Who Gets to be a Doctor?




I was intrigued by a recent article in the New York Times describing how a Swedish medical school admitted a student whom they later learned had done jail time for murder. Apparently Swedish universities aren’t allowed to do criminal background checks, and even if they were, the student in question had legally changed his name prior to his application to medical school. So now the murderous Swede is a medical student, and the school is wondering what to do with him.

In the article, many of his fellow medical students expressed harsh criticism of the school for admitting this student, if not outrage. But one student openly wondered who had the right to say that this person may not turn out to be a great doctor, in spite of his past misdeeds.

Who, indeed? After all, there are reports that some congressmen have prior convictions. George W. Bush may have been the first U.S. president to enter office with a criminal record. Even Bill Gates has a rap sheet, and I think it’s fair to say he’s doing pretty well for himself. Moreover, our country is faced with an imminent shortage of physicians, and declining interest in primary care. In light of such shortages, should we keep people who are willing and able out of medical school due to past offenses? And if so, where do we draw the line? Murder seems to be a likely exclusion criterion. How about rape? Assault with a deadly weapon? DUIs? Parking tickets? Domestic abuse? Animal cruelty? Fraud?

As anyone schooled in behavioral interviewing can confirm, the best predictor of future behavior is past behavior. A 2008 article published in the Annals of Internal Medicine found that physicians who had poor professionalism behaviors during residency were much more likely to face disciplinary actions as practicing physicians. In addition, a 2005 article published in the New England Journal of Medicine found that disciplinary actions by state medical boards were strongly associated with prior unprofessional behavior in medical school.

So to the extent that having a criminal record can be considered “unprofessional,” it seems that a criminal record — any criminal record — would be sufficient reason to keep someone from becoming a doctor. And if the Swedes don’t want to look for a record of criminal activity prior to admitting people to medical school, they’re going to have to make sure their medical licensing boards, as well as their citizens, are ready to suffer the consequences.

References

Altman, Lawrence. A Quandary in Sweden: Criminals in Med School. The New York Times, March 23, 2009: D1.

Papadakis M, Arnold G et al. Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards. Annals of Internal Medicine, June 3 2008. Volume 148, Issue 11, pp 869-876.

Papadakis, M. (2005). Disciplinary Action by Medical Boards and Prior Behavior in Medical School New England Journal of Medicine, 353 (25), 2673-2682 DOI: 10.1056/NEJMsa052596

T. A. McNamee, MD

T. A. McNamee, MD, is an associate professor and internal medicine residency program director at Sanford School of Medicine of the University of South Dakota.
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