Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016

What Can State Medical Boards Do to Effectively Address Serious Ethical Violations?

State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team's larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.

Dismissed Psychiatry Residents Who Appeal: Exploring Unprofessional Behavior

OBJECTIVE

Dutch psychiatry residents who are dismissed from their training program have the opportunity to appeal the decision. Those appeals are publicly available. This report explores the appeals of residents dismissed for unprofessional behavior.

METHODS

The authors analyzed caselaw of dismissed psychiatry residents brought before the conciliation board of The Royal Dutch Medical Association and compared them to a control group of caselaw of dismissed family medicine residents.

RESULTS

From 2011 to 2020, 19 psychiatry residents were dismissed for failing to meet the competencies of the CanMEDS professional domain and matched with 19 family medicine residents. Most psychiatry residents deficient in professionalism were considered deficient in their attitude, in reliability of keeping agreements, or in their ability to profit from supervisors' feedback. Insufficient professional behavior overlapped with insufficient communication, collaboration, and management. Half of the psychiatry residents with deficits in professionalism went on sick leave at some time. Between residents in psychiatry and family medicine, or between psychiatry residents with and without a favorable conciliation board decision, no statistical differences were found regarding gender, year of residency, and number of insufficient competencies.

CONCLUSIONS

The deficiencies in the professionalism of residents who challenged their program director's decision to be dismissed mostly consisted of inadequate attitude or the inability to profit from feedback, suggesting that these residents lack empathy, introspection, or both.

Does YouTube Promote Research Ethics and Conduct? A Content Analysis of YouTube Videos and Analysis of Sentiments Through Viewers Comments

More commonly today, research ethics and misconduct are ideas that are frequently violated. The availability of information sources and the dissemination of awareness among researchers can help to reduce this kind of violation. This study highlights how YouTube can be used to promote discussions of research misconduct and ethics. The study looked into how many videos there are on research ethics and misconduct, which colleges actively provide such videos, and how satisfied viewers are with the available videos by analyzing comments. Various software tools, including Webometric Analyst, R-studio, and Microsoft Excel, were applied for data collection and analysis. On 01-24-2023, 515 videos and 6984 comments were retrieved using the correct search queries that is "Research ethics" OR "Research misconduct" OR "Research conduct" OR "Scientific integrity" OR "Research integrity" OR "Scientific misconduct". Results indicate that 2020 was the most significant year, since the most videos (241) were posted in this year. The channels titled "PPIRCPSC, ABRIZAH A, and ALHOORI H" upload 10, 9, and 8 videos respectively, placing them in the first, second, and third positions. By analyzing viewer comments, it was determined that the majority of comments were favorable, indicating that viewers are generally pleased with the available videos.

Patient Online Record Access in English Primary Care: Qualitative Survey Study of General Practitioners' Views

BACKGROUND

In 2022, NHS England announced plans to ensure that all adult primary care patients in England would have full online access to new data added to their general practitioner (GP) record. However, this plan has not yet been fully implemented. Since April 2020, the GP contract in England has already committed to offering patients full online record access on a prospective basis and on request. However, there has been limited research into UK GPs' experiences and opinions about this practice innovation.

OBJECTIVE

This study aimed to explore the experiences and opinions of GPs in England about patients' access to their full web-based health record, including clinicians' free-text summaries of the consultation (so-called "open notes").

METHODS

In March 2022, using a convenience sample, we administered a web-based mixed methods survey of 400 GPs in the United Kingdom to explore their experiences and opinions about the impact on patients and GPs' practices to offer patients full online access to their health records. Participants were recruited using the clinician marketing service Doctors.net.uk from registered GPs currently working in England. We conducted a qualitative descriptive analysis of written responses ("comments") to 4 open-ended questions embedded in a web-based questionnaire.

RESULTS

Of 400 GPs, 224 (56%) left comments that were classified into 4 major themes: increased strain on GP practices, the potential to harm patients, changes to documentation, and legal concerns. GPs believed that patient access would lead to extra work for them, reduced efficiency, and increased burnout. The participants also believed that access would increase patient anxiety and incur risks to patient safety. Experienced and perceived documentation changes included reduced candor and changes to record functionality. Anticipated legal concerns encompassed fears about increased litigation risks and lack of legal guidance to GPs about how to manage documentation that would be read by patients and potential third parties.

CONCLUSIONS

This study provides timely information on the views of GPs in England regarding patient access to their web-based health records. Overwhelmingly, GPs were skeptical about the benefits of access both for patients and to their practices. These views are similar to those expressed by clinicians in other countries, including Nordic countries and the United States before patient access. The survey was limited by the convenience sample, and it is not possible to infer that our sample was representative of the opinions of GPs in England. More extensive, qualitative research is required to understand the perspectives of patients in England after experiencing access to their web-based records. Finally, further research is needed to explore objective measures of the impact of patient access to their records on health outcomes, clinician workload, and changes to documentation.

Academic Integrity Perceptions Among Health-Professions’ Students: A Cross-Sectional Study in The Middle East

A high level of professional integrity is expected from healthcare professionals, and literature suggests a relationship between unethical behavior of healthcare professionals and poor academic integrity behavior at medical school. While academic integrity is well researched in western countries, it is not so in the Middle East, which is characterized by different cultural values that may influence students’ academic integrity conduct. We conducted a cross-sectional study among health-professions students at a university in the Middle East to assess perceptual differences on various cheating behaviors, as well as to explore the reasons underlying the cheating behavior. A validated survey instrument disseminated among first and second-year undergraduate students resulted in 211 complete responses and this data was analyzed using descriptive and inferential statistics. Pearson’s Chi-square/ Fischer’s exact test was applied to test the association of various factors with academic misconduct. The major determinants of academic misconduct were investigated using Binary Logistic regression model. The conducted analysis and the results showed that preceding cheating behavior was the only factor significantly associated with cheating in the university (p < 0.001). No association was found between cheating behavior and age, college/major, awareness regarding academic integrity, or perception of faculty response. The reasons provided by students for cheating behavior were mainly academic workload and pressure to get a good grade. Various suggestions are made to enhance academic integrity among health-professions students including organizing workshops and events by the university to increase awareness and create an academic integrity culture, providing peer guidance as well as emotional and social support.

Professional authority and sexual coercion: A paradigmatic case study of doctor abuse

Professionals occupy a position of esteem in society. Doctors and health professionals tend to score especially highly on public opinion surveys of trust. Sexual violence and abuse (SVA) by medical professionals towards their patients is a grave breach of that confidence. This paper uses thematic analysis of a paradigmatic case study of doctor abuse, drawn from a larger sample of semi-structured interviews conducted for an Economic and Social Research Council (ESRC) funded United Kingdom (UK) study 2015-2018 into justice and gender based violence. It explores how professional authority can both facilitate and conceal sexual coercion through building dependency; use of language and authorship of the official record; and by functional complicity and 'data doubling' within intra and inter-professional cultures. While there is an established literature on child sexual abuse, including in institutional contexts, this paper focuses on the lived experience of grooming and sexual violence of an adult survivor of doctor abuse.

Associations between admissions factors and the need for remediation

This study examines the way in which student characteristics and pre-admissions measures are statistically associated with the likelihood a student will require remediation for academic and professionalism offenses. We anchor our inquiry within Irby and Hamstra's (2016) conceptual framework of constructs of professionalism. Data from five graduating cohorts (2014-2018) from McMaster University (Hamilton, Canada) (N = 1,021) were retroactively collected and analyzed using traditional and multinominal logistic regression analyses. The relationship among student characteristics, pre-admissions variables, and referral for potential remediation both by occurrence (yes/no) as well as type (academic/professional/no referral) were examined separately. Findings indicate that gender (OR = 0.519, 95% CI 0.326-0.827, p < 0.01) and undergraduate grade point average (GPA) (OR = 0.245, 95% CI 0.070-0.855, p < 0.05) were significantly associated with instances of referral for potential professionalism and academic remediation, respectively. Women were less likely than men to require remediation for professionalism (OR = 0.332, 95% CI 0.174-0.602, p < 0.001). Undergraduate GPAs (OR = 0.826, 95% CI 0.021-0.539, p < 0.01) were significantly associated with remediation for academic reasons. Lower undergraduate GPAs were associated with a higher likelihood of remediation. These findings point to the admissions variables that are associated with instances that prompt referral for potential remediation. Where associations are not significant, we consider the application of different conceptualizations of professionalism across periods of admissions and training. We encourage those involved in applicant selection and student remediation to emphasize the importance of the interactions that occur between personal and contextual factors to influence learner behaviour and professional identity formation.

Intimacy in Psychotherapy: An Exploratory Survey Among Therapists

A certain level of intimacy is necessary in psychotherapeutic relationships for them to be effective, but it can sometimes develop further into more intimate feelings and behaviors related to friendship and sexuality, into friendship, or even into sexual relationships. In this study, a self-administered questionnaire was sent to psychotherapists in Flanders (Belgium), asking about the occurrence of these situations. It provides an overview of these occurrences and comparative data to view for generational and cultural differences with previous studies. A response rate of 40% was obtained (N = 786): 69% of respondents were female therapists and none were transgender. A total of 758 therapists stated that they had actually provided psychotherapy and were included for further analysis. Three percent started a sexual relationship with a current and/or former client, 3.7% started a friendship during therapy, and 13.4% started a friendship after therapy. About seven out of ten therapists found a client sexually attractive, a quarter fantasized about a romantic relationship, and a fifth gave a goodbye hug at the end of a session (22%). In general, more male therapists reported sexual feelings and behaviors than female therapists. Older therapists more often behaved informally and started friendships with former clients compared to younger colleagues. Psychiatrists reported sexual feelings and fantasies less often than non-psychiatrists, and behavioral therapists reported this less frequently than person-centered and psychoanalytic therapists. Overall, prevalence rates of intimate feelings and behaviors related to friendship and sexuality are lower than those in previous studies.

On intimate relationships between healthcare professionals and patients: a nationwide cohort analysis of medical tribunal decisions in the Netherlands

Background

We examine the incidence of medical tribunal decisions and disciplinary actions (DAs) against healthcare professionals (HCPs). In addition, we studied whether an intimate relationship between an HCP and patient as part of the medical tribunal decision is associated with an increased likelihood of disciplinary actions.

Methods

We conducted a nationwide cohort analysis on the downloadable medical tribunal decisions from a medical disciplinary tribunal in the Netherlands from 2010 to 2017.

Results

We found that 117 (2.8%) of the 4,046 medical tribunal decisions involved an alleged intimate relationship between an HCP and patient. In these medical tribunal decisions the likelihood of a disciplinary action was significantly increased (odds ratio [OR] 12.97, 95% Confidence Interval [95% CI] 7.11–23.64). In addition, we found that nurses and psychiatrists are more frequently accused of and receive disciplinary actions due to intimate relationships than other HCP groups.

Conclusions

We found a limited number of medical tribunal decisions involving an intimate relationship. Especially given the total number of medical tribunal decisions and the number of yearly HCP-patient interactions, the number appears small. Furthermore, an alleged intimate relationship or inappropriate sexual conduct is associated with an increased likelihood of disciplinary action. Future research should obtain statistics on the number of intimate relationships that actually start between HCPs and patients.

Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems

BACKGROUND

Critical Incident Reporting Systems (CIRS) provide a well-proven method to identify clinical risks in hospitals. All professions can report critical incidents anonymously, low-threshold, and without sanctions. Reported cases are processed to preventive measures that improve patient and staff safety. Clinical ethics consultations offer support for ethical conflicts but are dependent on the interaction with staff and management to be effective. The aim of this study was to investigate the rationale of integrating an ethical focus into CIRS.

METHODS

A six-step approach combined the analysis of CIRS databases, potential cases, literature on clinical and organizational ethics, cases from ethics consultations, and experts' experience to construct a framework for CIRS cases with ethical relevance and map the categories with principles of biomedical ethics.

RESULTS

Four main categories of critical incidents with ethical relevance were derived: (1) patient-related communication; (2) consent, autonomy, and patient interest; (3) conflicting economic and medical interests; (4) staff communication and corporate culture. Each category was refined with different subcategories and mapped with case examples and exemplary related ethical principles to demonstrate ethical relevance.

CONCLUSION

The developed framework for CIRS cases with its ethical dimensions demonstrates the relevance of integrating ethics into the concept of risk-, quality-, and organizational management. It may also support clinical ethics consultations' presence and effectiveness. The proposed enhancement could contribute to hospitals' ethical infrastructure and may increase ethical behavior, patient safety, and employee satisfaction.

There's No Harm in Talking: Re-Establishing the Relationship Between Theological and Secular Bioethics

Theological and secular voices in bioethics have drifted into separate silos. Such a separation results in part from (1) theologians focusing less on conveying ideas in ways that contribute to a pluralistic and public bioethical discourse and (2) the dwindling receptivity of religious arguments within secular bioethics. This essay works against these drifts by putting forward an argument that does not bounce around a religious echo-chamber, but instead demonstrates how insights of Christian anthropology can be meaningfully responsive to secular bioethics' rightful concerns with inequality and injustice. We offer core concepts from Christian bioethics that encourage dialogue with secular and theological bioethicists. The theologically-grounded concepts, human dignity, sin, and the common good, provide intellectual resources to address major areas of bioethical concern that remain unresolved.

Comparison of the Professionalism Behaviours of Medical Students from Four GCC Universities with Single-gender and Co-educational Learning Climates

Background:

Medical professionalism is a multi-dimensional construct that is viewed differently across institutions. Such variations might be related to diverse cultural and societal characteristics of learners and faculty.

Objectives:

This study determined whether differences exist between proposed sanctions for a one-time academic integrity infraction associated with unprofessional behaviors. We selected four medical schools with either single-gender or co-educational learning environments in the Gulf Cooperation Council (GCC) countries.

Methods:

The 34-statement Dundee Polyprofessionalism Inventory I was disseminated to all medical students across years in selected institutions. Descriptive and inferential statistical analyses were conducted, and median scores were used to determine the respondents’ proposed sanctions.

Results:

Of the 1941 invitees, 1313 students responded (response rate of 68%). Significant similarity, as recorded by median sanction scores was recorded for 21 (62%) of the 34 inventory items from two medical schools. However, significant differences of one level of difference between all the median sanction scores for single-gender and co-educational students were found for 32% of inventory items. In co-educational schools, males were stricter than females for 9% and seniors were stricter than juniors for 12% of the inventory items. In contrast, in single-gender schools, females were stricter than males for only 6% of the inventory and seniors were more lenient than juniors for another 6% of the inventory.

Conclusions:

This study reports significant congruence and some differences in medical students’ perceptions of unprofessional behaviors. Educators are urged to develop a unified framework for enforcing sanctions to unprofessional behaviors.