The Art of Diagnosing: The Implications of Deliberate Misdiagnosis The misdiagnosis of a patient is an occurrence that happens quite frequently within clinical practice for various reasons. Many times these misdiagnoses are due to unintentional errors. However, there are times when practitioners intentionally misdiagnosis patients (Kirk and Kutchins, 1988). Deliberate acts of misdiagnosis exist that are universally viewed as being unethical such as blatant use of fraud or abuse. However, there are forms of deliberate misdiagnosis that are viewed less objectively, and are often justified as being in the best interest of the client. The inclination to justify the use of misdiagnosis is often intensified for clinicians due to internal and external …show more content…
However, conflict can arise when it is discovered that a client meets the criteria for a diagnosis that could negatively affect the client because of the stigma attached to that particular diagnosis. Clinicians often feel personal internal pressure as they grapple with diagnosing someone who they believe will suffer from more from being accurately diagnosed than he or she will, if given a less severe diagnosis. Clinicians often want to avoid the negative effects that the labeling of a severe diagnosis will have on a client’s self-esteem (1988). Along with internal pressure, external pressure also weighs heavily on clinicians. In order to adhere to external pressure brought on by agencies seeking and insurance companies seeking reimbursement, clinicians may be pressured to over-diagnosis patients. Over-diagnosis mainly stems from the desire to attain economic benefits rather than therapeutic benefits. Currently, both public and private payers base reimbursement for services off of clinical diagnosis. The more severe the disorder, the more reimbursement the insurance payers are willing to provide. The direct result of this payer system has led to an increase in clinical over-diagnosis (1988). According to the clinical study conducted by Kirk and Kutchins, eighty-percent of the clinical social workers that were surveyed, indicated that third party requirements for reimbursement …show more content…
Yet, for a patient, under or over diagnosis becomes problematic when it results in inappropriate treatment based on diagnosis. Clients, however are not the only ones affected by misdiagnosis. As Kirk and Kutchins conferred, “by focusing only on the presumed benefits to clients, clinicians avoid confronting the broad ethical implications that emanate from the practice of misdiagnosis.” (P. 232. 1988). These implications have ethical and practical consequences that are not limited to clients only, but also directly and indirectly affect others, such as clinicians, professional organizations, policymakers, third party payers, taxpayers and the government (1988). If clinicians, for instance, become aware of the prevalence of misdiagnosis within their own field, they may accept these patterns as normative and become more willing to engage in manipulating diagnoses as well. This continuation of corruption can spread into the entire profession and thus damage the integrity of the profession as a whole
Additionally, dismissing a patient when they do propose ideas. The patient has no chance of making any decision, it lies entirely with the doctor. Also, ordering treatments in which the patient is purely passive. For example, performing surgery leaves a patient completely passive. These last two restrictors can be very damaging for patients being treated with mental illness.
Richard J. Gelles was the director of the Family Violence Research Program at the University of Rhode Island. In his research, Gelles found that in many cases Social Workers as well as other professionals fail to look at the entire picture in terms of family intervention. According to Gelles, in the case of David, preexisting family issues were overlooked which should have played a major role in determining the suitability of David’s home. In his book, Gelles addresses several issues that state families should be maintained and that children are better off with their parents than in a custody system. “The Book of David,” is a nonfiction story about the short life of David Edward.
In doing so, doctors also disregarded the patients’ autonomy in their decision to have themselves committed for their altered mental state. Invalidating the patients claim and affecting their trust, which is the pinnacle of the patient-doctor relationship. With psychiatric patient even more so because there must be a level of trust in the person’s claim and in their determination, that they might be having a breakdown. A beneficial scenario for the parties involves would have been if the doctors’ actions promoted more good, or beneficence, and gave Jessie better tools to cope with his PTSD. Instead, of taking an inactive approach, which allowed the situation to escalate to the point he became a danger to himself and others.
A physician has an unenviable position. He is closest to man approaching a god-like stature and when that god stumbles, the consequences can be disastrous. This is even more so in the field of psychiatry where the fact that mental illness exists is not disputed, but the diagnoses and treatment is often suspect. However, despite the demise of 'doctor knows best ', we still need to trust a psychiatrist since diagnosis is based on a patient 's expressed thoughts and overt behaviours rather than solely on biological phenomena. This requires not only that the patient trust the doctor, but even before that, the doctor appreciates and understands the context of those behaviours; behaviours that are influenced by the patient 's environment.
Rosenhan states that labeling causes the doctors to make wrong ideas about the patient about his or her behavior even though it is not their
There are positives and negatives to labeling mental illness that affects the treatment, family, and social situations of the patient. The diagnosis is not a “cure all” and could worsen conditions of a lot of people when they realize that the diagnosis did not help. Additionally whenever the patient is label with a mental illness people are likely to create a stigma towards the patient and start avoiding him/her.
A moral dilemma that arises in a doctor-patient relationship is whether or not the doctor should always tell their patient the truth about their health. Although withholding information was a common practice in the past, in today’s world, patient autonomy is more important than paternalism. Many still are asking if it is ever morally permissible for a doctor to lie to a patient, though. David C. Thomasma writes that truth-telling is important as a right, a utility, and a kindness, but other values may be more important in certain instances. The truth is a right because respect for the person demands it.
My girlfriend is bipolar The title says it all. My girlfriend is bipolar. She also suffers from Borderline Personality Disorder. If she knew I was writing this, She’d kill me, both literally and figuratively.
In Joseph Collins article, “Should Doctors Tell the Truth?” he states that doctors shouldn’t tell the truth to their patients that deals with their life and death. Collins argued that doctor should withhold the truth on any circumstances. For example, when Collins blamed himself because of the death of a lawyer who suffered from kidney disease, only if he had lied to the lawyer about his health issue, the lawyer still could have been alive. However, I believe that doctors should always tell the truth to their patients regardless of the circumstances because withholding information violates patient’s autonomy and harms the doctor-patient relationship.
This patient was not treated with the ethical respectany patient should receive when seeking help/treatment. It is very alarming that a physician whose job is to take care of other humans would disregard giving a proper
Sissela Bok explores the moral and ethical complexities of lying and deception in her book, Lying: Moral Choice in Public and Private Life. One of the scenarios she considers is the normalization of lying and deception in medical contexts, such as in patient-doctor communication. Bok gives an example scenario of a patient who has just been diagnosed with cancer and has no other treatment options. The physician faces a difficult decision: whether to inform the patient of their diagnosis and the low chance of success with chemotherapy or to lie about the possibility of treatment. The physician chooses to tell the patient their cancer diagnosis but does not inform them of chemotherapy.
There are two classes of circumstance where decisions about medical treatment need to be taken for “incompetent” patients: ● When a patient is temporarily incompetent, e.g. if he or she is unconscious ensuing an accident or severe medical circumstance. ● When a patient is unlikely ever to be able to make a competent decision about his or her treatment, e.g. severe dementia or learning disability or been in the permanent vegetative
People lie for the evasion of punishment, for security of autonomy, for overwhelming others to obtain power, for manipulation of others, and to uphold self-importance (John). As such, dishonesties in medicine may be present in many forms, serve many purposes, and bring many different consequences (James). Patients, who are untold the truth about a medical intervention, are damaged of their autonomy and lose trust in their doctors. Doctors, whether inattentiveness to the truth or violations of honesty, face the termination of medical as an occupation if they no longer assure honesty in their medical practices (James). In such instance, patients, doctors, the medical profession, and the whole society dependent on trustworthy medicine are harmed (James).
4.3 Malpractice as an Ethical Issue Malpractice of doing the opposite of acting in good faith (Bruhn, s.a.:111). It is defined as the failure through ignorance or negligence, to render proper service, resulting in injury or loss to the client (Bruhn, s.a.:111). Professional negligence consists of departing from usual practice not exercising due care (Bruhn, s.a.:112). Any violations of confidentiality and sexual misconduct have received the greatest attention in the literature as grounds for malpractice suits (Bruhn, s.a.:112). The only violation practitioners are allowed to do is client’s confidentiality under those circumstances mandated by the ethical guidelines or by state law (Bruhn, s.a.:112).
There is a stigma attached to it that they might be “treated differently.” Moreover, once the patient’s fear prevails and continues it is more likely that their health care issues and concern will not be properly addressed and will develop to a substandard prognosis. There are also some instances where physicians are the ones who feel reluctant in taking the initiative to obtain the necessary information about their patient’s “social and sexual history.” Therefore, patient’s apprehension and physician’s lack of initiative is the phenomena that serve as an obstacle in obtaining the most pertinent information needed to assess their patient’s health status and to properly diagnose their health complaint (Tortelli,