NEUROPSYCHOLOGY

Ethics

• Why do we give test feedback?
• responsibility to the patient
• guidance for decision making
• assistance in rehabilitation/treatment planning
• provision of family support

How best to give feedback?

• reviewing purpose of testing
• defining the tests
• explaining test results and behavior
• describing strengths and weaknesses
• addressing diagnostic and prognostic issues
• making recommendations

Special considerations in giving feedback

• test-related limitations
• feedback to the patient’s family
• patient-related considerations
• denial

Bauer (1997)

• sensitivity vs. specificity
• false positives vs. superior sensitivity of neuropsych tests
• false positives from misinterpretation of data

“Deadly sins” of forensic neuropsychology

• “it’s elementary”
• an abnormal test result means the patient has brain damage
• WCST example and frontal impairment
• “what you see is what you get”
• testing always predicts functioning
• “two deficits are worse than one”
• each test as independent sample of behavior, not correlated
• “all people are created equal”
• all functions should be normal or above average in the intact individual
• “the proof is in the pudding”
• abnormal neuropsych findings but normal MRI shows superiority of neuropsych
• “one man’s ceiling is another man’s floor”
• subjectivity in interpretation by experts
• “you can use a wedge to putt from the fringe, as long as you blade it correctly”
• any test can be useful in the hands of a skilled neuropsychologist


• “if the patient complains, it must hurt”
• self report as reliable
• “what I don’t know won’t hurt me”
• no need for history, educational records, etc.
• “it’s all in the name”
• you can tell what a test measures by its name
• “three words to remember: localization, localization, localization”
• every test has its own special location in the brain

More Ethical Issues

Forensic work:

• who hires you?
• do you tailor reports to suit attorney’s request?
• expert witness vs. witness of fact
• reliability and validity issues
• confidentiality limits
• “mental state” and civil suits
• use of technicians
• standards and standardization
• base rates
• sample questions which may be asked during testimony

General concerns:

• should everyone have a neuropsych eval who wants one?
• to whom should feedback be given? What about confidentiality limits?
• should the patient be told everything?
• watch what you say in your report
• always entertain alternate hypotheses
• use of technicians
• what about time demands, say from managed care/primary employment setting?
• competence in specialty areas
• appropriate choice of tests
• watch for client distress during testing
• consent
• payment and reports