Corruption & Misuse in a Billion Dollar Industry
By: Michael G. Conner, Psy.D, Clinical & Medical Psychologist
Each year, more than four million Americans are pressured or forced to take a psychological evaluation. Doctors in the professions of psychiatry and psychology perform these evaluations for disability and fitness determinations, child custody disputes, worker compensation, injury and stress claims, job applications, denying medical services and for law suits initiated by individuals against employers, business or government. So many evaluations are conducted and for so many reasons, that virtually anyone can find him or her self in the position of being evaluated. Unless you have been evaluated, you probably don't realize that a psychological evaluation can profoundly affect your rights, your financial status and your future.
There are psychological evaluation procedures that are designed to be therapeutic and extremely helpful. These Therapeutic Assessments are distinctly different from evaluations implemented for the purpose of determining your rights, damages or considerations under the law. Another evaluation procedure that is designed to be helpful are Assessment Based Intervention (ABI). An ABI is an assessment protocol that combines crisis intervention and mediation with an objective psychological evaluation focused on solutions to problems, objective data and motivation for self-directed change.
This paper has been written to educate and support people who are asked, pressured, or forced to take a psychological evaluation. No book has ever been written for the public that clearly reveals the questionable and unethical behavior of a growing number of doctors in psychology and psychiatry. If you are involved with psychological evaluations you need to know what you can expect to happen, how to expose the misuse of an evaluation, how to protect yourself, as well as advise others.
The misuse of psychological evaluations is not a new problem, but it is a growing problem. Health care has become one of the largest industries in our country. Health care costs in the United States exceeded 850 billion dollars in 1996. As a profession, health care has grown steadily and brought with it the promise of great opportunities for those who were talented, caring and determined.
For many years our doctors' responsibility to the public and their patients was to provide treatment and support. The caring doctor-patient relationship grew during a time when doctors trained to run their own practices and when providing treatment was the best way to serve the public and the best way to make a living. Doctors were respected champions of health care and champions for their patients. Errors were often of the side of caution. But times have changed and the landscape of health care is becoming treacherous for patients. The pendulum of health care is swinging from "too much and too soon", toward "too little and too late". While many doctors are naturally curious and caring they no longer have permission to pursue a hunch or spend extra time with a patient during a complicated case.
Large corporations and companies now dominate and control health care - not your doctor. Insurance companies and Health Maintenance Organizations (HMOs) are severely limiting what they will cover and treat. Unlike your doctor just a few years ago, these for-profit health care companies are more intensely focused on denying health care instead of providing care. Denying treatment is generating huge huge profits for big business but is placing doctors and patients at greater risk. The practice of risk management and denying care is eroding, if not replacing the practice of medicine. Nowhere are these problems more evident than with doctors who specialize in mental health.
The job market in mental health has been undergoing massive changes. Many highly trained doctors in psychology and psychiatry are being replaced by technicians and assistants with less training, less experience and by those who are willing to work for less pay. Experts in mental health are predicting that up to fifty percent of all mental health professionals will be unemployed or leave the profession in five years. The reason is actually simple. Professionals in mental health are struggling to maintain a living in a field where the financial floor is crumbling. The amount of money that professionals make for treating patients is getting smaller and smaller.
Doctors are also being pressured by virtue of their contracts with large corporations to tell their unsuspecting patients that their treatment is adequate. The result is a growing moral vacuum. Doctors are increasingly pressured to abandon ethical and professional standards of treatment in order to keep their jobs and receive payment from insurance companies, health maintenance organizations (HMOs) and government agencies. Disillusionment with health care policy, financial pressure and fear of law suits has caused many doctors to restrict their practice and to look for additional ways to make a living. As a result, quality of care is suffering. A desperate search for new ways to make a living has created a new breed of professional: Doctors who represent the side of business, insurance companies and the government - not patients. Doctors who follow the money are aligning themselves with big business and big government money, and not their patients, the "little guy" or the underdog.
It is unfortunate, but true. There is more money and less risk for doctors in taking sides against patients who are injured, impaired or suffering from physical and psychological problems. That transformation from patient champion to patient opponent has become a growth industry. The naive belief that doctors have taken an oath of integrity and are champions for health care has left many of us overly trusting and then devastated when they discover how unethical and corrupt doctors can be. The mental and emotional harm that comes from these biased and corrupt evaluations can devastate healthy people and drive people who are injured and suffering to the brink of suicide and violence.
If you ever find yourself involved in a law suit, no matter how real or legitimate your impairment or injury, the other side can find and hire a doctor who will testify against you. Many of these doctors will agree to testify against you before they review your records, see the results of your testing or even meet you. These same doctors, and the attorneys they work with, will go so far as to ignore facts, viscously distort the truth, and blatantly misuse psychological evaluations to benefit the corporations and governmental agencies who pay them. They ,may even write false and defamatory reports about you that will become part of permanent files that follow can you the rest of your life.
In a court room, doctors are usually protected and can testify to almost anything with complete immunity. The whole purpose of their evaluation, opinion, report and testimony is to prevent you from winning your claim or law suit. If they cannot prevent you from winning, they will do their best to make sure that you win as little as possible.
For the public, there is little consolation for the wounded and there are many barriers to rectifying the injustice of these evaluations. Virtually every professional who is qualified to expose these problems, or challenge the injustices, is either part of the problem, believes that nothing can be done or is afraid of the repercussions. The majority of doctors prefer to avoid conducting evaluations altogether and naively minimize the reality that such practices exist in their profession.
Of course not all doctors who perform psychological evaluations will intentionally or quickly abandon their ethical responsibility. But the line that separates ethical from unethical practice usually sways in the direction of financial gain. At first, compromising professional ethics can seem minor or even harmless. But with each compromise there comes reinforcement and a growing belief that ethical lines can be moved without consequence. As reputations and careers begin to grow, doctors begin to act as if their ethical responsibilities matter only if there are serious consequences for ignoring them.
Every person who is pressured or forced to take a psychological evaluation is also forced to place their trust in doctors who are almost certainly biased and possibly corrupt. In nearly all legal and administrative settings, bias is only a matter of degree. Unfortunately there is no way to know which doctor you can trust and which doctor you can't ahead of time. People are harmed when they place their trust in the wrong person, when they are unprepared to take a psychological evaluation and when they lack the ability to recognize and expose their misuse.
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(c) 1998- 2004, Michael G. Conner