Does the punishment fit the crime? New study on disciplinary cases suggests patients and docs don't agree

A new study from researchers at the University of Toronto and Unity Health shows that physicians and the public have differing ideas about the severity of different types of violations, suggesting the risk of “in-group” bias when it comes to the adjudication procedures.In phase 1 of the study published earlier this month in the journal FACETS, the researchers surveyed 11 patients/family members and 17 physicians asking them to rate the severity of categories of misconduct and disciplinary actions on a scale of one to five in order to establish a hierarchy. In phase 2, the researchers analyzed a subset of 221 discipline summaries published by the College of Physicians and Surgeons of Ontario between 2010 and 2019. During phase 1, there was consensus among both physicians and patients when it came to the severity of some misconduct categories. Unlicensed activity, conviction of a crime, fraudulent behaviour, unprofessional conduct and sexual misconduct all received average severity scores of four or higher in both groups, with the latter being considered the most severe. Both groups also agreed that license revocation was the most severe disciplinary outcome.However, the patient group did rate two types of misconduct higher in severity than the physician group. Standard of care issues had an average severity score of 3.47 among physicians, but among patients, the score was 4.18. Similarly, inappropriate prescribing also had an average severity score of 4.18 among patients, while doctors only gave it a score of 3.53.Similarly, patients rated surrender of license and restriction of license as less severe compared to physicians. The average severity scores for these punishments were 3.28 and 2.64 for patients, compared to 4.12 and 3.29 for doctors, respectively.“This reflects a well-known phenomenon of ‘in-group’ bias that may impact how individuals assess outcomes,” the authors wrote. “This finding demonstrates the importance of including members of the public in complaints adjudication pathways as one step to build and maintain trust in physician regulatory processes, a practice currently adopted by the CPSO.”In phase 2 of the study, which analyzed the disciplinary cases, the most common allegations were unprofessional conduct (61.1%) followed by standard of care issues (52%) and sexual misconduct (22.6%). The researchers also found gender differences in the frequency of the types of misconduct cases. For example, sexual misconduct was reported more often among male physicians than female physicians (26.7% for men, 6.7% for women). Meanwhile inappropriate prescribing was more common among women physicians (33.3%) than men (18.8%).In addition, the findings also show a disproportionality in the severity of punishments compared to the severity of misconduct. Using the severity data developed in phase 1 of the study, the misconducts incidents that were analyzed had an average severity score of 4.11, while the disciplinary actions had an average severity score of 3.19.The researchers say these findings suggests that the adjudication process “may have room for improvement” in ensuring that the disciplinary actions match the severity of the violation—or ensuring that there is clear and transparent justification of the factors that warrant a less severe punishment.“Our findings suggest that adjudication processes may have room for improvement,” they wrote.

Does the punishment fit the crime? New study on disciplinary cases suggests patients and docs don't agree

Register for free access or login.

Related Topics