Deviance Among Physicians: Fraud, Violence, and the Power to Prescribe was written to address the phenomenon of deviant behavior exhibited by physicians. The book focuses on medical fraud, and violence by physicians toward patients. This book was written by Thaddeus L. Johnson, doctoral candidate in Criminology and Criminal Justice at the Andrew Young School of Policy Studies at Georgia State University; Natasha Johnson, doctoral candidate in the Educational Policy Studies Department at Georgia State University; and Christina Policastro, Assistant Professor of Criminal Justice in the Department of Social, Cultural, and Justice Studies at the University of Tennessee at Chattanooga.
This book is organized into five chapters: an introductory chapter exploring the definition of deviance and how it applies to medical professionals, followed by a chapter discussing medical insurance fraud by physicians. The book continues with a chapter exploring violence by physicians against patients, specifically the aspects of unnecessary procedures and sexual violence against patients. The book ends with a chapter discussing the literature surrounding response strategies to physician deviance.
The authors highlight important information regarding the phenomenon of physician deviance, which they define as “illicit or fraudulent acts committed by doctors for personal gain within the context of their profession” (p 1). The authors introduce theoretical framework concepts from the field of criminal justice, such as the routine activities theory (i.e., “Crime stems from the convergence of motivated offenders and suitable targets in settings where capable guardianship is missing” (p 15)), neutralization theory (i.e., “crime occurs when otherwise prosocial persons are able to suppress or neutralize conventional values and engage in malfeasance” (p 17)), and control balance theory (i.e., the presence of imbalances in the control ratio, defined as “a comparison between the amount of power one is subjected to and the amount of power one can exert” (p 28)). These theoretical frameworks are helpful to forensic psychiatrists and psychologists in conceptualizing criminal behavior among health care workers and provide a good introduction to theories commonly used in sociological and criminological frameworks. The authors provide some examples of conduct explained by these theoretical frameworks, including insurance fraud by physicians in the absence of oversight (explained through the routine activities theory) or rationalizing insurance fraud as a form of defiance against the administrative system (explained through the neutralization theory).
Although the topic of the book is relevant to forensic psychiatry and psychology, it lacks a neutral scientific tone commonly found in scholarly literature. The authors acknowledge the important fact that deviant behavior among physicians is an overall uncommon phenomenon. Simultaneously, the authors often adopt a prosecutorial tone while presenting evidence from the literature to support their viewpoint. There are indicators throughout the text suggesting the presence of bias by the authors when they describe what appears to be subjective opinion presented as if it were objective facts. Consider, for example, the following quotation from Chapter 4 (Responding to Crime and Deviance):Given the widespread inclination to blindly trust a trained doctor’s professional opinion, authorities often take the physician’s word for it … A 2015 case in California clearly demonstrates the leniency afforded to physicians in cases of sexual misbehavior … The physician pled no contest to five felony counts of sexual misconduct, but the judge did not send him to prison nor was he ordered to register as a sex offender (p 51).
The same chapter concludes by stating, “While most health care providers, physicians included, serve the public with integrity, a fair amount deal in the currency of deceit and corruption” (p 52). The use of words such as “clearly” without the support of clear evidence suggests a diversion away from a scientific viewpoint toward a more subjective view, which is not characteristic of forensic work. The text would have benefited had the authors included a more thorough legal background to the cases of physician deviance they discussed. Instead, many cases are presented as “a doctor was accused of X and responded with Y, and was only sentenced to Z instead of prison time or other sanctions.” These brief, superficial vignettes are then used as examples highlighting physician deviance and lack of oversight and regulations.
Nevertheless, this book remains an important contribution to the study of physician deviance, and serves as a cautionary reminder to all clinicians to be wary of potential boundary violations and illegal activities that can arise while practicing and caring for patients. More research and inquiry are needed to understand this phenomenon in greater detail and to develop an evidence base for potential interventions to address deviant behavior among health care workers.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2022 American Academy of Psychiatry and the Law
