16. The transcriptionist recognized the name of a patient as that of the son of a friend of hers. The report indicated a good prognosis for the child. Because the mother had been depressed and uneasy for her child, the transcriptionist felt it was all right to telephone her and reassure her. Was this action correct? Why?
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The scenario describes a transcriptionist who recognizes a patient's name as the son of a friend. She accesses the patient's report, which indicates a good prognosis. Knowing the mother is depressed and uneasy, the transcriptionist decides to call the mother to Show more…
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Susan is a new client and a 22-year-old female who works as a receptionist in a doctor's office. She has just revealed to you during the intake session that she has recently lost interest in most activities, has been sleeping a great deal yet feels tired all the time, and sometimes wishes she could cease to exist. She mentioned feeling as though she has been "on an emotional roller coaster" during the past year, throughout her on-again/off-again relationship with a 35-year-old married man. The last breakup with him seemed final, and Susan has felt herself sinking deeper and deeper into depression ever since. When probed further about suicidal ideations, Susan admitted that she has considered killing herself, although she is uncertain whether or not she would actually do it. She said that she is currently in possession of a gun that her friend allowed her to keep in her home following a rash of burglaries in the neighborhood, but she does not know whether she would actually use it. You have consulted with your supervisor, who has agreed that Susan should be referred immediately for a psychiatric evaluation and has instructed you to arrange for Susan to go directly from your office to a nearby hospital. Susan told you that her mother accompanied her and is in the waiting room, but she has emphatically stated that she does not want her mother to know what is going on with her. How should this delicate situation be handled? Why? What are three ethical and/or legal concerns about this case?
Supreeta N.
A colleague of yours, Dr. Solomon, contacts you for advice regarding a new client she has just seen. The client, Mr. Don Tellanyone, is a 47-year-old man who is seeking services for depression. During the initial phone contact, he asked repeatedly about privacy and wanted assurances that information discussed in the session was confidential. The patient repeated this line of questioning during the first face-to-face session. As the session progressed, he revealed that the source of his depression was the death of his mother one year ago. His mother had suffered from a combination of severe respiratory problems and Alzheimer's. Mr. Tellanyone had been caring for her and his father in his home for 6 years prior to her death. During the last two years, she required total care. He revealed that she had been suffering greatly and, out of compassion for her, he gave her an excess dose of her sleeping and pain pills. Medical personnel never questioned the death as the woman had been quite sick and "It was only a matter of time." Mr. Tellanyone goes on to explain that he is now caring for his father in similar circumstances, although there is no dementia. His father has declined rapidly since the death of his wife and now requires total care. Mr. Tellanyone reveals that recently he had a conversation with his father in which the father commented on how peaceful his wife's death was and how he hoped for a similar passing. Mr. Tellanyone is feeling quite guilty about his mother. Simultaneously, he strongly believes he made the right decision. He would like help to work through the issues. He is also very concerned about confidentiality and wants assurances from Dr. Solomon. Dr. Solomon, feeling uncomfortable with the situation, contacts you for a consultation about the potential ethical issues for this case.
Akash M.
Case example: Patrice works as a nurse counselor in a local hospital in the outpatient chemical dependency unit. She goes to the reception area to greet her new client, Fatima, who is waiting with her husband. Fatima introduces Patrice to her husband and asks the counselor to allow her husband to sit with her through the intake session. When Patrice inquires as to the reason for the request, Fatima explains that in her native culture it is unacceptable for a wife to have secrets from her husband, and that she would not be comfortable in the session without him there. The intake session is held with the couple. Patrice clarifies that future sessions will be conducted with Fatima alone so that the counseling process can be focused on the concerns that prompted Fatima to call for an appointment. Patrice explains that the confidentiality of information shared during the sessions belongs to Fatima and that she may share information with her husband whenever she wishes. The husband loudly interrupts to reiterate that if he does not attend sessions that he needs Patrice to call him after each session to tell him what happened during the session. He slams his fist down on his chair handle loudly to emphasize his point. Fatima nods her head in agreement, staring blankly down at the ground, a tear rolling down her face. During the team meeting to discuss this culturally based ethical dilemma, the team also met to discuss their decision to provide an initial DSM 5 diagnosis after the first meeting with clients. This decision would require a diagnosis for Patrice and other clients based on the first meeting with the counselor. This decision was the result of some pressure from the agency director, who made it clear that establishing a diagnosis and formulating a treatment plan were required by the HMO (insurance). On ethical grounds, some of the professional staff objected to the pressure to formulate a diagnosis and specific treatment plan at the initial session. Others on the staff did not share the same ethical concerns and believed some policies could be changed.
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