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Table 4 Frequencies and definitions of the apparent motives

From: Exploring unnecessary invasive procedures in the United States: a retrospective mixed-methods analysis of cases from 2008-2016

Financial gain

Performing unnecessary procedures generated significant revenue well beyond standard medical practice. E.g., literature highlighted that the physician billed >$1 million for unnecessary spinal fusion surgeries.

92.4%

Personality disorder

Literature provided evidence of 2 or more DSM-V criteria for a diagnosis of antisocial personality disorder. E.g., physician arrested for unrelated matters, continued performing unnecessary procedures after a patient death, and showed a lack of remorse.

48.1%

Poor problem solving

Unnecessary procedures appeared due to poor knowledge of standards of practice or deficient clinical skills.

11.4%

Ambition

Unnecessary procedures appeared motivated by career ambition, e.g., to enhance stature in the field or within the institution.

3.8%

Mental illness

Literature mentioned diagnosis with a severe mental illness such as bipolar disorder, schizophrenia, or major depression, and this appeared to play a causal role in the unnecessary procedures.

1.3%

Carelessness

Evidence that unnecessary procedures occurred due to carelessness rather than intentional fraud or incompetence.

1.3%

Substance abuse

Substance use disorder appeared to causally contribute to the performance of unnecessary procedures, e.g., by impairing judgment or creating an increased need for cash to support addiction.

0%

Stress

Significant personal stress such as bankruptcy or divorce appeared to impair decision making.

0%

Retaliation

Unnecessary procedures appeared motivated by the perception that the system is unjust or in retaliation against an institution for causing personal harm.

0%

None

No motive could be identified or reasonably inferred.

2.5%