Physicians' values and physician-value neutrality

For years articles have decried the lack of empathy in physicians' relationships with patients. In addition to being empathetic, physicians are called upon to assume the posture of value neutrality, i.e., not imposing one's values when dealing with patients. Empathy is clearly an expression of deeply held values; even the language used to define it is value-laden. Physicians are consistently called upon to exhibit traits which are expressions of their underlying values. However, if proponents of value-neutrality are to be taken literally one must not impose any of one's values on one's patients. But then one wonders how empathy could ever be expressed; further, it is hard to imagine what a truly value neutral physician would be like. It is time we recognize that any relationship between two persons requires the expression of values from both parties. These values help shape that relationship and define its further history. Physicians are not excluded from this process just because they consider themselves professionals. Divulging personal values to patients is both more honest and more in keeping with the concepts of justice, beneficence, non maleficence, and autonomy than to feign value-neutrality. A presentation of some type statement of values is timely and would give patients an idea of where a physician stands on a myriad of issues. Rather than being value-neutral, value non-neutrality seems a more right and reasonable posture for physicians to assume.     

Decision strategies and visual-field asymmetries in same-different judgments of word meaning

The accuracy with which observers judged whether two words belonged to the same semantic category was determined from a detection-theoretic analysis ofsame-different judgments. In Experiment 1, one word was presented centrally and the other word in either the left visual field (LVF) or the right visual field (RVF); in Experiment 2, both words were presented to either the LVF or the RVF. In order to obtain receiver-operating characteristics (ROCs) of performance, observers were asked to rate their confidence that the two words belonged to the same semantic category. Two models of the decision strategy were fitted to the obtained characteristics: a differencing model, in which the decision variable was the difference between the two observations; and an optimal model, in which each observation was judged in relation to a criterion. In both experiments, the optimal model provided a better fit than the differencing model to the obtained characteristics. Maximum-likelihood estimates of both the criterion-free parameter,d′, and the area under the operating characteristic,p(A), were greater for words presented in the RVF than for those presented in the LVF.     

The psychology of christian prayer: a review ofempirical research

This paper presents, discusses and evaluates empirical studies concerned with Christian prayer. These studies are classified within four main areas. The first area concerns what is known about the practice of prayer from empirical surveys and demonstrates that a much higher proportion of people pray privately than attend public places of worship. The second area concerns what is known about changing patterns of prayer during childhood and adolescence and argues that these changes need to be interpreted within the context of both developmental and social psychology. The third area concerns the subjective effects of prayer, beginning with Galton's early observations concerning the comparative longevity of the clergy (who are regarded as praying people) and including more recent studies of the psychological correlates of self-reported prayer, like personal well-being and purpose in life. It is concluded that, while such studies may demonstrate the beneficial nature of prayer, they cannot demonstrate the causal efficacy of prayer. The fourth area concerns the objective effects of prayer, beginning with Galton's early observations concerning the absence of comparative longevity among royalty (who are regarded as prayed for people) and including more recent studies of the growth correlates of prayer for pot plants. It is concluded that such studies currently provide contradictory evidence. It is recommended that further research in the field needs both to observe the strict criteria of objective empirical research and to be alert to theological nuances regarding the actual claims made for the efficacy of prayer within the community of believers.     

The current environment for medical decision making: Alternative efficiency concepts and decision motivation

Health services delivery is rapidly changing in the U.S. and along with it the incentives and motives for making decisions about the use of services. This paper discusses the economic criteria for making good decisions from both individual and social perspectives. The position is taken that individual criteria for decision-making efficiency in health services is quite different from social efficiency criteria but the two perspectives can be viewed as complementary. These criteria are used to examine current developments in health services, including aggressively competitive managed care. The analysis concludes that current directions may be in conflict with both social and individual efficiency. Alternative public policies are required to alter motives and incentives such that decisions better meet the complementary efficiency criteria.Originally prepared for presentation at the Annual Meeting of the American Association for the Advancement of Science, Atlanta, Georgia, February 17, 1995, as part of the symposium Cognitive Interpersonal, and Societal Influences on Medical Decision Making (A. M. Isen and B. S. Moore, Chairs).     

Book reviews

Science as Salvation: a Modern Myth and its Meaning, Mary Midgley, 1994. London, Routledge x +256pp., Hb 04 15062713, £35; Pb 04 15107733, £8.99

Philosophical Naturalism, David Papineau, 1993 Oxford, Basil Blackwell xii +219pp., Hb 0631189025, £40; Pb 0631189033, £14.99

F. H. Bradley, Writings on Logic and Metaphysics, James W. Allard & Guy Stock (Eds), 1994. Oxford, Clarendon Press xv+357pp, Hb 0–198–24445–2, £40.00; Pb 0–198–24438‐X, £14.95

Invariance and Heuristics: Essays in Honour of Heinz Post, Steven French & Harmke Kamminga (Eds), 1993 Boston Studies in the Philosophy of Science, Vol. 148 Kluwer Academic Publishers, Dordrecht

Beyond Reason: Essays on the Philosophy of Paul Feyerabend, GONZALO MUNÉVAR (Ed.), 1991. Dordrecht, Kluwer Academic Publishers xxi + 535pp., hb, ISBN 0–7923–1272–4, £104.20

World Changes: Thomas Kuhn and the Nature of Science, Paul Horwich (Ed.), 1993. Cambridge, MA, Bradford Books/MIT Press vi + 356pp., pb, ISBN 0262581388, £14.95

Realism Rescued: How Scientific Progress is Possible, Jerold L. Aronson, Rom Harré & Eileen Cornell Way, 1994 London, Duckworth vii +213pp., Hb 0715624768, £30.00

Scientific Nihilism: On the Loss and Recovery of Physical Explanation, Daniel Athearn, 1994. State University of New York Press, Albany ix + 387pp., Hb ISBN 0–7914–1807–3, £52

Theism, Atheism, and Big Bang Cosmology, William Lane Craig & Quentin Smith, 1993. Oxford, Clarendon Press x +342pp., Hb 0198263481, £35; Pb 019826383X, £13.95     

Outcomes of inpatient group psychotherapy associated with dispositional and situational affiliativeness

Before and after participating in an intensive three-week program of group psychotherapy, 33 recently rehospitalized male veterans (mean age=42) completed the Symptom Check List-90R and the Profile of Mood States. Prior to this program they also completed a trait affiliativeness measure and later rated their subsequent group therapy sessions for situational affiliativeness. The outcome measures indicated medium to large effect size benefits, which consistently associated positively with both separate and joint measures of trait and situational affiliativeness. The results encourage greater clinical attention to affiliativeness, a construct central to interpersonal theories of personality.This article is based upon a dissertation submitted to the Department of Psychology, Michigan State University, in partial fulfillment of the requirements for the Ph.D. by the senior author.The authors express appreciation for the interest and cooperation of Drs. Bruce Vreeland, Larry Schwartz, Robert Munley, and Hope Conte and the patients of the Veterans Administration Medical Center, Battle Creek, Michigan.     

The Cost of Client Transfer

Clients undergoing transfer from one counselor to another were compared on the Generalized Contentment Scale and a DSM-III-R measure with clients staying with the same counselor over the same length of treatment. In three 12-week blocks, the clients with the same counselor made the greatest progress in the first 12 weeks, making less progress in each successive block. The clients who were transferred in the middle of the second 12-week block also made the greatest progress in the first time block, lost some of the progress in the transfer block, and made significant progress with the new counselor in the third time block, ending with no significant differences in either generalized contentment or DSM-III-R outcome from clients who had not been transferred.