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"Truth Disclosure"
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Disclosing Medical Errors to Patients: It’s Not What You Say, It’s What They Hear
ABSTRACT
BACKGROUND
There is consensus that patients should be told if they are injured by medical care. However, there is little information on how they react to different methods of disclosure.
OBJECTIVE
To determine if volunteers’ reactions to videos of physicians disclosing adverse events are related to the physician apologizing and accepting responsibility.
DESIGN
Survey of viewers randomized to watch videos of disclosures of three adverse events (missed mammogram, chemotherapy overdose, delay in surgical therapy) with designed variations in extent of apology (full, non-specific, none) and acceptance of responsibility (full, none).
PARTICIPANTS
Adult volunteer sample from the general community in Baltimore.
MEASUREMENTS
Viewer evaluations of physicians in the videos using standardized scales.
RESULTS
Of 200 volunteers, 50% were <40 years, 25% were female, 80% were African American, and 50% had completed high school. For designed variations, scores were non-significantly higher for full apology/responsibility, and lower for no apology/no responsibility.
Perceived
apology or responsibility was related to significantly higher ratings (chi-square, 81% vs. 38% trusted; 56% vs. 27% would refer, p < 0.05), but inclination to sue was unchanged (43% vs. 47%). In logistic regression analyses adjusting for age, gender, race and education, perceived apology and perceived responsibility were independently related to higher ratings for all measures. Inclination to sue was reduced non-significantly.
CONCLUSIONS
Patients will probably respond more favorably to physicians who apologize and accept responsibility for medical errors than those who do not apologize or give ambiguous responses. Patient perceptions of what is said may be more important than what is actually said. Desire to sue may not be affected despite a full apology and acceptance of responsibility.
Journal Article
Insurgent truth : Chelsea Manning and the politics of outsider truth-telling
\"This book is about Chelsea Manning's leaking of government documents. Manning told the truth about war and a social order sustained by it. Her truth-telling also revealed the complicity of public and private in casting her - a non-gender-conforming individual - as an improper truth-teller. And Manning's truth-telling unsettled hierarchies of truth-telling that prop up a discriminatory and often oppressive social order. I read Manning not as an isolated political actor, but instead as an outsider truth-teller within a cohort of outsider truth-tellers (such as Virginia Woolf, Bayard Rustin, Audre Lorde), whose practices are distinct yet connected, and whose significance becomes more apparent when read in conjunction with each other\"-- Provided by publisher.
Book
Principles of Clinical Ethics and Their Application to Practice
An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.
Journal Article
The madness of crowds
\"You're a coward.\" Time and again, as the New Year approaches, that charge is leveled against Armand Gamache. While the residents of the Quebec village of Three Pines take advantage of the deep snow to ski and toboggan, to drink hot chocolate in the bistro and share meals together, the Chief Inspector finds his holiday with his family interrupted by a simple request. He's asked to provide security for what promises to be a non-event. A visiting Professor of Statistics will be giving a lecture at the nearby university. While he is perplexed as to why the head of homicide for the Sûreté du Québec would be assigned this task, it sounds easy enough. That is until Gamache starts looking into Professor Abigail Robinson and discovers an agenda so repulsive he begs the university to cancel the lecture. They refuse, citing academic freedom, and accuse Gamache of censorship and intellectual cowardice. Before long, Professor Robinson's views start seeping into conversations. Spreading and infecting. So that truth and fact, reality and delusion are so confused it's nearly impossible to tell them apart. Discussions become debates, debates become arguments, which turn into fights. As sides are declared, a madness takes hold. Abigail Robinson promises that, if they follow her, ça va bien aller, all will be well. But not, Gamache and his team know, for everyone. When a murder is committed, it falls to Armand Gamache, his second-in-command Jean-Guy Beauvoir, and their team to investigate the crime as well as this extraordinary popular delusion. And the madness of crowds. Provided by publisher
Book
Measuring the Prevalence of Questionable Research Practices With Incentives for Truth Telling
Cases of clear scientific misconduct have received significant media attention recently, but less flagrantly questionable research practices may be more prevalent and, ultimately, more damaging to the academic enterprise. Using an anonymous elicitation format supplemented by incentives for honest reporting, we surveyed over 2,000 psychologists about their involvement in questionable research practices. The impact of truth-telling incentives on self-admissions of questionable research practices was positive, and this impact was greater for practices that respondents judged to be less defensible. Combining three different estimation methods, we found that the percentage of respondents who have engaged in questionable practices was surprisingly high. This finding suggests that some questionable practices may constitute the prevailing research norm.
Journal Article
The right not to know: the case of psychiatric disorders
This paper will consider the right not to know in the context of psychiatric disorders. It will outline the arguments for and against acquiring knowledge about the results of genetic testing for conditions such as breast cancer and Huntington's disease, and examine whether similar considerations apply to disclosing to clients the results of genetic testing for psychiatric disorders such as depression and Alzheimer's disease. The right not to know will also be examined in the context of the diagnosis of psychiatric disorders that are associated with stigma or for which there is no effective treatment.
Journal Article
Contemporary issues concerning informed consent in Japan based on a review of court decisions and characteristics of Japanese culture
Background
Since Japan adopted the concept of informed consent from the West, its inappropriate acquisition from patients in the Japanese clinical setting has continued, due in part to cultural aspects. Here, we discuss the current status of and contemporary issues surrounding informed consent in Japan, and how these are influenced by Japanese culture.
Discussion
Current legal norms towards informed consent and information disclosure are obscure in Japan. For instance, physicians in Japan do not have a legal duty to inform patients of a cancer diagnosis. To gain a better understanding of these issues, we present five court decisions related to informed consent and information disclosure. We then discuss Japanese culture through reviews of published opinions and commentaries regarding how culture affects decision making and obtaining informed consent. We focus on two contemporary problems involving informed consent and relevant issues in clinical settings: the misuse of informed consent and persistence in obtaining consent. For the former issue, the phrase \"informed consent\" is often used to express an opportunity to disclose medical conditions and recommended treatment choices. The casual use of the expression \"informed consent\" likely reflects deep-rooted cultural influences. For the latter issue, physicians may try to obtain a signature by doing whatever it takes, lacking a deep understanding of important ethical principles, such as protecting human dignity, serving the patient’s best interest, and doing no harm in decision-making for patients.
There is clearly a misunderstanding of the concept of informed consent and a lack of complete understanding of ethical principles among Japanese healthcare professionals. Although similar in some respects to informed consent as it originated in the United States, our review makes it clear that informed consent in Japan has clear distinguishing features.
Summary
Japanese healthcare professionals should aim to understand the basic nature of informed consent, irrespective of their attitudes about individualism, liberalism, and patient self-determination. If they believe that the concept of informed consent is important and essential in Japanese clinical settings, efforts should be made to obtain informed consent in an appropriate manner.
Journal Article
