For decades, “defensive medicine” has been the leading argument driving reforms of medical malpra... more For decades, “defensive medicine” has been the leading argument driving reforms of medical malpractice laws throughout the United States. Defensive medicine is the presumed practice of administering excessive tests and treatments as a stratagem for reducing healthcare providers’ risk of malpractice liability, despite the absence of any expected benefit for the patient. The practice is widely believed to exist throughout American healthcare as a response to fears of malpractice litigation, and thought to be enormously wasteful of healthcare dollars. In consequence, it has become a justification for law reforms insulating the healthcare industry from tort liability. These claims are promoted by the healthcare industry even though they imply that most providers routinely engage in healthcare fraud and violate their own ethical rules. We review the evidence behind these beliefs — including direct physician surveys, clinical scenario studies, and multivariate analyses of actual case data...
This study explores behavioral health professionals’ perceptions of granular data. Semi-structure... more This study explores behavioral health professionals’ perceptions of granular data. Semi-structured in-person interviews of 20 health professionals were conducted at two different sites. Qualitative and quantitative analysis was performed. While most health professionals agreed that patients should control who accesses their personal medical record (70%), there are certain types of health information that should never be restricted (65%). Emergent themes, including perceived reasons that patients might share or withhold certain types of health information (65%), care coordination (12%), patient comprehension (11%), stigma (5%), trust (3%), sociocultural understanding (3%), and dissatisfaction with consent processes (1%), are explored. The impact of care role (prescriber or non-prescriber) on data-sharing perception is explored as well. This study informs the discussion on developing technology that helps balance provider and patient data-sharing and access needs.
Integrated mental and physical care environments require data sharing, but little is known about ... more Integrated mental and physical care environments require data sharing, but little is known about health professionals’ perceptions of patient-controlled health data sharing. We describe mental health professionals’ views on patient-controlled data sharing using semi-structured interviews and a mixed-method analysis with thematic coding. Health information rights, specifically those of patients and health care professionals, emerged as a key theme. Behavioral health professionals identified patient motivations for non-sharing sensitive mental health records relating to substance use, emergency treatment, and serious mental illness (94%). We explore conflicts between professional need for timely access to health information and patient desire to withhold some data categories. Health professionals’ views on data sharing are integral to the redesign of health data sharing and informed consent. As well, they seek clarity about the impact of patient-controlled sharing on health profession...
A main objective of this study is to assess the opinions of 50 behavioral health patients on sele... more A main objective of this study is to assess the opinions of 50 behavioral health patients on selective control over their behavioral and physical health information. We explored patients' preferences regarding current consent models, what health information should be shared for care and research and whether these preferences vary based on the sensitivity of health information and/or the type of provider involved. The other objective of this study was to solicit opinions of 8 behavioral health providers on patient-driven granular control of health information and potential impact on care.Electronic surveys were implemented at an outpatient Behavioral Health facility that provides care for behavioral health patients with non-serious mental illnesses. The Patient Survey included questions regarding patients' demographics and about their concerns and preferences for data sharing for care and research. The Provider Survey included questions about their view on the current consent...
Turning Practice into Progress: Better Lawyering Through Experimentation Michael J. Saks* This Ar... more Turning Practice into Progress: Better Lawyering Through Experimentation Michael J. Saks* This Article argues that trial practitioners and programs that ... I suggest a way that National Institute of Trial Advocacy (NITA) courses, with the investment of modest additional effort, could ...
Thanks to empirical research conducted over the past several decades, we can be reasonably sure t... more Thanks to empirical research conducted over the past several decades, we can be reasonably sure that quite a lot of discussion about medical malpractice and corresponding law proceeds on erroneous assumptions, speculations, and anecdotal impressions about the operation and effects of the existing system. The tort system's most serious problem in the medical malpractice area is not that plaintiffs bring claims too readily and too often, or that the system affords relief too easily, or that the relief granted is overly generous. Rather ...
Symptoms, symptom dominance patterns, and precipitating circumstances were investigated in groups... more Symptoms, symptom dominance patterns, and precipitating circumstances were investigated in groups of male and female Argentine psychiatric patients divided on the basis of father’s socioeconomic level, own socioeconomic level, and social mobility. Upon comparison of the results obtained with those of a closely related North American study, the conclusion was reached that virtually no findings were identical in the two investigations. There were, however, similarities in theme and character of the relationships between symptom and social class variables in the two countries. Overt, impulsive, and bizarre symptomatology predominated among lower class patients, intermediate levels of socioeconomic status tended toward self-blame and guilt, and the highest groups included in this study expressed anxiety, tension, and alienation. The interculturally consistent and the specifically Argentine components of these findings were discussed in relation to the available reports on the ways of li...
For decades, “defensive medicine” has been the leading argument driving reforms of medical malpra... more For decades, “defensive medicine” has been the leading argument driving reforms of medical malpractice laws throughout the United States. Defensive medicine is the presumed practice of administering excessive tests and treatments as a stratagem for reducing healthcare providers’ risk of malpractice liability, despite the absence of any expected benefit for the patient. The practice is widely believed to exist throughout American healthcare as a response to fears of malpractice litigation, and thought to be enormously wasteful of healthcare dollars. In consequence, it has become a justification for law reforms insulating the healthcare industry from tort liability. These claims are promoted by the healthcare industry even though they imply that most providers routinely engage in healthcare fraud and violate their own ethical rules. We review the evidence behind these beliefs — including direct physician surveys, clinical scenario studies, and multivariate analyses of actual case data...
This study explores behavioral health professionals’ perceptions of granular data. Semi-structure... more This study explores behavioral health professionals’ perceptions of granular data. Semi-structured in-person interviews of 20 health professionals were conducted at two different sites. Qualitative and quantitative analysis was performed. While most health professionals agreed that patients should control who accesses their personal medical record (70%), there are certain types of health information that should never be restricted (65%). Emergent themes, including perceived reasons that patients might share or withhold certain types of health information (65%), care coordination (12%), patient comprehension (11%), stigma (5%), trust (3%), sociocultural understanding (3%), and dissatisfaction with consent processes (1%), are explored. The impact of care role (prescriber or non-prescriber) on data-sharing perception is explored as well. This study informs the discussion on developing technology that helps balance provider and patient data-sharing and access needs.
Integrated mental and physical care environments require data sharing, but little is known about ... more Integrated mental and physical care environments require data sharing, but little is known about health professionals’ perceptions of patient-controlled health data sharing. We describe mental health professionals’ views on patient-controlled data sharing using semi-structured interviews and a mixed-method analysis with thematic coding. Health information rights, specifically those of patients and health care professionals, emerged as a key theme. Behavioral health professionals identified patient motivations for non-sharing sensitive mental health records relating to substance use, emergency treatment, and serious mental illness (94%). We explore conflicts between professional need for timely access to health information and patient desire to withhold some data categories. Health professionals’ views on data sharing are integral to the redesign of health data sharing and informed consent. As well, they seek clarity about the impact of patient-controlled sharing on health profession...
A main objective of this study is to assess the opinions of 50 behavioral health patients on sele... more A main objective of this study is to assess the opinions of 50 behavioral health patients on selective control over their behavioral and physical health information. We explored patients' preferences regarding current consent models, what health information should be shared for care and research and whether these preferences vary based on the sensitivity of health information and/or the type of provider involved. The other objective of this study was to solicit opinions of 8 behavioral health providers on patient-driven granular control of health information and potential impact on care.Electronic surveys were implemented at an outpatient Behavioral Health facility that provides care for behavioral health patients with non-serious mental illnesses. The Patient Survey included questions regarding patients' demographics and about their concerns and preferences for data sharing for care and research. The Provider Survey included questions about their view on the current consent...
Turning Practice into Progress: Better Lawyering Through Experimentation Michael J. Saks* This Ar... more Turning Practice into Progress: Better Lawyering Through Experimentation Michael J. Saks* This Article argues that trial practitioners and programs that ... I suggest a way that National Institute of Trial Advocacy (NITA) courses, with the investment of modest additional effort, could ...
Thanks to empirical research conducted over the past several decades, we can be reasonably sure t... more Thanks to empirical research conducted over the past several decades, we can be reasonably sure that quite a lot of discussion about medical malpractice and corresponding law proceeds on erroneous assumptions, speculations, and anecdotal impressions about the operation and effects of the existing system. The tort system's most serious problem in the medical malpractice area is not that plaintiffs bring claims too readily and too often, or that the system affords relief too easily, or that the relief granted is overly generous. Rather ...
Symptoms, symptom dominance patterns, and precipitating circumstances were investigated in groups... more Symptoms, symptom dominance patterns, and precipitating circumstances were investigated in groups of male and female Argentine psychiatric patients divided on the basis of father’s socioeconomic level, own socioeconomic level, and social mobility. Upon comparison of the results obtained with those of a closely related North American study, the conclusion was reached that virtually no findings were identical in the two investigations. There were, however, similarities in theme and character of the relationships between symptom and social class variables in the two countries. Overt, impulsive, and bizarre symptomatology predominated among lower class patients, intermediate levels of socioeconomic status tended toward self-blame and guilt, and the highest groups included in this study expressed anxiety, tension, and alienation. The interculturally consistent and the specifically Argentine components of these findings were discussed in relation to the available reports on the ways of li...
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