Doctors are less likely to be struck off for dishonesty than other health workers

Authors: Clare Dyer 

Publication date:  08 Nov 2017


The stresses of work and the influence of a malfunctioning workplace are important factors when doctors and other healthcare professionals are charged with professional misconduct, research has concluded.[1]

An analysis of 6714 cases of professional misconduct brought by three healthcare regulators, including the General Medical Council (GMC), identified three types of perpetrators. These are described as: the self serving “bad apple”; the individual who is corrupted by falling standards in the workplace; and the depleted perpetrator struggling to cope with the pressures of life.

The study, led by Rosalind Searle, professor of organisational behaviour and psychology at the University of Coventry, looked at professional misconduct cases from 2014 to 2016 seen by the GMC, the Nursing and Midwifery Council, and the Health and Care Professions Council. The determinations came from the database of the Professional Standards Authority for Health and Social Care (PSA), which oversees nine regulators.

Harry Cayton, PSA chief executive, commented, “This research is the most ambitious project yet undertaken to use the information contained in the authority’s database of fitness to practise determinations. In this report, Professor Searle offers us a rich and fascinating discussion of the complex and subtle interplay between individual professionals, teams, workplaces, gender and culture.”

The researchers said that “bad apples” operate as sole agents for their own benefit. The second category, “corrupting barrels,” involves “the normalisation of misconduct, and thus the erosion of perpetrators’ moral compasses.” The final category, “depleting barrels,” involves the cumulative “erosion of individuals’ resources through stress or resource depletion, and therefore misconduct emerges through omission and error.”

The authors noted, “We find evidence in our qualitative analysis of stressed health professionals making poor judgements, which at times is exacerbated by the intimate and emotional nature of health consultation and treatment, or from relentlessly witnessing ongoing traumas.

“Clearly, delivering a 24-hour health service has inherent shift requirements that can create sleep problems for some, but with the accumulative exposure from years of working in inherently more stressful professional roles, such as accident and emergency, it is easy to see how some individuals, either more prone or over-exposed, can experience ego-depletion.”

The research looked in more detail at two types of misconduct: sexual boundary violations and dishonesty. The latter, which included theft and lying about qualifications or restrictions on practice, was the most frequent form of misconduct by doctors.

Sexual misconduct allegations seemed to be more frequent among doctors than the other professions, the study found; however, doctors were likely to receive lesser sanctions for sexual misconduct than nurses or midwives, who were more likely to be struck off the register.

Guidance lays down that perpetrators who show insight into their actions and regret or remorse should receive lesser sanctions. “It is, however, not possible from the current analysis to consider whether doctors are more insightful about their wrongdoing than nurses, or whether they ‘know the right things to say’ in order to better reduce their punishments,” said the researchers. “Further research in this area is thus required.”

In terms of dishonesty, a sample of cases also showed that doctors were less likely to be struck off than nurses or other healthcare professionals. “Given the obvious increased financial rewards for fraud for this profession, it was somewhat surprising that greater sanctions were not applied to those who could arguably do greater harm to service users and to institutions,” the researchers concluded.

References

  1. Searle RH, Rice C, McConnell AA, Dawson FF. Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: insights into sexual misconduct and dishonesty. University of Coventry. Nov 2017. [Link] .

Clare Dyer The BMJ

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