Psychiatrists are twice as likely as other Canadian doctors to face professional discipline generally and almost four times as apt to be sanctioned for sexual misconduct, concludes a new study that underscores long-held concerns about the speciality.
Experts blame the problem in part on psychiatrists’ unusually close and long relationships with their patients, compared to surgeons and some other specialists who often have relatively brief contact with the people they treat.
Past research has suggested many of the wayward therapists may also be “lovesick,” middle-aged men in isolated practices who fall for younger women, the study notes.
Regardless, the new analysis of a decade of discipline cases across Canada more than confirmed anecdotal evidence and a previous study that suggested a problem with psychiatry, said Dr. Chaim Bell of Toronto’s Mt. Sinai Hospital, who co-authored the paper.
“This is surprising in how consistent it is across the various provinces, how consistent it is in different years, and how consistent it is with penalties and fines,” he said. “It’s also consistent with the sort of sensational, one-type anecdotal coverage you might get…. The [discipline case] that gets the front page is often the psychiatrist.”
Just this month, in fact, at least two psychiatrists have been in the news for sexual-abuse allegations. A London doctor under investigation by the Ontario College of Physicians and Surgeons for allegedly masturbating and inappropriately videotaping female patients was charged by police with sexual assault and voyeurism. In Calgary, meanwhile, a psychiatrist is being tried on charges of sexually assaulting 10 male patients.
Dr. Bell, an internal-medicine specialist, stressed that it is still a small percentage of psychiatrists — about two per thousand — who get in trouble with their regulatory colleges. Given the “catastrophic” effect even rare cases of misconduct can have on patients and the public trust, however, psychiatry must do more to curb wrongdoing, the study’s authors say.
At the same time, the average psychiatrist who faced discipline over the 10-year study period had been practising for more than 30 years, perhaps reflecting a shrinking generation of practitioner, said Dr. Molyn Leszcz, Mt. Sinai’s chief of psychiatry.
Younger psychiatrists have been exposed to training on appropriate boundaries with patients, are more conscientious about their own emotional health and actually do their jobs differently, said Dr. Leszcz, who was not involved in the study. They are more likely to practise with groups of other doctors and spend less time in one-on-one psychotherapy sessions, he said.
“If you sit in your office and experience the kinds of strong feelings that get generated in psychotherapy all the time, in isolation, then it becomes harder to maintain professional perspective,” said Dr. Leszcz.
Still, the results from Dr. Bell’s study are “disappointing” in light of the measures taken to combat sexual abuse, said Dr. Donald Addington, chair of the Canadian Psychiatric Association.
“This kind of report makes us think about ‘What more could be done?’ and at this point, we don’t have a particular new plan or direction,” said the University of Calgary professor.
Dr. Bell said the regulatory colleges in each province do little tracking themselves of trends in discipline, so he and his colleagues developed a database of physicians punished for wrongdoing from 2000 to 2009, a total of just over 600 cases.
Psychiatrists made up 14% of that number, twice their percentage in the medical profession, concluded the study, just published in the journal Plos One. They were 3.62 times more likely than other physicians to be found guilty of sexual abuse of patients, had 2.32 times more chance of being convicted of fraud-related discipline offences, and were three times as apt to be found guilty of unprofessional conduct, the paper said.
Little research has been done on psychiatrists who “violate boundaries” with patients, but one 1989 study suggested a small number are actually psychotic, a somewhat larger group show antisocial or exploitative behaviour, and the largest category are the “lovesick” — typically neurotic, socially isolated middle-aged men who fall for much younger patients.
A 1997 Canadian study that followed a group of new psychiatrists over time concluded that the two who were eventually convicted of sexual abusing patients had identifiable personality problems even while still in training.
That raises the “ethically challenging” prospect of screening medical students for sexually exploitative tendencies before they are assigned to specialty training, the new study noted.
It is simply unclear, meanwhile, why a disproportionate number of psychiatrists are found guilty of fraud-related discipline charges, he said.