Discipline for Psychiatrists

To the Editor: James Morrison, M.D., and Theodore Morrison, M.P.H. (1), concluded in their article that psychiatrists were significantly more likely than nonpsychiatric physicians to be disciplined for sexual relationships with patients. However, in reaching a conclusion with possible widespread implications, the authors did not present the data typically seen in other published scientific studies. Specifically, the definition of “sexual contact” used by the board was not reported. The process used to determine whether “sexual contact” occurred was also not defined.

The authors acknowledged that the psychiatrist’s office is a unique medical setting involving, for example, isolation from other professionals. However, it is unclear to what extent psychiatrists, compared to nonpsychiatric physicians, made judgments regarding sexual misconduct in these cases. Similarly, the background of the psychiatrists involved, specifically their type and level of expertise in dealing with such issues, was not discussed. Also, whether the medical board sought consultation with the state psychiatric association to validate its findings was not mentioned.

Without this information, the article can be seen as suggesting another unsettling hypothesis that the authors did not consider. Psychiatric patients may be more apt to file questionable or distorted complaints with a state board, and at least a subgroup of psychiatrists may seek to settle when confronted with an expensive adversarial process in an unfavorable environment.