Substance abuse is known to be our nation's number one public health problem. Physicians and other health providers can develop chemical dependency problems that create significant quality assurance and risk management dilemmas. Not all of society understands drug dependence to be a treatable medical disease and behavioral problem. Sometimes impaired providers are ignored or punished rather than treated and rehabilitated. This results in an enormous waste of human and monetary resources. In the last 10 years, impaired physician programs have developed focus and credibility. But certain difficulties exist in these programs: namely, that such programs are affected by tensions between medical societies and state licensing boards; that substance-dependent providers escape detection by moving to other states; that existing impaired provider programs have limited practical application within the federal health care system; and that liability risks are incurred if institutions rely on impaired provider policies that do not include all members of the medical staff. Hence, we argue that existing impaired provider policies might be worth rethinking. To promote that dialogue, we offer a sample policy for consideration and review. It includes specific actions and procedures for the identification, referral, and reentry of impaired providers and allows for National Practitioner Data Bank reporting in that process. The Data Bank has been in place for only a few years and offers society and the health community a new opportunity to better control chemically dependent, licensed medical staff without dismantling existing impaired provider programs. The policies for managing chemically dependent health professionals are changing from a focus on stigma and prosecution to one of early identification, rehabilitation, and reentry. We hope to advance that process.
Color vision deficits occur in 10% of the American white male population. Thus, color blindness may invalidate diagnostic hypotheses generated from Rorschach data. The Rorschach protocols of 43 white, college male color-blind subjects were compared to the protocols of normally sighted controls. The color-blind group manifested fewer pure "C" responses. No significant between group differences emerged for any of the other primary Rorschach color variables. Pure "C" responses rarely figure prominently in Rorschach evaluations, and the apparent lowered frequency of these responses by the color-blind is insufficient to warrant modification of current Rorschach practice. The data suggest that color blindness is unlikely to confound Rorschach assessment.
There is an unnoticed step that occurs before a person becomes a patient, that is, every prospective patient must first express his or her need for care to a health professional who responds by describing how the patient might access that care. When the health professional accepts the patient as someone to talk with at the outset, this is termed “acceptance.” Acceptance has been defined as the hidden ethic and core value underlying the applied ethical tool of universal patient acceptance (UPA). Acceptance impacts access to care. Published reactions to acceptance and UPA have so far ranged from thoughtful and constructive, to emotionalized and reactive. As the practical applications of acceptance and UPA are discussed in national forums on access to care, some general trends have emerged. This paper is a status update on UPA and speaks to those proposals and recommendations. The ethical basis of UPA is expanded upon, and the attempt is made to more effectively operationalize the concept and further justify its relevance to the allied-health professions. A clearly articulated notion of acceptance is needed to protect professional conscience from secular interests of patients. It is only after broader multi-disciplinary review and debate, however, that UPA can become less hidden or presupposed, and actually find expression in the ethics codes and training curricula of all the health professions. Once expressed within these professional forums, it will likely gain more relevance in the critical evaluations of acceptance as it is more broadly used in the conversations of economics, politics, and secular (non-professional) society.
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