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Does Psychiatry Have a Discipline Problem?

By Ross Pomeroy

Psychiatry is a medical profession entirely different from most others. Instead of dealing strictly with physical problems, psychiatrists treat mental disorders, which are far more abstract conditions. Moreover, differences in the nature of the patient-physician relationship are manifold. The psychiatrist-patient relationship is often far more personal, and psychiatrists frequently deal with patients lacking mental faculties.

For these reasons, a team of Canadian medical professionals sought to discern whether or not psychiatrists were more likely to commit medical misconduct than non-psychiatrists. To examine the issue, they constructed a database of all Canadian physicians disciplined between 2000 and 2009.

In all, 606 physicians were disciplined during the period studied. Of these, 82 (14%) were psychiatrists, approximately double the national proportion of psychiatrists (7%). Delving further, the researchers found that psychiatrists were 3.6 times more likely to be disciplined for sexual misconduct, 2.3 times more likely to be disciplined for fraudulent behavior, and 3.1 times more likely to be disciplined for unprofessional conduct.

The study had a couple noteworthy limitations: A small proportion of disciplinary data was unavailable in certain provinces and territories for specific years, and 23 disciplinary cases were excluded because they lacked the physician's name.

It should be noted that the overall incidence of disciplinary actions taken against physicians each year is small -- 0.5% in the United States and 0.1% in Canada -- so the vast majority of psychiatrists aren't committing misconduct.

Furthermore, the results are inherently ambiguous and can be interpreted in a variety of ways. They certainly aren't an indictment of psychiatry as a whole.

"The nature of the problems that may render psychiatric patients especially vulnerable to inappropriate caregiver relationships may also make them more reluctant or conversely, inclined, than most to report sexual misgivings," the researchers wrote.

The study was published Nov. 28 in the open-access journal PLoS ONE.

Source: Alam A, Kurdyak P, Klemensberg J, Griesman J, Bell CM (2012) The Characteristics of Psychiatrists Disciplined by Professional Colleges in Canada. PLoS ONE 7(11): e50558. doi:10.1371/journal.pone.0050558

Ross Pomeroy is the assistant editor for Real Clear Science. Follow him on Twitter @SteRoPo.

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