Understanding the Severity of Wrongdoing in Health Care Delivery and Research: Lessons Learned From a Historiometric Study of 100 Cases

Abstract

Background: Wrongdoing among physicians and researchers causes myriad problems for patients and research participants. While many articles have been published on professional wrongdoing, our literature review found no studies that examined the rich contextual details of large sets of historical cases of wrongdoing. Methods: We examined 100 cases of wrongdoing in health care delivery and research using historiometric methods, which involve the statistical description and analysis of coded historical narratives. We used maximum-variation, criterion-based sampling to identify cases involving 29 kinds of wrongdoing contained in a taxonomy of wrongdoing developed for the project. We coded the presence of a variety of environmental and wrongdoer variables and rated the severity of wrongdoing found in each case. This approach enabled us to (a) produce rich descriptions of variables characterizing cases, (b) identify factors influencing the severity of wrongdoing, and (c) test the hypothesis that professional wrongdoing is a unified, relatively homogeneous phenomenon such as “organizational deviance.” Results: Some variables were consistently found across cases (e.g., wrongdoers were male and cases lasted more than 2 years), and some variables were consistently absent across cases (e.g., cases did not involve wrongdoers who were mistreated by institutions or penalized for doing what is right). However, we also found that some variables associated with wrongdoing in research (such as ambiguous legal and ethical norms) differ from those associated with wrongdoing in health care delivery (such as wrongdoers with a significant history of professional misbehavior). Conclusions: Earlier intervention from colleagues might help prevent the pattern we observed of repeated wrongdoing across multiple years. While some variables characterize the vast majority of highly publicized cases of wrongdoing in health care delivery and research—regardless of the kind of wrongdoing—it is important to examine and compare sets of relatively homogeneous cases in order to identify factors associated with wrongdoing.

Keywords:

• professionalism
• medical ethics
• research ethics
• misconduct
• organizational deviance
• professional misbehavior

ACKNOWLEDGMENTS

We thank Michael Mumford for discussions contributing to the initial approach taken in this study. We thank the following research assistants for writing cases and other tasks: Kelly Carroll, Tyler Gibb, Elena Kraus, Shane Levesque, Andrew Plunk, Timothy Rubbelke, Meghan Vasher, and Rebecca Volpe. We thank the following colleagues for rating the severity of wrongdoing found in cases: Ana Iltis, Tracy Koogler, Sahana Misra, and Lisa Parker.

Notes

All cases were eventually published, but we did not count the publication as a negative career consequence if publication occurred after retirement or death.