However, since this report focuses on mental health in particular, it should also be pointed out that culture and background will also drive the mental health issues that will tend to emerge and it would also guide how they should be properly dealt with. While differences in outcomes with different cultural groups, even in the same setting, can be based on racism and cultural insensitivity, it could also be based on real differences and trends compounded by being submerged in a dominant culture that is very different and confusing (Atkin, 2003)
Of course, religion and other factors can make cultural insensitivity worse. While it would be best to align the patient's and clinician's social/cultural traits, this is not always practical or possible and any ethical counselor is not going to let that become an issue (Brinson, 2004; Wilcoxon, Magnuson & Norem, 2008)
However, if there is a cultural disconnect between practitioner and patient and this matters at all to the patient (and it often does), then the experience for both the patient and the provider can be awkward if not maddening. Throw in a situation with a child or adolescent, and the stakes can get higher a lot more quickly (Lopez, 2011)
For example, American clinicians are famous for being driven by hard data and the questionnaire. However, there is far more complexity and depth to issues that surround counseling patients in Puerto Rico and this is true in Australia and other corners of the world as well (Rogler, 1999)
Further, a "cookie-cutter" approach to fettering out cultural and societal cues might seem like a good idea but it will potentially rub the patient the wrong way. Instead, the therapist or counselor needs to adjust and pivot based on the feedback received from the patient (Sangganjanavanich & Black, 2009)
Analysis To be sure, there are going to be situations in the lives and careers of therapists and counselors where a counselor is addressing a person with a culture or background with which they are not familiar. Indeed, counselors and therapist are charged with helping people address topics and situations such as grief, sadness, mourning and depression (Stuart, 2010)
As such, keeping a patient at ease and assuring them that they are among a friend, even if that "friend" is of a different culture, is paramount. Many people see being unique and different as a source of strength but wider societies have a way of making that a liability and the minority in groups know this lesson full well (Weinrach, 2003)
Positive leadership is often the difference between the success of a venture and its failure. According to a recent report "effective leaders are especially capable of fostering group cohesiveness and promoting efficacy in goal attainment" (Ruggieri, Abbate, 2013, p
In addition to the intrinsic ethical duty to provide the best possible care and the ethical malfeasance of letting other objectives enter into the decision-making process, there are very real practical considerations that must be taken into account in maintaining appropriate objectives and care levels. The malpractice climate in which modern medicine takes place means that medical errors or negative outcomes can have a direct impact on financial resources available to the organization, and this necessarily has an impact on the level of care that can be provided (Bosk, 2003; Gawande, 2008)
Second, the Epilepsy Fellow who was directing Matty's care -- whether or not she knew it -- from her cell phone appears to have made decisions to treat Matty's seizures in a manner that was counter to standard medical practice and the inclinations of other medical personnel, treating far more conservatively than warranted in an attempt to ensure success in the surgery itself. This exposed Matty to danger and the hospital to liability, and was both ethically and pragmatically inappropriate (Gawande, 2008)
The administrator at Boston Children's ultimately bears the responsibility for ensuring that clear objectives exist, clear practices outlined, and clear controls put in place to ensure that the objectives and practices are adhered to. Though of course doctors and nurses are undoubtedly responsible for their own practice and making sure that they comply with ethical as well as organizational and professional guidelines, when there is a breakdown in the hierarchy of responsibility and decision-making amongst the direct providers of medical care it must be the administrator who steps in to solve the problem (Groopman, 2008; Timmermans & Berg, 2005)
Specifically, the failure of the neurosurgical team to recognize the clinical significance of the patient's hematocrit level reported by the lab in light of the available objective information particular to this patient condition prior to surgery represents a cognitive error in connection with the objective analysis of information from various sources that lies at the root of so many medical errors (Groopman, 2008). In this case, the nature of the oversight and failure to reconcile post-operative clinical indicators with pre-operative status amounted to an indefensible medical error rather than a reasonable (but retrospectively erroneous) medical decision and treatment option (Bosk, 2003)
The Need for Standardization of Care in Medical Intensive Care Units This case illustrates a lack of diligence on the part of various senior members of the healthcare team as well as of the institutional administration. In principle, diligent medical practice entails, at a minimum, devoting sufficient attention to detail to prevent avoidable medical errors (Gawande
Failure to Recognize Clinical Exceptions to Empirical Scientific Data There were specific errors in clinical judgment in this case that contributed substantially to the crisis. Specifically, the failure of the neurosurgical team to recognize the clinical significance of the patient's hematocrit level reported by the lab in light of the available objective information particular to this patient condition prior to surgery represents a cognitive error in connection with the objective analysis of information from various sources that lies at the root of so many medical errors (Groopman, 2008)
In this case, for example, all three MSICU nurses recognized that the seizures (and, more generally,) the medical emergency was being handled inappropriately. Nevertheless, they all failed to voice their concerns, as frequently in the case as between nurses and physicians or between nurses and surgeons in the operating room (Timmermans, 2003)
They stress the necessity to continue the research in the field of testing with older participants, using sample faces that vary in age, for example. The ethnic match factor is another important element that the authors pinpoint as potentially decisive or inconclusive in establishing a diagnosis: "In the "other-race effect," memory and perceptual discrimination is poorer for faces not of the participant's race than for own race faces" (Bowles, McKone, Dawel, Duchaine, Palermo, Schmalzl, Rivolta, Wilson, Yovel, 2009)
The very "human" nature of this ability makes the research even more difficult since studies on animals are limited to the perception of objects, faces among them, but not specific, and their reaction responses in specific parts of the brain. In this sense, Sperry makes an interesting observation: the distinction between apperceptive and associative prosopagnosia has been made more than a century ago, when Lissauer concluded that there are patients who "are unable to match or copy a picture presented to them" (apperceptive prosopagnosia), along with others that "fail to recognize objects or pictures in spite of adequate visual capacity" and their "ability to copy accurately an object or picture even if unable to appreciate its name or nature" (Sperry, ed
Neil Martin was drawing another interesting conclusion in the chapter dedicated to prosopagnosia, in his book Human Neuropsychology: "to date, prosopagnosia has never occurred in pure form, i.e. without associated perceptual deficits" (Martin, 2006)
At the beginning of the twenty-first century, in the field of cognitive neuroscience, the research dedicated to prosopagnosia focuses on the brain regions where the process of recognizing faces takes place. Following fMRI studies on humans, researchers have observed that "within ventral temporal cortex" there is "a discrete region in the middle fusiform gyrus, the fusiform face area (FFA), that responds preferentially to faces as compared to assorted common objects"(Marotta, Genovese, Behrmann, 2001)
To date, there is no treatment for prosopagnosia, just alleviation methods. Mindick makes a point in admitting that since researches have shown over the years that the incidence of the condition may be as high as over two percent of the total population, even higher in some regions, prosopagnosia may be accepted as "simply another manifestation of the cognitive diversity that characterizes us as a species, and the opportunity to address it a chance to act on our understanding of the talent differences crucial to our communities"(Mindick, 2011) There is no doubt that the research in the field of the visual impairment known as prosopagnosia is extremely complex due to its numerous forms of manifestation, its various degrees in severity, its association (most case) with other visual impairments, its acquired or developmental, associative vs