May 2003

Program addresses ethically challenged physicians

ORLANDO, FLA — Doctors of chiropractic who find themselves “ethically challenged” could find themselves summoned to a special weekend intervention by their regulatory boards. Participants of the FCLB’s annual conference at Walt Disney World heard about a weekend program for ethically impaired physicians.

The program – ProBE (an acronym for Professional/Problem-Based Ethics) is designed to help rehabilitate physicians who have been brought before their regulatory boards for disciplinary actions, Joseph C. d’Oronzio, PhD, MPH, told conference participants.

D’Oronzio, faculty associate with Columbia University’s Center for Bioethics and a principal with Ethics Group LLC, told the audience that he and his organization have conducted approximately 250 interventions on medical personnel between 1992-2003. Approximately 15-20 of these individuals have been chiropractors and 70 percent of the participants have been physicians in specialties similar to chiropractic.

Regulatory boards have requested these physicians to attend the intervention because of a variety of ethics transgressions, including:

• Boundary infractions (30 percent). He explained that boundary issues include enmeshing relationships and mixing professional and financial or sexual or other types of relationships;

• Fraud (20 percent);

• Misrepresentation (32 percent);

• All other infractions (18 percent).

The intervention lasts a weekend. During that time, the physicians engage in a variety of introspective tasks. For example, they:

• Explore the values and attributes of the “good” doctor;

• Identify the flipside of the “good doctor” attributes;

• Write a summary of what caused the participant to be “invited” to the intervention;

• Share their summaries with other participants in a 10-minute presentation; and

• Learn about appropriate clinician-patient relationships, including appropriate boundaries.

One of the most powerful segments of the intervention, explained d’Oronzio, occurs when participants start to open up about what brought them to the weekend. “Once a couple of people start to open up,” he said, “others see that they are not alone. They see that normal, constructive and accomplished people have gone the same route and can talk about the problem.”

No one is immune from becoming an ethically challenged physician, said d’Oronzio. He said that 85 percent of participants in the interventions are male, with an average age of 48.3. About 70 percent come from five specialities – internal medicine, family medicine, pediatrics, psychiatry and OB/GYN.

And, he said, these five specialties are similar to doctors of chiropractic because they all involve to some extent hands-on examination. “The closer you get to patients, there is more possibility for boundary-crossing and transgression,” he stated.

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