BALTIMORE – A significant number of medical residents who are referred for professionalism problems have Axis I or Axis II psychopathology.
Dr. Gabrielle S. Hobday, forensic psychiatry fellow at Emory University, Atlanta, and Dr. Glen O. Gabbard, professor of psychiatry at the Baylor College of Medicine, Houston, reviewed records of outpatient psychiatric evaluations of U.S. and Canadian physicians conducted by Dr. Gabbard from 1997 to 2009.
Extracting physicians who were in training at the time of referral, the researchers came up with 18 cases, which they presented in a poster at the annual meeting of the American Academy of Psychiatry and the Law.
Of the residents involved, 83% were male, and 72% were white. Their mean age was 34 years (range 26-47). Among the specialties involved, primary care–including family practice, internal medicine, and pediatrics–was the most common, at 55%.
The reasons residents were referred were grouped into four categories: sexual boundary violations (four residents), non–sexual boundary violations (three residents), disruptive/irresponsible behavior (nine residents), and clinical competence concerns (two residents). Eleven of the 18 subjects had had previous disciplinary measures, such as dismissal from a program or program probation; previous mental health treatment and/or evaluation; or medical board involvement.
Psychiatric diagnoses were common in this group, with 61% meeting criteria for personality disorders or significant personality traits, and 78% having been diagnosed with a non–substance abuse Axis I disorder. Another 16% were diagnosed with a substance abuse disorder, and 50% of the residents in the study had Axis I and II comorbidities.
Deciding whether to refer a physician-in-training for psychiatric help is not always easy, Dr. Hobday said in an interview. “Some people have been under the watchful eye of their program for a year, and things aren't getting any better. … What do we do with this person who's been a resident for 4 years and only has 1 year left?”
Of the 18 trainees in the study, 12 were deemed fit for duty while undergoing concurrent treatment/rehabilitation. Psychiatric treatment, including psychotherapy and/or medication, was recommended in 15 cases.
“In this era of heightened concern about professionalism, great emphasis has been placed on education in medical school and … monitoring in residency,” the authors noted. “However, we also have observed that education is not sufficient to address all of the underlying causes of misconduct.”
The study did not involve outside funding. The authors said they had no conflicts of interest related to the study.