Medical school applicants should be screened for personality disorders to prevent ethical disasters

November 28, 2001

Medical schools should screen applicants for personality disorders before granting them entry, finds a study in the Journal of Medical Ethics. This would help clarify their ethical stance and help to avoid disasters such as the Shipman murders, say the authors.

The authors are aware that this is not an easy task, and discount an aptitude for moral reasoning, as the evidence shows that education can change this and that it may not relate to the decisions people end up making. They also discount ethical beliefs, as these could be liable to change, and contrived scenarios because students might simply approach these as an exercise.

Instead the authors conducted interviews with 32 academics, general staff, and clinicians at the University of Newcastle, Australia, and its hospitals, to find out if they had had professional experience of any unethical behaviour among doctors. The participants were then asked to describe these behaviours.

They chose similar words, all of which described personality traits, rather than the behaviour itself. "Arrogant," "brash," "condescending," "power-seeking," "devious," "self centred," "patronising" and "devious," were some that frequently appeared in the list.

The authors suggest that there have always been strong links between the ethical domain and psychiatry, citing the criteria for antisocial personality, which includes a disregard for, and violation of, the rights of others; and narcissistic personality disorder, which includes a lack of empathy and exploiting other people.

The authors admit that screening out narcissists might deprive medicine of future leaders and innovators, but believe that it is possible to distinguish between the doctor who is merely egocentric and unpleasant and the one whose narcissism will lead to unethical behaviour. The latter, they suggest, display a lack of empathy and reciprocity, take others for granted, shamelessly use others to enhance their personal progress, feel entitled and are prepared to give very little.

They conclude: "Credible attempts should be made to at least minimise the chances of unethical behaviour occurring. Not to do so would seem to be ethically inappropriate in itself."
[Is it possible to assess the "ethics" of medical school applicants? 2001; 27: 404-8]

BMJ Specialty Journals

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