Article

Wie schreib ich’s meinem Patienten? Datenschutzprobleme bei der digitalen Kommunikation

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Abstract

Digitale Kommunikation ist aus dem Alltag nicht mehr wegzudenken; im privaten Bereich sind insbesondere soziale Messenger-Dienste weit verbreitet. So scheint es für manche Patienten1 nahliegend zu sein, solche Kommunikationsmittel auch für die Kommunikation mit ihren professionellen Behandlern zu verwenden. Aus organisatorischen Gründen scheint dies auch für Psychotherapeuten Vorteile mit sich zu bringen; dies darf jedoch nicht unreflektiert dazu führen, die enormen Probleme solcher Plattformen, insbesondere mit Blick auf den Datenschutz, aus den Augen zu verlieren. Trotz rechtlich verpflichtender Einführung der Telematik-Infrastruktur in der ambulanten vertragspsychotherapeutischen/vertragsärztlichen Versorgung existiert bisher keine unproblematische Kommunikationsplattform für Psychotherapeuten und ihre Patienten. Spezielle Messenger-Dienste, die Metadaten ausdrücklich nicht speichern, scheinen neben der klassischen Telefonverbindung oder einem Brief die wenigsten Nachteile zu haben, sie sind jedoch bisher kaum verbreitet. Dieser Artikel möchte Psychotherapeuten für ihre Verantwortung sensibilisieren, und es sollen darin technische Möglichkeiten dargestellt werden, die individuell sorgfältig abgewogen werden müssen, um gegebenenfalls den Datenschutz der digitalen Kommunikation in der Praxis zu verbessern.

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Background: The Internet is of great importance in today's health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants' type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet's role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.
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„Social network sites“ (SNS) sind selbstverständlicher Teil der Lebenswelt Jugendlicher. Ihre hohe Bedeutung für das Leben der Jugendlichen legt es nahe, SNS als wichtige Entwicklungsumgebung zu betrachten, die auch in der Psychotherapie mit Jugendlichen berücksichtigt werden muss. Psychotherapeuten sollten kompetent sowohl mit möglicherweise auftretenden Problemen (z. B. Cybermobbing) umgehen können als auch die Möglichkeiten nutzen können, die sich durch die SNS-Aktivitäten für die Psychotherapie ableiten. So ergeben sich neue und erfolgversprechende Möglichkeiten der Unterstützung für den Identitätsaufbau, die Gestaltung sozialer Kontakte und für Kriseninterventionen bei Jugendlichen.
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Anxiety disorders are among the most prevalent mental disorders. In panic disorder, panic attacks often occur at unpredictable times, making it difficult to study these episodes in the laboratory. In specific phobias, symptoms occur in very circumscribed situations and specific triggers are sometimes difficult to reproduce in the laboratory. Ambulatory assessment, or ecological momentary assessment, can further the understanding of the natural course and scope of symptoms under ecologically valid circumstances. Because bodily symptoms are integral to the diagnosis of anxiety disorders, the objective assessment of physiological responses in the patients' natural environment is particularly important. On the one hand, research has highlighted intriguing discrepancies between the experience of symptoms and physiology during panic attacks. On the other hand, it has validated symptom reporting during therapeutic exposure to phobic situations. Therefore, ambulatory assessment can yield useful information about the psychopathology of anxiety disorders, and it can be used to monitor change during clinical interventions.
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We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators. Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families. We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder. Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.
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Psychologists and psychiatrists recently started using electronic mail (e-mail) to conduct therapy. This article explores relevant ethical and legal issues including, among others, the nature of the professional relationship, boundaries of competence, informed consent, treating minors, confidentiality, and the duty to warn and protect. To illustrate these complex issues, two services currently operating are discussed. To address potential hazards to clients and the profession, a new ethical standard for e-mail therapists is offered.
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Women with breast carcinoma commonly experience psychologic distress following their diagnosis. Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives. Web-based breast cancer social support groups are widely used, but little is known of their effectiveness. Preliminary evidence suggests that women benefit from their participation in web-based support groups. Seventy-two women with primary breast carcinoma were assigned randomly to a 12-week, web-based, social support group (Bosom Buddies). The group was semistructured, moderated by a health care professional, and delivered in an asynchronous newsgroup format. The results indicate that a web-based support group can be useful in reducing depression and cancer-related trauma, as well as perceived stress, among women with primary breast carcinoma. The effect sizes ranged from 0.38 to 0.54. Participants perceived a variety of benefits and high satisfaction from their participation in the intervention This study demonstrated that the web-based program, Bosom Buddies, was effective in reducing participants' scores on depression, perceived stress, and cancer-related trauma measures. The effect size of the intervention was in the moderate range. Although web-based social support groups offer many advantages, this delivery mechanism presents a number of ethical issues that need to be addressed.
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