Cognitive guidelines for simplifying medical information: Data framing and perception

In this paper, 1 describe psychological guidelines for simplifying medical information — methods to aid the perception and recognition of abnormalities in medical test reports. These techniques resemble natural human editing strategies outlined in prospect theory. The methods pre-edit data as humans do but to reduce human effort. I review empirical studies assessing these techniques and discuss needs for further research.     

RESCUE AND RECOVERY AS A THEOLOGICAL PRINCIPLE,AND A KEY TO MORALITY IN EXTRATERRESTRIAL SPECIES

New theological understanding can emerge with the advancement of scientific knowledge and the use of new concepts, or older concepts in new ways. Here, the authors present a proposal to extend the concept of “rescue and recovery” found in the United Nations Law of the High Seas, off-world and within a broader purview of other intelligent and self-aware species that humans may someday encounter. The notion of a morality that extends to off-world species is not new, but in this analysis, rescue and recovery become an imperative when any intelligent and self-aware species is in harm's way. Rescue and recovery encompass a necessary action component except perhaps in those cases where rescuers are in danger. The authors explore three biblical examples of rescue and recovery to derive a fundamental meaning of the concept.     

Cultural psychological processes underlying workplace remuneration in Japanese and European American contexts

Japan's remuneration systems are moving away from seniority-based pay towards individual performance-based pay. We tested how the latter system works within the Japanese cultural context and whether the operation and functioning of the system reflects general psychological tendencies found in Japan. Japanese (Study 1 n = 197; Study 2 n = 235) and European American (Study 1 n = 201; Study 2 n = 186) participants read vignettes that described workplace success centred on a focal employee and including a team. Participants attributed contribution and rewards (financial and status) to a range of agents and factors with graded levels of focus, from the focal employee having the greatest and luck having the least. In general, we found that Japanese participants attributed greater contribution and reward to less focal agents and factors while European American participants attributed greater contribution and reward to more focal agents, in addition to some specific differences between the tasks and reward types. We discuss implications for more nuanced theorizing of the interaction between institutional systems and psychological processes.     

“Being human”: A grounded theory approach to exploring how trainers on clinical psychology doctorate programmes decide whether or not to disclose personal experiences of psychological distress to clinical psychology doctorate trainees

Objective

Recent research and guidelines recommend that trainers on clinical psychology doctorate training programmes consider disclosing personal experiences of psychological distress to trainees. Disclosure is thought to promote cultures of openness, validate and normalise trainee distress, encourage trainee disclosure and help-seeking and challenge stigmatising narratives. However, little is known about how trainers decide whether, what or how to disclose. This study aims to address that gap by exploring the processes and factors involved in trainers deciding whether or not to disclose personal experiences of psychological distress to trainees, generating findings of relevance across counselling, psychotherapy and psychology training courses.

Methods

In-depth interviews were conducted with nine trainers on UK clinical psychology doctorate programmes from around the country and analysed in accordance with constructivist grounded theory methods.

Results

Findings indicated that participants valued disclosure personally and professionally but were wary of the dangers of disclosure. Disclosure decisions were made by judging the context against internally held criteria. If criteria were not met, then disclosures were not made. Outcomes, whether positive or negative, served to reinforce the value of disclosure and the importance of managing risks, creating a positive feedback loop.

Conclusions

The findings of this study suggest factors that are important for trainers to consider when deciding whether or not to disclose. The six-factor framework developed may be useful for trainers to consider within reflective practice, supervision or during guided self-reflection in order to make safe, helpful and ethical decisions.     

All's well that ends well? Outcome bias in pilots during instrument flight rules

The objective of the present study was to examine if the Outcome Bias also occurs in pilots flying under instrument flight rules (IFR). In a scenario-based survey, 60 pilots evaluated weather-related decisions made by hypothetical pilots. Participants rated the decisions as better, less risky, and regarded the probability that they would have made the same decision as higher when they were followed by a positive outcome, than when they were followed by a negative outcome. This effect showed likewise for novice pilots and for experienced pilots. These findings could be relevant for the flight-related decision-making of pilots, which sometimes is affected by the decisions made by third-party pilots. In particular, decisions made by other pilots that have led to positive outcomes might be hastily followed, whereas those that have led to negative outcomes might be hastily rejected.     

Ethics in health care and medical technologies

In this paper a case is used to demonstrate how ethical analysis enables health care professionals, patients and family members to make treatment decisions which ensure that medical technologies are used in the overall best interests of the patient. The claim is made and defended that ethical analysis can secure four beneficial outcomes when medical technologies are employed: (1) not allowing any medical technologies to be employed until the appropriate decision makers are identified and consulted; (2) insisting that medical technologies be employed not merely to promote the medical interests of the patient but rather on the basis of their ability to contribute to the overall well-being of the patient; (3) challenging caregivers to reflect on the dynamic interplay between their conscious and unconscious values and consequent determinations of what is in the patient's best interests; and (4) providing a justification for selected interventions which makes possible rational dialogue between caregivers espousing different viewpoints about treatment options.     

Medicine as business and profession

This paper analyzes one dimension of the frequently alleged contradiction between treating medicine as a business and as a profession, namely the incompatibility between viewing the physician patient relationship in economic and moral terms. The paper explores the utilitarian foundations of economics and the deontological foundations of professional medical ethics as one source for the business/medicine conflict that influences beliefs about the proper understanding of the therapeutic relationship. It, then, focuses on the contrast and distinction between medicine as business and profession by critically analyzing the classic economic view of the moral status of medicine articulated by Kenneth Arrow. The paper concludes with a discussion of some advantages associated with regarding medicine as a business.     

Reflections on segregating and assessing areas of competence

Various complexities that arise in the application of legal and/or clinical criteria to the actual assessment of competence/capacity are discussed, and a particular way of understanding the nature of such criteria is recommended.     

Do medical decision analyses' largest gains grow from the smallest trees?

Some decision analysts recommend reserving their models for careful, complete study of complex problems. Others believe simple problem analyses provide the greatest gains. To clarify these issues, I tested: (1) whether simple published analyses compared to complex ones, produced results as non-intuitive; and (2) whether non-intuitiveness represented analytic gain (or equivalently, intuitive loss). Very limited data also examined (3) the gain from adding model intricacy for a given problem vs. selecting more complex problems for analysis. To assess two non-intuitiveness measures, 75 subjects (33 physicians and 42) non-physicians stated their intuitive preferences in 40 (22 published and 18 unpublished) medical dilemmas. For both physicians and non-physicians, simpler models (those with lees than 30 terminal branches in the decision tree) had about one third the non-intuitiveness of more complex ones. Three tests also supported the premise that analyses outperform intuition, therefore that on average the formers' non-intuitiveness reflects less analytic gain. In addition, for different models of the same problem, tree complexity did not correlate with gain. Thus, simpler trees may not generally gain less because they inadequately describe problems. Instead, simpler analyses may represent simpler problems, with more similar intuitive and formal solutions. If so, these findings may help us avoid some costly but unnecessary simple analyses.