RESUMEN
Ethical codes and guidelines for mental health professionals focus on traditional avenues of practice, leaving considerable gaps for clinicians in unique settings, such as behavioral health providers in integrated primary care. In this article, an ethical scenario is presented, where a behavioral health provider is faced with a colleague physician seeking assistance for emotional distress. The scenario highlights important ethical questions about multiple relationships/conflict of interest, impaired colleagues, informed consent, and confidentiality. We review gaps in ethical guidance pertinent to the scenario and provide an eight-step rubric for ethical clinical decision making in integrated primary care.
Asunto(s)
Confidencialidad/ética , Relaciones Interprofesionales/ética , Inhabilitación Médica , Relaciones Médico-Paciente/ética , Atención Primaria de Salud/ética , Estrés Psicológico/psicología , Confidencialidad/normas , Conflicto de Intereses , Humanos , Consentimiento Informado/ética , Consentimiento Informado/normas , Relaciones Interpersonales , Masculino , Registros Médicos/normas , Grupo de Atención al Paciente/ética , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/tendencias , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/tendencias , Estrés Psicológico/complicaciones , Estrés Psicológico/terapiaRESUMEN
Integrated primary care research in the Patient-Centered Medical Home (PCMH) presents unique challenges not found in other behavioral health or medical care settings. The PCMH service delivery principles and supporting systems are designed to maximize quality and outcomes of care while controlling health care costs. Conducting ethical research in this setting requires following processes and procedures established by federal statutes that threaten to disrupt this delicate balance. In addition, clinical researchers must consider the ethical requirements and guidance from their respective professional organizations to ensure they adhere to guidelines for conducting ethical research and practice. Given the setting, there is a high likelihood researchers from various disciplines who may adhere to different ethical standards will be collaborating. We present a case example of an ethical concern to illustrate the tension between research and clinical care, discuss federal and professional research guidelines, and propose recommendations for balancing ethical and effective research and clinical care in integrated primary care research in the PCMH.