Ethical Issues Involved in Assessment & Clinical Diagnosis

Clinical Diagnosis Definition: organized system for conceptualizing and defining various clinical conditions. Definition: organized system for conceptualizing and defining various clinical conditions. Value: improved professional communication and treatment planning. Value: improved professional communication and treatment planning. Current Diagnostic System: DSM-IV-TR Current Diagnostic System: DSM-IV-TR

“On Being Sane in Insane Places” (Rosenhan, 1973) 8 research confederates presented at 12 psychiatric hospitals complaining of hearing unclear voices (“empty”, “thud”) that may have suggested existential concerns. 8 research confederates presented at 12 psychiatric hospitals complaining of hearing unclear voices (“empty”, “thud”) that may have suggested existential concerns. Confederates were admitted and typically diagnosed with schizophrenia. Confederates were admitted and typically diagnosed with schizophrenia. Confederates acted normal in the hospital and took notes of what they observed. Confederates acted normal in the hospital and took notes of what they observed.

Some other patients, but none of the staff, concluded confederates were not real patients. Some other patients, but none of the staff, concluded confederates were not real patients. Another hospital heard about the experiment and bragged that their staff could not be fooled. Another hospital heard about the experiment and bragged that their staff could not be fooled. Rosenhan told the hospital he would send some confederates to this hospital within the next three months. Rosenhan told the hospital he would send some confederates to this hospital within the next three months. Rosenhan never sent any confederates, but 41 patients were identified by staff members as probable confederates. Rosenhan never sent any confederates, but 41 patients were identified by staff members as probable confederates.

Ethical Issues involved in Diagnosis Proper diagnosis of mental disorders. Proper diagnosis of mental disorders. Client’s right to know his or her diagnosis and its potential implications (employment, insurance, placement decisions, etc.). Client’s right to know his or her diagnosis and its potential implications (employment, insurance, placement decisions, etc.). DSM-IV diagnoses are usually required for third-party reimbursement: medical necessity. DSM-IV diagnoses are usually required for third-party reimbursement: medical necessity. Who is allowed to make diagnoses? Who is allowed to make diagnoses? Low reliability of DSM-IV diagnoses. Low reliability of DSM-IV diagnoses.

Potential Diagnostic Errors Conceptualizing normal behavior as pathological. (DSM-IV framework is applied to all problems of living). Conceptualizing normal behavior as pathological. (DSM-IV framework is applied to all problems of living). Upcoding: giving a diagnosis or more severe diagnosis to obtain insurance reimbursement. Upcoding: giving a diagnosis or more severe diagnosis to obtain insurance reimbursement. Downcoding: giving a less severe diagnosis to obtain insurance reimbursement (e.g., Major Depression instead of BPD). Downcoding: giving a less severe diagnosis to obtain insurance reimbursement (e.g., Major Depression instead of BPD).

Issues involved in Testing Competent use of standardized or clinical assessment techniques. Competent use of standardized or clinical assessment techniques. Copyright violations. Copyright violations. Test security. Test security. Legal restrictions on “Psychological Testing.” Legal restrictions on “Psychological Testing.” Admonition to rely on multiple sources for making clinical or educational decisions. Admonition to rely on multiple sources for making clinical or educational decisions. Multicultural issue: use of appropriate norm groups. Multicultural issue: use of appropriate norm groups.

Informed consent: Why is the assessment being completed and how will the results be used? Informed consent: Why is the assessment being completed and how will the results be used? Appropriate feedback to clients. Appropriate feedback to clients. Release results only to other competent professionals. Release results only to other competent professionals. Computerized test interpretation. Computerized test interpretation.