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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%