Study Shows Ethics Complaints in Psychiatry Could Be Declining
If someone makes an ethics complaint against an American Psychiatric Association (APA) member, one of its 72 district branches handles it. But at a 2019 meeting of the APA Ethics Committee, members realized the last time any data were collected on ethics complaints was in 2007.
Thus, researchers recently examined the number and type of complaints received, how those complaints were handled, and the attitude of district branches toward ethics review.1 “The sorts of complaints we are seeing are ones that are very recognizable from what’s been previously published in the literature,” according to Michelle Hume, MD, PhD, the study’s lead author and a forensic psychiatrist at the Mendota Mental Health Institute in Madison, WI.
Hume and colleagues did not examine individual allegations to avoid discovering identifiable information. Instead, they reviewed only the topic area of the complaints. “There’s a fairly robust existing literature about the types of complaints that typically occur against physicians in a variety of specialties, including psychiatrists,” Hume notes. “Our study confirmed that the topic areas people have been concerned about are consistent with what we are seeing.” The most common complaints were about boundary violations, financial or billing-related issues, and practice issues (e.g., concerns about diagnosis or prescribing).
For an ethics complaint to move forward within the APA process, there must be a substantive violation. “Sometimes, people just call in because they are unhappy about their diagnosis or something else, but there hasn’t been a clear violation in terms of what would be ethically problematic for psychiatrists to do,” Hume reports.
Of the 95 total ethics-related complaints, only 22 were eligible to go forward to the next step (a peer review process). In most cases, “either the complainant didn’t follow up, or there wasn’t a recognized ethics violation that was alleged,” Hume says.
Over the years, the APA has collected data on ethics complaints in various ways. This makes direct comparisons impossible, but overall there seem to be fewer complaints. “The number of ethics complaints does appear to be decreasing since the initial APA data were collected between the 1950s and 1980s and now — and possibly even since 2007,” Hume says. One reason could be the emphasis on ethics education in psychiatry. When faced with ethical questions, APA members can rely on opinions, resource documents, and other materials. “People reported this was very helpful in terms of understanding the right thing to do,” Hume says.
- Hume M, Hobart K, Briz L, et al. Ethics oversight in psychiatry: Data from a model of organizational monitoring. Psychiatr Clin North Am 2021;44:563-570.
One reason could be the emphasis on ethics education in psychiatry.
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