The Role of Family of Origin in Physicians Referred to a CME Course

Abstract

Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly white, middle-aged males who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one's family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs

“…First, we found some indication of defensive responding in the self-report measures of attachment style and maladaptive beliefs, consistent with prior studies [7]. Last, though the gender, age and specialty composition of our group parallel those of similar samples [5,16,49], extension of these findings to other nonreferred provider or physician samples should be done judiciously. Specifically, a reliance on self-report measures may have overestimated the correlations among variables.…”

“…Although prior reports in referred samples have noted dysfunctional family-of-origin dynamics and high levels of exposure to childhood abuse in boundary-challenged health care professionals [1,5,16,[49][50][51], our study is the first to use a well-validated, standardized tool to assess multiple categories of childhood trauma, including neglect [39]. Notably, however, even the CTQ does not assess all substantive categories of maltreatment: almost one-third of respondents described in their autobiographies adverse childhood experiences not captured by the CTQ (e.g., bullying, witnessing frequent arguments between parents).…”

“…Opposed to these more proximal factors for boundary violations are distal risk factors, which include childhood maltreatment and family-oforigin issues [16], insecure attachment and individual psychological processes [early maladaptive schemas (EMSs); see below) [17]. Importantly, assessment of these distal factors abets an individualized approach to risk reduction.…”

“…A relatively limited literature has used standardized instruments to identify distal risk factors in boundary-challenged physicians [7,9,16,18]. Overall, these studies find that compared to controls, boundary-challenged physicians are more likely to have problematic personality traits [7,9,18] and dysfunctional families of origin [16].…”

“…Despite these limitations, the extant literature suggests that certain specific characteristics of physician's early environment and personality traits confer risk for boundary violations [7,9,16,18]. Based on these data and our experience with referred physicians, we identified three distal risk factors that can be assessed with brief, well-validated self-report scales: (a) childhood abuse and neglect, (b) attachment anxiety and avoidance, and (c) maladaptive beliefs (also known as "EMSs" [23]).…”