Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic

For years, violence against doctors and healthcare workers has been a growing social issue in China. In a recent series of studies, we provided evidence for a motivated scapegoating account of this violence. Specifically, individuals who feel that the course of their (or their family member's) illness is a threat to their sense of control are more likely to express motivation to aggress against healthcare providers. Drawing on existential theory, we propose that blaming and aggressing against a single individual represents a culturally afforded scapegoating mechanism in China. However, in an era of healthcare crisis (i.e., the global COVID-19 pandemic), it is essential to understand cultural variation in scapegoating in the context of healthcare. We therefore undertook two cross-cultural studies examining how people in the United States and China use different scapegoating responses to re-assert a sense of control during medical uncertainty. One study was conducted prior to the pandemic and allowed us to make an initial validating and exploratory investigation of the constructs of interest. The second study, conducted during the pandemic, was confirmatory and investigated mediation path models. Across the two studies, consistent evidence emerged that, both in response to COVID-related and non-COVID-related illness scenarios, Chinese (relative to U.S.) individuals are more likely to respond by aggressing against an individual doctor, while U.S. (relative to Chinese) individuals are more likely to respond by scapegoating the medical industry/system. Further, Study 2 suggests these culture effects are mediated by differential patterns of primary and secondary control-seeking.

INTERNATIONAL PERSPECTIVES ON WELL-BEING AND BURNOUT WITHIN HEALTH SYSTEMS

Objectives: To reflect on the present international culture of professional burnout in health care systems and the need for a radical new approach with an increased understanding of a person- and people-centered attitudes in the promotion of training in wellbeing and the prevention and management of burnout among physicians and health care professionals Methods: A literature search worldwide was undertaken for significant research papers on professional education related to burnout with particular reference to both medical staff resilience and health care system factors. Findings: Burnout among doctors is a global phenomenon. The incidence of burnout reported in a selection of studies among pediatric residents and staff are 25% in Argentina, 37% in the United Kingdom, and 70% in Saudi Arabia. In a national survey in the United States where the overall rate was 59% burned out residents reported significantly increased stress, poorer mental health, and decreased empathy, mindfulness, resilience, self-compassion, and confidence in providing compassionate care Three levels of change that should be the focus of training in prevention, health promotion, and stress reduction awareness have been recommended to reduce the risk of burnout: (1) modifying the organizational structure and work processes; (2) improving the fit between the organization and the individual doctor through professional development programs so that better adaption to the work environment occurs; and (3) individual-level actions to reduce stress and poor health symptoms through effective coping and promoting healthy behavior. Discussion: The history of burnout shows important links with increased work complexity. Narrow training interventions such as debriefing after an adverse clinical event have not been found effective. A more comprehensive personcentered approach with a variety of measurable interventions has resulted in a reduction of 50% in the pediatric faculty in one study. A person- and people-centered cybernetic approach is needed with six standards are to establish and sustain a healthy work environment (1) authentic leadership (2) meaningful recognition, (3) skilled communication, (4) true collaboration, (5) effective decision making, and (6) appropriate staffing. Conclusion: With such high levels of burnout, health systems worldwide can be viewed as failing their populations on a grand scale. Only an organizational paradigm change to a person- and people cybernetic centered system that incorporates complexity is adaptive and integrative will a health system be effective in preventing and ameliorating the effects of burnout and reduce the increasingly unaffordable misuse of human resources.

THE ANALYTIC HIERARCHY PROCESS IS A PROMISING TOOL WHEN PROCESSING DATA AND MAKING DECISIONS IN PSYCHIATRY

Objectives. Formation of results of processing of rank (clinical, psychometric) information in the scale of relations [1] based on the Analytical Hierarchy Process (AHP, Saaty T. L., 2008). Methods. Clinical, psychometric, statistical and AHP algorithms. Results. When evaluating a patient's state, decisions must be made based on clinical, psychometric, social, and neurobiological characteristics. These characteristics correspond to measurement scales: categorical, rank (dimensional, psychometric), and relationship scales. Only the latter are numerical, so it is not possible [1] to create correct models of states taking into account neurobiological indicators. Rank estimates do not allow calculating even average values. Analysis of the problems of evaluating psychopathological states on the basis of categorical and rank scales shows that these problems can be presented in the form of appropriate hierarchies, the structure of which must be taken into account when processing initial information [1]. Therefore, the use of the AHP tools in these situations is most natural. The implementation of AHP procedures for processing rank information is based on the application of the AHP normative approach. In [1], using the simplest examples of General medical significance, the technique of using the AHP normative approach is demonstrated. In practice, both individual doctor evaluations (personalized patient management method) and average expert evaluations (team method) can be used. Conclusions. The AHP approach is promising when constructing integral models of the corresponding processes and correctly using the resulting estimates in practice and research. References. 1. Mitikhin V.G., Solokhina T.A. S.S. Korsakov Journal of Neurology and Psychiatry, 2019, 119(2): 49-54. doi:10.17116/jnevro201911902149

The New Challenges for Medical Ethics

The evolution of medicine confronts healthcare professionals with new ethical challenges. Elements such as professional secrecy, patient benefit, justice in the distribution of resources are put in crisis by the evolution of medical procedures. Today, doctors must make life-and-death decisions about many patients. As the resources are not enough for all patients, the ‘first-come, first-served’ criterion crumbles under the weight of the overwhelming demand for treatment. Consequently, they can no longer make treatment decisions based only on proportionality and clinical appropriateness criteria. They must take into account the availability of resources and prioritise patients with ‘the longer life expectancy’. This amounts to saying ‘the weakest will die’ … with the doctors’ consent. While the guidelines issued by scientific societies may well protect doctors from lawsuits, the choice of who to treat and who to let die is left to the conscience of the individual doctor; and it is a choice sharply clashing with the Hippocratic oath and with professional and personal ethics. This and others are a real ethical problem.

How to Determine When SARS-CoV-2 Antibody Testing Is or Is Not Useful for Population Screening: A Tutorial

Extensive testing lies at the heart of any strategy to effectively combat the SARS-COV-2 pandemic. In recent months, the use of enzyme-linked immunosorbent assay–based antibody tests has gained a lot of attention. These tests can potentially be used to assess SARS-COV-2 immunity status in individuals (e.g., essential health care personnel). They can also be used as a screening tool to identify people that had COVID-19 asymptomatically, thus getting a better estimate of the true spread of the disease, gain important insights on disease severity, and to better evaluate the effectiveness of policy measures implemented to combat the pandemic. But the usefulness of these tests depends not only on the quality of the test but also, critically, on how far disease has already spread in the population. For example, when only very few people in a population are infected, a positive test result has a high chance of being a false positive. As a consequence, the spread of the disease in a population as well as individuals’ immunity status may be systematically misinterpreted. SARS-COV-2 infection rates vary greatly across both time and space. In many places, the infection rates are very low but can quickly skyrocket when the virus spreads unchecked. Here, we present two tools, natural frequency trees and positive and negative predictive value graphs, that allow one to assess the usefulness of antibody testing for a specific context at a glance. These tools should be used to support individual doctor-patient consultation for assessing individual immunity status as well as to inform policy discussions on testing initiatives.

Otolaryngologists and the Doctor-Patient Relationship during a Pandemic

The COVID-19 pandemic has forced otolaryngologists and their patients to confront issues that they have rarely if ever previously faced. Prominent among these is the need to put the collective good ahead of the interests of individual patients with otolaryngologic disorders. We argue that the individual doctor-patient relationship remains paramount even at a time when public health principles mandate systems-level thinking.

Unlocking medical leadership’s potential: a multilevel virtuous circle?

Background and aim Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled.Method Couched in extant international literature, this paper provides a conceptual framework to analyse ML’s potential in the context of healthcare’s complex, multifaceted setting.Results We identify four interrelated levels of analysis, or domains, that influence ML’s potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems.

Scheduling Emergency Physicians Based on a Multiobjective Programming Approach: A Case Study of West China Hospital of Sichuan University

In China, emergency room residents (EMRs) generally face high working intensity. It is particularly important to arrange the working shifts of EMRs in a scientific way to balance their work and rest time. However, in existing studies, most of the scheduling models are based on the individual doctor or nurse as a unit, less considering the actuality of operation and management of emergency department (ED) in large public hospitals in China. Besides, the depiction of the hard and soft constraints of EMR scheduling in China is insufficient. So in order to obtain the scientific and reasonable scheduling shifts, this paper considers various management rules in a hospital, physicians’ personal preferences, and the time requirements of their personal learning and living and takes the minimum deviation variables from the soft constraints as the objective function to construct a mixed integer programming model with the doctor group as the scheduling unit. The analytic hierarchy process (AHP) is used to determine the weights of deviation variables. Then, IBM ILOG CPLEX 12.8 is used to solve the model. The feasibility and effectiveness of the scheduling method are verified by the actual case from West China Hospital of Sichuan University. The scheduling results can meet the EMRs’ flexible work plans and the preferences of the doctor teams for the shifts and rest days. Compared with the current manual scheduling, the proposed method can greatly improve the efficiency and rationality of shift scheduling. In addition, the proposed scheduling method also provides a reference for EMR scheduling in other China’s high-grade large public hospitals.

Miscellaneous Public Authority Functions

Doctors owe a duty of care to their patients, and this duty will be owed regardless of whether the doctor is a public sector employee operating within a statutory framework or is providing health care privately. Medical negligence claims in relation to the care which doctors provide to individual patients are outside the scope of this book. Cases arise, however, that do not involve individual doctor-patient relations and raise broader questions of medical policy. In such instances, the fact that the defendant is a public authority exercising public powers is likely to be material to a determination of whether a duty of care should be imposed, and it is such cases we consider in this section. It should be noted that the potential liabilities in negligence of the bodies that regulate the medical profession are not considered in this chapter, but are examined in Chapter 14, where we consider professional regulators.