Confidentiality in The Healthcare Systems Discussion Questions

Initial Telepsychology Session for Free?

A) Dr. Larry Ellison, a psychologist colleague, contacts you about a marketing plan for his telepsychology services. He has over 1,000 followers on Twitter and a strong social media presence on Facebook. His plan is this: He wants to offer one free psychotherapy session to potential patients. He explains he is trying to promote his telepsychology practice and show that psychologists are open, friendly, and willing to help, potentially for free to get treatment started. The overarching goal is to develop a robust telepsychology practice.

Knowing the rules of his state, Dr. Ellison will make it clear that services are only available in the states that he is licensed. Dr. Ellison will use a HIPAA-compliant videoconferencing service. He is looking for general feedback, such as thoughts on a good marketing plan or any ethical concerns.

Upon hearing his plan, do you have any ethical concerns about this marketing plan?

What are some of the practical or potential pitfalls of this plan?

What are some of the overarching ethical principles involved in this decision?

What state laws would you consider to help make this decision?

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B) Dr. Vanessa Ives works in a solo private practice. She has been working with Mr. Dorian Gray for several months for signs and

symptoms of depression. Mr. Gray comes to some sessions as emotionally intense, and high strung. Dr. Ives has considered the possibility that Mr. Gray suffers with some type of cyclic mood disorder.

As part of treatment, Mr. Gray admitted to experiencing anger management problems, to the point where he described physically intimidating his wife and pushing her down. They worked on anger management skills. Mr. Gray reported progress in this area.

Dr. Ives receives a phone message from Mr. Gray’s wife. In the voicemail, Mrs. Gray reports that Mr. Gray has become more physically intimidating and has starting to push her around. The voicemail indicated he has not caused her any significant harm. She requested a session to see Dr. Ives to explain what is happening between them. Dr. Ives only met Mrs. Gray informally while she sat in the waiting room before and after several sessions.

Dr. Ives wants to be helpful, but she is struggling with whether she should even return Mrs. Gray’s phone call. Dr. Ives has a personal history of being involved in a physically abusive relationship herself and is concerned about both the clinical and ethical issues involved regarding calling Mrs. Gray back.

Feeling uncomfortable about what is happening with this patient and his wife, Dr. Ives calls you for a professional consultation. She wants to make an appointment to talk with you candidly about her history as well as the dynamics of the current case.

What are the ethical issues involved in this case?

What are the pertinent clinical issues in this case?

How would you help Dr. Ives deal with her emotions related to this situation, given how her history relates to this patient and his wife?

Would you recommend Dr. Ives return the call or not?

What are some possible options should Dr. Ives return the phone call?

How much transparency would you suggest to Dr. Ives with Mr. Gray about the phone message?

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