Grateful Patient Fundraising: Stories from Physicians.

This symposium includes 12 personal narratives from physicians who have been encouraged by their institutions to solicit donations from patients. This issue also includes three commentaries on these narratives by Stacey A. Tovino, Ceciel Rooker & Alyssa Sutton, and Richard Culbertson. This symposium presents a range of real life examples of how physicians and institutions navigate the ethical issues around fundraising from grateful patients paying particular attention to attempting to establish best practices to minimize any ethical conflicts. Some potential problem areas are also explored around transparency, real or perceived coercion and respect for boundaries.

From the Defense Health Board: Military Accessions and the Continuum of Mental Health Research.

The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.

Clinical Workflows and the Associated Tasks and Behaviors to Support Delivery of Integrated Behavioral Health and Primary Care.

Integrating primary care and behavioral health is an important focus of health system transformation. Cross-case comparative analysis of 19 practices in the United States describing integrated care clinical workflows. Surveys, observation visits, and key informant interviews analyzed using immersion-crystallization. Staff performed tasks and behaviors-guided by protocols or scripts-to support 4 workflow phases: (1) identifying; (2) engaging/transitioning; (3) providing treatment; and (4) monitoring/adjusting care. Shared electronic health records and accessible staffing/scheduling facilitated workflows. Stakeholders should consider these workflow phases, address structural features, and utilize a developmental approach as they operationalize integrated care delivery.

Ethics in managed care.

The current era of managed costs and care create ethical dilemmas based on economic constraints and incorporation of principles of distributive justice. Traditional ethical concerns related to confidentiality, conflicts of interest, double agentry, and honesty are complicated by interference in the doctor-patient relationship caused by intrusive utilization management. National health reform must take these issues seriously to ensure that the cure promised by such reform efforts is not worse than the disease. The challenge for psychiatrists is to adapt to these constraints without losing sight of traditional ethical medical positions. If the ethics become diseased, then no cure may exist at all.