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.     

Why we can't get along

The author examines various arguments to explain the internal conflicts and schisms that have afflicted depth psychology since its beginnings. These arguments include the inevitable splits that occur in the course of institutional development, the inheritance of family schisms within the profession, historical, geographical and political influences, Freud's notion of the 'narcissism of minor differences' along with Gordon's idea of the need for enemies in establishing identity, and the impact of market forces. The author refutes these arguments and postulates instead that the profession attracts narcissistically disturbed members who have not been or cannot be sufficiently analysed. The profession needs to address this endemic narcissism in order to prevent further splitting and to establish a more ecumenical framework.     

Evaluation of two methods of prompting drivers to use specific exits on conflicts between vehicles at the critical exit

The Florida Department of Transportation used a series of changeable-message signs that functioned as freeway guide signs to divert traffic to Universal Theme Park via one of two eastbound exits based on traffic congestion at the first of the two exits. An examination of crashes along the entire route indicated a statistically significant increase in crashes at the first eastbound exit following the actuation of the system. Furthermore, all of the crashes occurred in close proximity to the exit gore (the crosshatched area at exits that drivers are not supposed to enter or traverse) at the first exit. In Experiment 1, behavioral data were collected using an alternating treatments design. These data revealed that reassigning the exit signs was effective in producing a change in the percentage of drivers using each of the two exits. These data also showed that the reassignment of the theme park exit was associated with an increase in the percentage of motor vehicle conflicts that consisted of vehicles cutting across the exit gore. An analysis revealed that the method used for switching the designated or active theme park exit on the series of changeable-message signs led to the presentation of conflicting messages to some motorists, thus resulting in erratic driving behavior (cutting across the exit gore). In Experiment 2, the treatment evaluated the use of a phased method of switching the designated theme park exit to eliminate the delivery of conflicting messages. The new method for switching the designated theme park exit was not associated with an increase in motorists cutting across the exit gore.     

Michael Balint's Group Approach: The Boston Balint Group

Michael Balint was a physician/psychoanalyst who trained in Hungary and emigrated to England in 1939 when Nazi Germany began to dominate Europe. At the Tavistock Clinic, he and his wife met with social workers and physicians around case discussion seminars. With his strong interest in medicine and his curiosity about the patient-physician relationship, he initiated research/training groups with interested physicians, which ultimately led to publication of the now-classic The Doctor, His Patient, and the Illness, a rich text that has become a virtual staple of family practice residencies, along with Balint Groups for training. Balint refrained from considering his groups psychotherapy in order to minimize resistance of his physician-students. But because the groups lasted sometimes for years and explored transference and countertransference in patient-physician relationships, he acknowledged that the result was personal growth of the participants. His techniques are described and an example of a Balint Group (Boston Group) are presented here.     

医患风险沟通：角色与信息匹配的视角

医患沟通失真常引发高误诊率、医患冲突。现有风险具体观和抽象观各自提出风险沟通模型,但存在诸多矛盾或不一致。通过引入角色与信息匹配视角,从建构水平理论提出事件体验(事件吸引力)和概率体验(概率敏感性)解释,有助于调和矛盾并提出建议：为医生匹配抽象风险信息、患者匹配具体风险信息,能减少沟通失真,提高风险沟通质量。未来需进一步深究个体差异对匹配效应的影响、探索匹配效应的生态效度、开发科学有效的沟通模式。     

Conflict of interest from a Romanian geneticist’s perspective

This paper examines Romanian bioethics regulations for biomedical sciences, looking in particular at the genetics area as a source for conflict of interest. The analysis is focused on the organizational level, national regulations, the sources for generating conflicts of interest, and management of conflicts. Modern biotechnology and gene technology are among the key technologies of the twenty-first century. The application of gene technology for medical and pharmaceutical purposes is widely accepted by society, but the same cannot be said of the development and application of gene technology in agriculture and food processing. Because the use of a technology in the production and processing of food is regarded more sceptically than in the production of biomedical products, there can be areas of conflict in many cases when communication is undertaken about gene technology in the agro-food sector. Ethical concerns play an important factor in this, but a society’s attitude to a developing technology is an amalgam of many effects which are beyond ethics as such. This paper contains a study carried out by the author for the Romanian Association for Consumer Protection about the attitudes of consumers towards genetically modified (GM) foods. This study revealed that in Romania more than 98% of consumers did not know anything about GM foods and frequently were confused about the definitions of these terms. In conclusion, it is necessary to say that there is a low level of knowledge regarding biotechnology in Romania and this is an important reason why there is neither public acceptance of gene technology products nor is there a rejection. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. Ioana Ispas, MD in Molecular Biology, is a scientific researcher and Member of the Romanian Association for Consumer Protection, NCP for FP5-Quality of life and management of living resources.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

The Martin Buber-Carl Jung disputations: protecting the sacred in the battle for the boundaries of analytical psychology

The Martin Buber-C.G.Jung disputations rather than the Freud-Jung split or Samuels's post-Jungian categories is considered the more significant paradigm for understanding the conflicts erupting within the Jungian community surrounding clinical practice and candidate training. Looking through the lens of the Freud-Jung split keeps the conflicts focused on the theoretical and technical differences concerning such concepts as object-relations, transference-countertransference, neutrality, clinical boundaries. The Buber-Jung disputations move the discussion into a different and more foundational arena, namely the vertical and horizontal psychological considerations of the experience of the Sacred and how that dimension is supported or thwarted in clinical practice and candidate training by the respective allegiances of the 'warriors' in the 'Holy Wars'. Experiencing the texture of the Buber-Jung disputations as well as grappling with their content suggests that a more dialogical approach to actual clinical material may be a more fruitful way to understand the work of analysis and the business of candidate training.     

利益冲突

探讨利益冲突的概念及其要素,影响利益冲突的可能因素。利益冲突的危害,并在探讨这些问题基础上提出处理利益冲突的若干措施。     

Contributors to this issue

James Astor
Christian Gaillard
Verena Kast
Thomas B. Kirsch
Greg Mogenson
Hester McFarland Solomon
Barbara D. Stephens
Anita von Raffay
Jan Wiener