Given Baby P/Shipman whats more important, evidence based medicine or admission ?

[ipsiLoquitor]

Originally Posted by Muffin2

Oh for F**ks sake, stop psychoanalysing everyone! It's irritating! Your a frikkin nobody on a forum! Some weirdo loser who has nothing better to do.

Btw, this is Eponine_hugo speaking through my alter ego Muffin 2..... yes I have multiple personalities, what do you think of that Ipsi baby? Bit of psychodynamic therapy coming my way.

Northern light give it up mate, this dudes gonna twist everything round, don't waste your time. People like this will get bored very easily once ignored.

Stimulus:

Baby P was a 17 month old baby boy who died on 3rd August, 2007 after suffering months of abuse inflicted on him by his mother, her boyfriend and their lodger.

He was visited over 60 times during this period by various health and social workers, yet he was allowed to remain with the very people who ultimately took his life.

The mother, her boyfriend and the lodger have been convicted of causing or allowing the death of a child and will be sentenced on 15th December, 2008.

Response of Muffin2/Eponine Hugh ?
Oh for F**ks sake, stop psychoanalysing everyone! It's irritating! Your a frikkin nobody on a forum! Some weirdo loser who has nothing better to do.

Evidence base ?

> 200, 000 other people with nothing to do on Facebook...

[northoftherriver]

Originally Posted by ipsiLoquitor

One Q at a time:

Try this link for inventories (widely and currently used tool in NHS).
Personality Assessment Inventory
You will see that doing this kind of assessment is entirely different from the current set up, in a different league in fact.

This is one step (psychological assessment) of those I mentioned.

More references to follow as requested...

Her is a quote on what is called 'reliability studies'

The PAI is a thoroughly validated instrument with data from three (3) samples:

(a) a census-matched normative sample of 1000 community-dwelling adults (matched on the basis of gender, race and age);

(b) a sample of 1265 patients from 69 clinical sites;

(c) a college sample of 1051 students .

Reliability studies show that PAI scales have a high degree of internal consistency. Validity studies demonstrate the convergent and discriminant validity of PAI scales with more than 50 other measures of psychopathology.

I'm not sure that really counts as peer-reviewed reliable evidence, seeing as it is on the website of the company selling the test! Where are those figures from?

A lot of the literature on Pubmed focuses on using this tool in a therapeutic context, which is a little different from the context of a medical interview. I did find this paper on its use in recruiting police officers:

IngentaConnect The Personality Assessment Inventory Borderline, Drug, and Alcoho...

"Abstract:
Previous studies have established the utility of self-report personality inventories in the pre-employment screening of police officers. The present study therefore sought to explore the relationship between the Personality Assessment Inventory (PAI) Borderline, Drug, and Alcohol Scales and performance as a police officer. The PAI results of 632 police officers who took the test as part of pre-employment screening procedures were used in discriminant function and multiple regression analyses to determine whether or not these scales are useful in the pre-employment screening of police officers. These scales did not predict performance as a police officer when the entire sample of 632 was used. However, the Borderline Negative Relations subscale combined with the Drug scale of the PAI were marginally predictive of the 132 poorest performing officers in the sample when an exploratory stepwise multiple regression model was used. The implications of these findings for police selection are discussed."

(My emphasis)

Not exactly a ringing endorsement - there are three kinds of lies after all - and even when they do more careful analysis the predictive pwer is marginal. Hardly seems fair that this would be used to decide someones future.

Do you have other (published, peer-reviewed) research in mind specifically relating to medical or other recruitment scenarios?

The point here being that when there are a surplus of applicants to study medicine, the only thing from the patient's perspective to fear is if such inventories discriminated in favour of psychopathology.

Which mental illnesses should preclude one becoming a Dr?

Compare this to discussing your hobbies and motivations with a 3 doctor panel consisting of people who whilst highly qualified in many things generally have no specialist knowledge of psychological assessment.
[There are numerous studies showing that e.g. tall people and especially men are credited with greater intelligence etc than shorter men e.g. of (ref Argyll - Psychology of Interpersonal Relations) This is why I call the process 'prejudicial' and a form of intellectual racism.

Which is why many medical schools have an interview process that is a little more involved and objective, eg structured interviews, various other activities to assess empathy and teamwork and so on.

There is a body of literature regarding medical admissions and outcomes. The onus is on you to prove that your proposal would result in tangible and consistent benefit for patients, and furthermore that this benefit could not be achieved more easily another way, eg post-qualification assessment of competencies, for example.

[BeanOfJelly]

I would like to point out that the Baby P case doesn't say anything about current medical school applications procedures, as the doctor involved did not undergo them- they did whatever was in practise when they applied to medical school some 25 years ago. In other words, it wouldn't really strengthen your argument if you said it once, so there's really no need to keep repeating the details over and over again.
Also, what happened to this "spectrum" I was anticipating so avidly? You have failed to produce any evidence for your loony claims, so I don't see why I should just accept them.
That is to say, it is not a "far greater lie" to "hear ideas and actively reject them time and time again" if said ideas are just plain stupid/illogical. How many times do I have to tell you the moon is made of cheese, before you should either accept what I'm saying or "face the limits of competence"?

[ipsiLoquitor]

Are those words coming from a thinking would be medic or a big jawed spider ?

I can recommend a couple of good books on logic if it will help.

Here is an example of your sloppy thinking:

1. The doctor may or may not have gone to medical school in the UK. In either case she had an 'entry route' to working as a doctor in the UK as discussed above. That entry route has an admission process. That admission process does not involve e.g. personal inventories.
2. Given that the steps I am proposing are absent in current admissions processes it doesn't really make a difference if they were also absent 25 years ago. That is just obiter dictum.
3. You haven't responded to the initial posting of evidence (or acknowledged its existence) unlike other members of this forum. As such you disqualify yourself from being considered to have read the thread.
4. Clearly if you haven't yet been admitted to med school and neither have the knowledge etc of a doctor you are by all estimates currently incompetent even if in the future you are admitted and gain competencies. Therefore, to take personally remarks directed at those claiming to be doctors or (doctors -1) is a little egocentric.
5. The issue here is what an adequate response is to the training and management of doctors, from admission to commission, in response to the preventable death of Baby P.

Do you have one single idea about how admission to medical school could be improved ?

[BeanOfJelly]

Originally Posted by ipsiLoquitor

Are those words coming from a thinking would be medic or a big jawed spider ?

1. The doctor may or may not have gone to medical school in the UK. In either case she had an 'entry route' to working as a doctor in the UK as discussed above. That entry route has an admission process. That admission process does not involve e.g. personal inventories.
2. Given that the steps I am proposing are absent in current admissions processes it doesn't really make a difference if they were also absent 25 years ago. That is just obiter dictum.
3. You haven't responded to the initial posting of evidence (or acknowledged its existence) unlike other members of this forum. As such you disqualify yourself from being considered to have read the thread.
4. Clearly if you haven't yet been admitted to med school and neither have the knowledge etc of a doctor you are by all estimates currently incompetent even if in the future you are admitted and gain competencies. Therefore, to take personally remarks directed at those claiming to be doctors or (doctors -1) is a little egocentric.
5. The issue here is what an adequate response is to the training and management of doctors, from admission to commission, in response to the preventable death of Baby P.

Do you have one single idea about how admission to medical school could be improved ?

Firstly, I am not a spider. Have you had any bad experiences with them during your childhood that you may need to consider before posting?*

1. and 2. You suggest that the reason for the doctor's failure with baby P is due to current failings in the application process. This cannot be true as the doctor did not proceed through current admissions, but those of 25 years ago (quite different to today's with less focus on work experience and well-roundedness), or as you say by "entry route" or whatever. Hence, baby P cannot be used as evidence of current failings/ or the need for any further quasi-tests.
3. Research posted by the designers of a test as to its reliability is hardly strong evidence. Yes, I did bother to read it, but there was no need to make a comment as NOTR had already done so. Even so, its hardly the spectrum you promised, and is not sufficient to change my viewpoint. I would also say that you're not really in a position to disqualify posters- maybe you should consult the moderator?*
4. The point you made applies to yourself.
5. Totally in agreement. Dunno why you're rambling on about personality profiling.

Yes, I think fewer unsubstantiated quasi-tests will improve the admissions process greatly. Although, other than that, I think the admissions process is pretty good.

*To anyone reading, I have adopted a certain somebody's discussion style for these sentences.

[ipsiLoquitor]

We were supposed to be discussing a constructive response to Baby P but since the would-be medics here (or 3/4 of them LOL) don't like to engage unless they see themselves I'll just quickly mention ambiguity.

In psychological assessment it has been shown that those people unable to tolerate ambiguity are also more likely to have racist beliefs and beliefs of superiority. Should these people become doctors? Piraticus has a number of meanings and therefore demonstrates ambiguity, one of which is a type of spider which you have quoted on every posting made - I wonder is it phobia or fetish - who cares as long as you love your mother.

You are making a logical error which is horific in the context of presenting yourself as a 'scientist'. If the doctor in question didn't undergo the usual entry procedures ancient or modern, that doesn't mean that psychological profiling wouldn't help identify her issues, just that it wasn't tested. IF you ever become a paediatrician and your child has anaemia suspected by the mother, I suggest you listen to her (or Giella's mother) and then do an FBC. As you know there are a large number of anaemias, another terms with more than one meaning, like Piraticus.

The inventory site posted was labelled as an introductory example if you read the thread, which you appear not to have done. Again, inventories exist in their scores, the MMPI. Are you claiming that a particular company has designed the entire literature on inventories ? Did you appreciate what was measured in them ?

If you have any interviews left, I recommend keeping as quiet as possible. If you are reasonably good looking, tall and don't break any preconceived ideas of what a doctor should be on visual inspection, just get some As in your A-levels and all may be well. Most of the doctors I know, however, will find your willingness to be dogmatic about something you have no evidence about worrying in the extreme. You see, despite the deficiencies that allow unqualified entry to some incompetent doctors, the vast majority are highly skilled and dedicated. When you voice an opinion based on ignorance so dogmatically, so dismissively, you insult not me but everyone you approach to say 'I have the qualities to join you.'

Whilst comprehensive evidence isn't routinely used in admission it is used in diagnosis and treatment - become friends with it. just in case you do not receive 4 rejections. The author of Gone With The Wind received over 100. Is that evidence of anything at all ?

[ipsiLoquitor]

Originally Posted by Airtones

Shipman was an incredibly intelligent man, as good as any other doctor with regards to brain power. The fact he killed 215 people isn't because he was some sort of moron, its vastly more complex than that.

The question with Baby P is how a child managed to have 60 visits with health care professionals yet none identified that he was being harmed. One even managed to fail to identify that he had 8 broken ribs and probably a broken spine... great doctoring there. Now haringey are banding round saying they support the system - well obviously they do, they want to make it seem like everything was done by the book when clearly there were repeated failings in the process.

This may help. It is taken from MMPI on Wiki:-

MMPI
The original MMPI was developed in the late 1930s using an empirical keying approach, which means that the clinical scales were derived by selecting items that were endorsed by patients known to have been diagnosed with certain pathologies. [2] [3][4][5][6] The difference between this approach and other test development strategies used around that time was that it was atheoretical (not based on any particular theory) and thus the initial test was not aligned with the prevailing psychodynamic theories of that time. The atheoretical approach to MMPI development enabled the test to capture aspects of human psychopathology that were recognizable and meaningful despite changes in clinical theories.

[ipsiLoquitor]

Originally Posted by BeanOfJelly

I would like to point out that the Baby P case doesn't say anything about current medical school applications procedures, as the doctor involved did not undergo them- they did whatever was in practise when they applied to medical school some 25 years ago. In other words, it wouldn't really strengthen your argument if you said it once, so there's really no need to keep repeating the details over and over again.
Also, what happened to this "spectrum" I was anticipating so avidly? You have failed to produce any evidence for your loony claims, so I don't see why I should just accept them.
That is to say, it is not a "far greater lie" to "hear ideas and actively reject them time and time again" if said ideas are just plain stupid/illogical. How many times do I have to tell you the moon is made of cheese, before you should either accept what I'm saying or "face the limits of competence"?

Didn't want to 'punish' you with evidence and the evidence posted below only applies to my introductory point (think of it being a thesis with these references applying to the introductory paragraph).

However, now we know you don't know what inventories are, what they measure or how they work, you can look them up on Wiki and notice some of the references which I cut and paste only to demonstrate that if you take my theory stepwise and logically, each element of it is fully supported by the data. The following references simply support some general concepts and do not represent my adaptations to the tests:

1. ^ Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation. Minneapolis, MN: University of Minnesota Press.
^ Hathaway, S. R., & McKinley, J. C. (1940). A multiphasic personality schedule(Minnesota): I. Construction of the schedule. Journal of Psychology, 10, 249-254.
^ Hathaway, S. R., & McKinley, J. C. (1942). A multiphasic personality schedule (Minnesota): III. The measurement of symptomatic depression. Journal of Psychology, 14, 73-84.
^ McKinley, J. C, & Hathaway, S. R. (1940). A multiphasic personality schedule (Minnesota): II. A differential study of hypochondriasis. Journal of Psychology, 10,255-268.
^ McKinley, J. C, & Hathaway, S. R. (1942). A multiphasic personality schedule (Minnesota): IV. Psychasthenia. Journal of Applied Psychology, 26, 614-624.
^ McKinley, J. C, & Hathaway, S. R. (1944). A multiphasic personality schedule (Minnesota): V. Hysteria, Hypomania, and Psychopathic Deviate. Journal of Applied Psychology, 28, 153-174.
^ Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A, & Kaemmer, B. (1989).The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.
^ Butcher, J. N., Hostetler, K. (1990). Abbreviating MMPI Item Administration. What Can Be Learned From the MMPI for the MMPI—2?. Psychological Assessment: A Journal of Consulting and Clinical Psychology, March 1990 Vol. 2, No. 1, 12-21
^ Butcher, J.N., Williams, C.L., Graham, J.R., Archer, R.P., Tellegen, A., Ben-Porath, Y.S., & Kaemmer, B. (1992). Minnesota Multiphasic Personality Inventory-Adolescent Version(MMPI-A): Manual for administration, scoring and interpretation. Minneapolis, MN: University of Minnesota Press.
^ Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation. Minneapolis, MN: University of Minnesota Press.
^ Arbisi, P. A., Sellbom, M., & Ben-Porath, Y. S. (2008). Empirical correlates of the MMPI-2 Restructured Clinical (RC) Scales in psychiatric inpatients. Journal of Personality Assessment, 90, 122-128.
^ Castro, Y., Gordon, K. H., Brown, J. S., Cox, J. C., & Joiner, T. E. (In Press). Examination of racial differences on the MMPI-2 Clinical and Restructured Clinical Scales in an outpatient sample. Assessment.
^ Forbey, J. D., & Ben-Porath, Y. S. (2007). A comparison of the MMPI-2 Restructured Clinical (RC) and Clinical Scales in a substance abuse treatment sample. Psychological Services, 4, 46-58.
^ Handel, R. W., & Archer, R. P. (In Press). An investigation of the psychometric properties of the MMPI-2 Restructured Clinical (RC) Scales with mental health inpatients. Journal of Personality Assessment.
^ Kamphuis, J.H., Arbisi, P.A., Ben-Porath, Y.S., & McNulty, J.L. (In Press). Detecting Comorbid Axis-II Status Among Inpatients Using the MMPI-2 Restructured Clinical Scales. European Journal of Psychological Assessment.
^ Osberg, T. M., Haseley, E. N., & Kamas, M. M. (2008). The MMPI-2 Clinical Scales and Restructured Clinical (RC) Scales: Comparative psychometric properties and relative diagnostic efficiency in young adults. Journal of Personality Assessment. 90, 81-92.
^ Sellbom, M., Ben-Porath, Y. S., & Bagby, R. M. (In Press). Personality and Psychopathology: Mapping the MMPI-2 Restructured Clinical (RC) Scales onto the Five Factor Model of Personality. Journal of Personality Disorders.
^ Sellbom, M., Ben-Porath, Y. S., & Graham, J. R. (2006). Correlates of the MMPI-2 Restructured Clinical (RC) Scales in a college counseling setting. Journal of Personality Assessment, 86, 89-99.
^ Sellbom, M., Ben-Porath, Y. S., McNulty, J. L., Arbisi, P. A., & Graham, J. R. (2006). Elevation differences between MMPI-2 Clinical and Restructured Clinical (RC) Scales: Frequency, origins, and interpretative implications. Assessment, 13, 430-441.
^ Sellbom, M., Graham, J. R., & Schenk, P. (2006). Incremental validity of the MMPI-2 Restructured Clinical (RC) Scales in a private practice sample. Journal of Personality Assessment, 86, 196-205.
^ Simms, L. J., Casillas, A., Clark, L .A., Watson, D., & Doebbeling, B. I. (2005). Psychometric evaluation of the Restructured Clinical Scales of the MMPI-2. Psychological Assessment, 17, 345-358.
^ Sellbom. M., & Ben-Porath, Y. S. (2006). Forensic applications of the MMPI. In R. P. Archer (Ed.), Forensic uses of clinical assessment instruments. (pp. 19-55) NJ: Lawrence Erlbaum Associates.
^ Sellbom, M., Ben-Porath, Y. S., Baum, L. J., Erez, E., & Gregory, C. (2008). Predictive validity of the MMPI-2 Restructured Clinical (RC) Scales in a batterers' intervention program. Journal of Personality Assessment, 90. 129-135.
^ Sellbom, M., Ben-Porath, Y. S., Lilienfeld, S. O., Patrick, C. J., & Graham, J. R. (2005). Assessing psychopathic personality traits with the MMPI-2. Journal of Personality Assessment, 85, 334-343.
^ Sellbom, M., Ben-Porath, Y. S., & Stafford, K. P. (2007). A comparison of measures of psychopathic deviance in a forensic setting. Psychological Assessment, 19, 430-436.
^ Sellbom, M., Ben-Porath, Y. S., Graham, J. R., Arbisi, P. A., & Bagby, R. M. (2005). Susceptibility of the MMPI-2 Clinical, Restructured Clinical (RC), and Content Scales to overreporting and underreporting. Assessment, 12, 79-85.
^ Sellbom, M., & Ben-Porath, Y. S. (2005). Mapping the MMPI-2 Restructured Clinical (RC) Scales onto normal personality traits: Evidence of construct validity. Journal of Personality Assessment, 85, 179-187.
^ Sellbom, M., Fischler, G. L., & Ben-Porath, Y. S. (2007). Identifying MMPI-2 predictors of police officer integrity and misconduct. Criminal Justice and Behavior, 34, 985-1004.
^ Stredny, R. V., Archer, R. P., & Mason, J. A. (2006). MMPI-2 and MCMI-III characteristics of parental competency examinees. Journal of Personality Assessment, 87, 113-115.
^ Wygant, D. B., Boutacoff, L. A., Arbisi, P. A., Ben-Porath, Y. S., Kelly, P. H., & Rupp, W. M. (2007). Examination of the MMPI-2 Restructured Clinical (RC) Scales in a sample of bariatric surgery candidates. Journal of Clinical Psychology in Medical Settings, 14, 197-205.
^ Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation. Minneapolis, MN2). An MMPI handbook: Vol. I. Clinical interpretation. Minneapolis: University of Minnesota Press.
^ Caldwell, A. B. (1988). MMPI supplemental scale manual. Los Angeles: Caldwell Report.
^ Harkness, A. R., McNulty, J. L., Ben-Porath, Y. S., & Graham, J. R. (2002). MMPI-2 Personality-Psychopathology Five (PSY-5) Scales: Gaining an overview for case conceptualization and treatment planning. Minneapolis, MN: University of Minnesota Press.
^ Butcher, J. N., Hamilton, C. K., Rouse, S. V., & Cumella, E. J. (2006). The deconstruction of the Hy Scale of MMPI-2: Failure of RC3 in measuring somatic symptom expression. Journal of Personality Assessment, 87, 186-192.
^ Caldwell, A. B. (2006). Maximal measurement or meaningful measurement: The interpretive challenges of the MMPI-2 Restructured Clinical (RC) Scales. Journal of Personality Assessment, 87, 193-201.
^ Rogers, R., Sewell, K. W., Harrison, K. S., & Jordan, M. J. (2006). The MMPI-2 Restructured Clinical Scales: A paradigmatic shift in scale development. Journal of Personality Assessment, 87, 139-147.
^ Archer, R. P. (2006). A perspective on the Restructured Clinical (RC) Scale project. Journal of Personality Assessment, 87, 179-185.
^ Tellegen, A., Ben-Porath, Y. S., Sellbom, M., Arbisi, P. A., McNulty, J. L., & Graham, J. R. (2006). Further evidence on the validity of the MMPI-2 Restructured Clinical (RC) Scales: Addressing questions raised by Rogers et al. and Nichols. Journal of Personality Assessment, 87, 148-171.
^ David Armstrong, (March 5, 2008) "Malingerer Test Roils Personal-Injury Law; 'Fake Bad Scale' Bars Real Victims, Its Critics Contend The Wall Street Journal

Hope that helps Piraticus Heap.

[BeanOfJelly]

Originally Posted by ipsiLoquitor

In psychological assessment it has been shown that those people unable to tolerate ambiguity are also more likely to have racist beliefs and beliefs of superiority. Should these people become doctors?

I'm sorry, what? So people who don't agree with you are racist?

Originally Posted by ipsiLoquitor

Piraticus has a number of meanings and therefore demonstrates ambiguity, one of which is a type of spider which you have quoted on every posting made - I wonder is it phobia or fetish - who cares as long as you love your mother.

Piraticus refers to the gospel of the flying spaghetti monster, you should read up on your religions.

Originally Posted by ipsiLoquitor

If the doctor in question didn't undergo the usual entry procedures ancient or modern, that doesn't mean that psychological profiling wouldn't help identify her issues, just that it wasn't tested.

True, I didn't say that though. I said it doesn't provide any evidence that current admissions processes do require psychological profiling.

Originally Posted by ipsiLoquitor

The inventory site posted was labelled as an introductory example if you read the thread, which you appear not to have done.

Okay then, so I wasn't wrong when I said you hadn't posted any evidence.

Originally Posted by ipsiLoquitor

If you have any interviews left, I recommend keeping as quiet as possible.

That's nice. Real nice.

Originally Posted by ipsiLoquitor

Most of the doctors I know, however, will find your willingness to be dogmatic about something you have no evidence about worrying in the extreme.

So my asking you for evidence to support you claims, and you refusing to do so makes me dogmatic?

Originally Posted by ipsiLoquitor

just in case you do not receive 4 rejections. The author of Gone With The Wind received over 100. Is that evidence of anything at all ?

No. Certainly not anything relevant. And I'm going to post on your profile as soon as an offer comes through (looking forward to it)

I'm sick of you and I'm not posting on this thread again. Read into that how you want.

[ipsiLoquitor]

Originally Posted by BeanOfJelly

I'm sorry, what? So people who don't agree with you are racist?


Piraticus refers to the gospel of the flying spaghetti monster, you should read up on your religions.


True, I didn't say that though. I said it doesn't provide any evidence that current admissions processes do require psychological profiling.


Okay then, so I wasn't wrong when I said you hadn't posted any evidence.


That's nice. Real nice.


So my asking you for evidence to support you claims, and you refusing to do so makes me dogmatic?


No. Certainly not anything relevant. And I'm going to post on your profile as soon as an offer comes through (looking forward to it)

I'm sick of you and I'm not posting on this thread again. Read into that how you want.

If I may remind you of one of FSM's commandments ( a quote from your church):

"I'd really rather you didn't go around telling people I talk to you. You're not that interesting. Get over yourself. And I told you to love your fellow man, can't you take a hint?".

Baby P. will never learn of this church because she was killed by those who should have cared for her and not rescued by those who had the opportunity.

Sometimes, serious issues require serious minds. FSM has its own website - perhaps you could post your acceptance letter there ?