Truth, Deception and Ethics of Integrating Online
Services
in the Land of Managed Care
by Marlene M. Maheu, Ph.D.
Given the number of choices we have in treating patients, as well as pressures from managed care companies to limit sessions, many practitioners struggle with how truthful to be with patients. Shall we not discuss the severe limitations being imposed on us by Managed Care Organizations to urge them toward medication, when a longer course of psychotherapy could benefit them equally well; or shall we simply push them toward medication as quickly as possible to lower our session count? Shall we outline various treatment modes at our disposal; or push them through the quickest solution to this week's crisis? Shall we reveal a diagnosis to the patient; or shall we shield him/her from the harsh reality of our diagnostic terminology as reflected in their own patient record?
With an extensive body of research to draw upon, we can very clearly make statements regarding what is helpful for a wide range of patients who come to us for care. To ignore the role of clear psychoeducation in psychotherapy is as unprofessional as imposing our personal likes and dislikes, and financial agendas upon patients. Given the information revolution, how much of a service are we doing a patient if we withhold a diagnosis that would allow them to access resources regarding their disorder on the Internet? How much of a service are we doing a patient if we don't tell our patients their diagnosis, and refer them to online support groups for their particular disorder?
We must be able to give patients the benefit of research-based information. Although certainly not perfect, our scientific method has taught us a few things about reality: helpful communication skills; successful child-rearing practices; coping strategies for stress, anger, and anxiety; the role of sociocultural and political forces upon our world views and sense of well being, to name but a few. Therefore, we ought to be able to point our patients to such information catalogs online if they have computers.
Furthermore, we ought to be required to be familiar with online self-help resources for our patients, as much as we are required to be familiar with offline resources, such as local clinics and support groups in our geographic communities. Furthermore, as professionals, we ought to at least have a sense of reality regarding the basic requirements for mental health. We ought to be clear in communicating such requirements as well as diagnoses, unless we have reason to believe a particular individual is incapable of understanding the ramifications of such diagnoses. Language and metaphors used to convey these basic requirements are a matter of personal style, talent, belief, and training.
As a result, patients ought to be able to choose their mode of treatment for any identifiable disorder: medication, self-help and support groups, online email interactions within discussion lists, newsgroups, distance learning classrooms or chat rooms, bibliotherapy, art therapy, psychotherapy - alone, or in combination. For example, patients can be asked whether they want to explore the existential nature of their life situation, and/or prefer to develop and implement a strategy for behavior change using face-to-face contact with a therapist, with or without online self-help through psychoeducational reading and participating in an email support group. If we respectfully treat patients as consumers with decision-making powers, we could at least occasionally minimize our personal struggles with truth and deception.
4/17/98
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