Preventing Egregious Ethical Violations in Medical Practice: Evidence-Informed Recommendations from a Multidisciplinary Working Group

Abstract

This article reports the consensus recommendations of a working group that was convened at the end of a 4-year research project funded by the National Institutes of Health that examined 280 cases of egregious ethical violations in medical practice. The group reviewed data from the parent project, as well as other research on sexual abuse of patients, criminal prescribing of controlled substances, and unnecessary invasive procedures that were prosecuted as fraud. The working group embraced the goals of making such violations significantly less frequent and, when they do occur, identifying them sooner and taking necessary steps to ensure they are not repeated. Following review of data and previously published recommendations, the working group developed 10 recommendations that provide a starting point to meet these goals. Recommendations address leadership, oversight, tracking, disciplinary actions, education of patients, partnerships with law enforcement, further research and related matters. The working group recognized the need for further refinement of the recommendations to ensure feasibility and appropriate balance between protection of patients and fairness to physicians. While full implementation of appropriate measures will require time and study, we believe it is urgent to take visible actions to acknowledge and address the problem at hand.

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“…One benefit of using Behavior substitution is that this strategy may be more acceptable to healthcare professionals (HCPs) than current ways to reduce low-value or harmful care, which may be more punitive and extreme (e.g. financial penalties, medical practice sanctions, or restrictive measures) 7 …”

Scientific Ethical Integrity and Human Research Subjects Protections Non-compliance Remediation: Commentary on Practical Considerations and Implications

“…[30,31] This is probably the consequence of their embarrassing and sensitive nature, so that only direct participants are truly privy to them. [17][18][19][20]…”

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