification is not always related to poorer psychosocial outcomes. Future research should examine the impact of parentification on other aspects of functioning and should assess how individual, familial, and cultural variables (e.g., age, gender, duration, perceived fairness, ethnicity, and family support) moderate the impact of parentification on long-term adjustment.     

The timing of verbal/vocal communications between mothers and their infants: a longitudinal cross-cultural comparison

Early dialogues between parent and child constitute an important factor for the acquisition of culture and hence verbal interaction is considered to be a universal parenting system. Parenting strategies and socialization practices are strongly influenced by the cultural conception of the self, prototypically defined as the model of independence and interdependence. Our study focuses on the temporal organization of spontaneous verbal/vocal behavior of 20 German middle-class and 28 Cameroonian Nso mother–infant dyads. The infants and their mothers were observed weekly in a 5 min free-play interaction scene from 0 to 3 months of age. We hypothesized to find different amounts of vocalization time, synchronous vocalizations, and contingent maternal responses in the verbal/vocal patterns of the two samples. The findings indicate cross-cultural differences in the temporal structure of verbal/vocal interactions already during the first three months of life, reflecting underlying differences in the culture-specific modes of verbal interaction.     

The use of perceptual features in categorization by orangutans (<Emphasis Type="Italic">Pongo abelli</Emphasis>)

The extent to which categorization of natural classes in animals reflects a generalization based on perceptual similarity versus an abstract conceptual representation remains unclear. Here, two experiments were conducted to identify the perceptual features used by orangutans when categorizing pictures. In Experiment 1, subjects were trained and tested for transfer on a concrete discrimination (gorillas or orangutans vs. other primates). Analysis of performance on both positive and negative exemplars revealed that performance was best on photos with faces, particularly close-ups. Moreover, error trials did not seem to reflect instances of mistaken identity, but rather, exemplars that may have been distracting for other reasons, such as novel coloration or morphology. In Experiment 2, photos were modified to test the effects of various features. Color modifications caused the biggest decrease in performance, and eye modifications also affected performance deleteriously. Therefore, two perceptual features, namely eye regions and color, played a key role in subjects' ability to categorize. However, performance based on an underlying concept cannot be ruled out, because both of these features are highly relevant in terms of defining category membership. Although a subset of features was identified as playing a key role in categorization, these features differed depending on whether feature-use was studied indirectly, as in Experiment 1, or directly, as in Experiment 2.     

A Survey of Clinical Supervision in Genetic Counseling

Three hundred and thirty-five full members of the National Society of Genetic Counselors completed a survey concerning the nature of clinical supervision for genetic counseling students. Slightly over half (54.3%, n = 182) had provided clinical supervision within the past 5 years. Of those who supervised, 66.7% had 5 years or less supervision experience, and 55% had supervised 10 or fewer students. The majority became supervisors because they enjoy teaching and contributing to the profession. Common reasons for not supervising include no local graduate program, and had never been asked to supervise. Live supervision is the most prevalent student evaluation method: every supervisor reported providing one-on-one oral feedback, and 47.3% indicated that they always provide feedback immediately following a counseling session. The most frequent challenges involve students who lack technical knowledge and who fail to incorporate feedback. Training, policy, and research implications are discussed.     

How regulatory fit enhances motivational strength during goal pursuit

Higgins' (2000) theory of regulatory fit proposes that motivational strength will be enhanced when the manner in which people work toward a goal sustains (rather than disrupts) their regulatory orientation. This enhanced motivational strength in turn should improve efforts at goal attainment. In Experiment 1, predominantly promotion‐ and prevention‐focused participants were given the goal of writing a report on their leisure time, and were assigned either eagerness‐ or vigilance‐framed means to use. Promotion/eagerness and prevention/vigilance participants were about 50% more likely to turn in their reports than promotion/vigilance and prevention/eagerness participants. In Experiment 2, participants read either a promotion‐ or a prevention‐framed health message urging them to eat more fruits and vegetables, and were then asked to imagine either the benefits of compliance or the costs of non‐compliance. Promotion/benefits and prevention/costs participants subsequently ate about 20% more fruits and vegetables over the following week than promotion/costs and prevention/benefits participants. The implications of regulatory fit's enhancement of motivational strength are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Women and Alcoholism: A Biopsychosocial Perspective and Treatment Approaches

Viewing alcoholism in women from a biopsychosocial perspective reveals a unique set of circumstances and challenges that women alcoholics face when compared with men. Biologically, women react differently to alcohol ingestion than do men. Women reach higher blood alcohol levels and sustain more somatic and cognitive damage than men when consuming equivalent amounts of alcohol. Psychosocially, women alcoholics face societal rebuke and chastisement of a greater magnitude than do men. Finally, barriers to treatment faced by women, such as the need for child care, cost of treatment, familial opposition, denial of alcoholism, and inadequate diagnostic training of physicians, must be overcome to create successful treatment approaches for the female alcoholic. Obstacles to and implications for treatment are also discussed.