Papers by Nicholas D Lawson MD JD
The Lancet Psychiatry, 2019
Hastings Center Report
Medical professionals exert enormous influence over the lives of persons with disabilities by pro... more Medical professionals exert enormous influence over the lives of persons with disabilities by providing medical care and by generating medical research and medical information about them that form the basis for policies and practices that affect their everyday lives. Yet persons with disabilities remain substantially underrepresented within the U.S. Department of Health and Human Services' workforce, among academic medical centers' employees, and in the health professions. The U.S. HHS and academic medical centers appear to be noncompliant with their obligations to engage in disability affirmative action under sections 501 and 503 of the Rehabilitation Act. This essay describes these requirements and contrasts them with medical leaders' "well-being" agendas. It also describes ongoing medical research on "burnout" being conducted on medical employees and further enabled through the Dr. Lorna Breen Health Care Provider Protection Act. The essay calls for a wholesale change in approaches to persons with disabilities within the health and medical professions.
Journal of Law and Education, 2022
The Garrett Lee Smith Memorial Act (GLS) was first enacted in 2004 for the purposes of early scre... more The Garrett Lee Smith Memorial Act (GLS) was first enacted in 2004 for the purposes of early screening, intervention, and prevention of suicide in students ten to twenty-four years of age, and to hire more college counselors. More than sixteen years later, GLS suicide prevention programs have not been found to be effective in reducing suicide rates, while their harms have not been considered. This Article reviews the state of the evidence on school suicide prevention and explores the suicide surveillance of the GLS and its peer-to-peer monitoring and reporting of marginalized students “at risk”—students with disabilities; racial/ethnic, sexual, and religious minorities; victims of bullying; students with homelessness or foster care records; and other suicide risk factors. It explores the GLS public health approach to address the burdens of suicidal students, isolate suicide risks, and avoid suicide contagion. It also describes possible harms of the GLS suicide surveillance approach: stigmatization; violated privacy; estrangement from peers, parents, therapists, and other social supports; police involvement and warrantless searches; potential exacerbation of suicidality; and restricted civil rights in non-school settings such as employment and involuntary commitment proceedings. It then compares the threats imposed by school surveillance for violence and suicide and suggests that paternalistic justifications might account for the relative lack of concerns raised so far regarding the latter. The Article then briefly considers the functions of participating in suicide surveillance for teachers and staff. It concludes with recommendations to stop surveilling these students and start including them in school and on campus in meaningful ways.
Academic Medicine
The authors place great weight on their finding that residents alleged to have made a harmful err... more The authors place great weight on their finding that residents alleged to have made a harmful error scored 7.1 on depression based on the Harvard Department of Psychiatry/National Depression Screening Day Scale, and those who did not scored 4.8 (a score of ≥ 9 is required to indicate depression). The authors suggest that the 0.25 difference in the mean number of harmful medical errors (0.33 vs 0.08) between these groups might be attributable to various “neurocognitive [deficits], particularly, attention, processing speed, and elements of executive function. . . . [and] decreased ability to self-correct or intercept errors before they go on to cause harm.” However, the differences may relate to the authors’ method of measuring medical errors, which relied on residents to selfreport the errors they made. Indeed, there are many reasons to suspect that residents with burnout or depression may be more honest and self-critical and therefore more likely to report making medical errors but do not actually make more errors.
Substance abuse treatment, prevention, and policy, Aug 23, 2018
Physician health program websites in 23 states provide many descriptions of possible physician im... more Physician health program websites in 23 states provide many descriptions of possible physician impairment. This study sought to determine whether these descriptions are so broad that almost everyone might potentially be suspected of being impaired given these descriptions. The authors randomly selected 25 descriptions of impairment and then presented them anonymously online to members of the general population in full-time employment through Amazon's Mechanical Turk (N = 199). Half of the respondents randomly received a narrowly worded version, and half received a broadly worded version of the survey questions. In the narrowly worded version of the survey, 70.9% of respondents endorsed at least one description of impairment, and 59.2% endorsed more than one. In the broadly phrased version, 96.9% endorsed at least one description, and 95.8% endorsed more than one. These respondents endorsed a median of 10 out of 25 (40%) descriptions. These findings call into question whether the...
Medical Education
First, Tackett suggests that ‘addressing students’ prejudice against mental illness might make th... more First, Tackett suggests that ‘addressing students’ prejudice against mental illness might make them more open to and accepting of mental illness’ after noting that Schwenk et al. revealed that ‘prejudice against care seeking is often worst among the students and physicians with severe mental illness’. This is a problematic interpretation of Schwenk et al.’s data. Schwenk et al.’s papers suggest that trainees with more severe symptoms of depression think that ‘telling a counsellor I am depressed would be risky’ and would avoid seeking treatment ‘due to concerns about confidentiality’. This is quite understandable because experimental evidence suggests that a history of receiving psychological counselling makes residency programmes view applicants less favorably and because the treatments offered to these trainees are often not confidential. Trainees with mental disorders do not have a ‘prejudice’ against care seeking just for being more aware of these facts. Terms like prejudice and discrimination are also more commonly used to describe beliefs or behaviours enacted by more powerful groups or individuals against those who are less powerful.
Journal of graduate medical education, 2017
SpringerPlus, 2016
This study examined the relationship between estimates of the prevalence of mental disorders and ... more This study examined the relationship between estimates of the prevalence of mental disorders and mental health stigma. It also examined whether stigma might be more greatly associated with the terms "mental illness, " "mental disorder, " or "mental health condition. " Methods: Respondents (N = 302) on Amazon's Mechanical Turk completed an online survey designed to measure social distance, which is one variant of stigma. Half of the respondents were informed at the beginning of the survey that the lifetime morbid risk (LMR) of meeting criteria for at least one mental disorder at some point in life was 70-80 %, while the others were asked to provide their own LMR estimates. All respondents were also randomly assigned to view the survey with either the term "mental illness, " "mental disorder, " or "mental health condition. " Results: Higher LMR estimates (B = −0.030; β = −0.154), having a mental disorder (B = −2.002; β = −0.200), and a history of contact with an individual with a mental disorder (B = −2.812; β = −0.298), each significantly predicted lower desire for social distance. Respondents in the "mental disorder" group endorsed greater desire for social distance. Participants who were informed about LMR at the start of the survey did not score lower on social distance. Conclusions: Estimates for LMR were more than half as predictive of social distance scores as contact with individuals with mental disorders. But anti-stigma interventions may need to do more than inform individuals about the high prevalence of mental disorders in order to be effective.
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, Oct 1, 2018
To the Editor: Parry and colleagues’ [1] recent report on residents’ presentations to their physi... more To the Editor: Parry and colleagues’ [1] recent report on residents’ presentations to their physician health program (PHP) raise a number of key issues pertaining to voluntary referrals that are important to clarify in order to resolve points of confusion in academic medicine. While the authors define “voluntary referrals [as] participants who sought services of their own accord,” other definitions consider the presence of controlling external influences and perceptions of threat when determining voluntariness [2]. From a legal perspective, residents referred when there is any expectation that their program will receive or request results, ask residents follow-up questions, or learn whether they participated, would not be considered voluntary [3]. Nor would referrals for evaluations performed by an agent of the program or hospital be considered voluntary [3]. Similar principles also apply to signed waivers of confidentiality. It is not clear how the authors’ considerations of voluntariness accord with these later definitions. But any discrepancies, if they exist, would be concerning from a public policy perspective if they reflect and/or promote very different understandings about the laws that apply to these referrals in the legal and medical communities. We have many questions for Parry and colleagues (e.g., why they think it is important for residents to voluntarily engage in services at their PHP as opposed to other providers; why they are making the case for residents to engage voluntarily to residency programs/employers and not to the residents themselves, etc.) and concerns related to PHP research and outreach. But we agree that increasing the proportion of resident intakes that truly are voluntary should be an important goal. We are therefore hopeful that the authors, and all PHPs, residency programs, and academic medical centers, will consider posting the text of the federal law relating to these referrals [3, 4] on their websites, in institutional handbooks, and other resources, in order to prevent nonvoluntary referrals that do not comply with the law. Under the Americans with Disabilities Act, programs and hospitals cannot implicitly or explicitly request psychiatric information from, or require a psychiatric evaluation of, a resident without objective evidence that:
Annals of Internal Medicine, 2019
The American College of Physicians' position paper on state physician health programs (PHPs) clai... more The American College of Physicians' position paper on state physician health programs (PHPs) claims to have the best interests of physicians at heart. However, this is difficult to believe when the authors do not inform physicians of their rights under the Americans with Disabilities Act (ADA) to be free from unwarranted medical inquiries and referrals to
PHPs for evaluation. We suspect that state PHPs (as well as associated medical boards) have repeatedly failed to notify physicians of these rights in part because this legislation provides clear rules that would prevent many unwarranted referrals to these programs.
American Journal of Medicine, 2021
The American Journal of Medicine
Annals of Internal Medicine
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 9, 2018
General hospital psychiatry, Jan 9, 2018
Journal of Graduate Medical Education, 2016
Clinical schizophrenia & related psychoses, Jan 18, 2016
So far, demographic variables have not consistently been found to predict clinical response to an... more So far, demographic variables have not consistently been found to predict clinical response to antipsychotics. This study examines some differences in response to ziprasidone, which has been shown to be effective, with a better metabolic side effect profile, but was little used in New York State Hospitals. The aim was to study state hospital patients switched to ziprasidone. The results led to questions about different responses in different groups. Subjects from state hospitals who needed a change of antipsychotic participated in this openlabel 8 week trial of up to 240 mg ziprasidone. Analyses included comparisons of the very different results from two sites. Of the 36 study subjects, 12 terminated early. The 17 outpatients from Buffalo, who were older and on lower doses of antipsychotics pre-study, improved significantly. The 19 inpatients from the Bronx, overall younger and on higher pre-study doses, barely changed. Improvements in PANSS total score were significantly associated...
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Papers by Nicholas D Lawson MD JD
PHPs for evaluation. We suspect that state PHPs (as well as associated medical boards) have repeatedly failed to notify physicians of these rights in part because this legislation provides clear rules that would prevent many unwarranted referrals to these programs.
PHPs for evaluation. We suspect that state PHPs (as well as associated medical boards) have repeatedly failed to notify physicians of these rights in part because this legislation provides clear rules that would prevent many unwarranted referrals to these programs.