Patterns of unprofessional conduct by medical practitioners in South Africa, 2014 - 2023
Article Sidebar
Main Article Content
Abstract
Background. Over the past decade, South Africa (SA)’s healthcare landscape has shifted significantly as a result of policy reforms, including the Consumer Protection Act and amendments to the National Health Act. These changes have reframed the doctor-patient relationship, introducing economic and systemic pressures that may influence ethical decision-making.
Objectives. To revisit the patterns of professional misconduct of SA medical practitioners from 2014 to 2023, comparing findings with those of a previously published study (covering 2007 - 2013) to identify emerging trends and to reflect on the efficacy of past recommendations.
Methods. A mixed-methods approach was used to analyse published disciplinary records from the Health Professions Council of South Africa, excluding 2019 owing to data unavailability. Quantitative data were analysed using statistical tests to assess differences in transgression frequencies and sanction patterns between time periods. Qualitative analysis was used to categorise transgressions into several general and specific types to assess shifts in the patterns of professional misconduct.
Results. The average percentage of practitioners found guilty of misconduct decreased significantly from 0.164% (2007 - 2013) to 0.087% (2014 - 2023) of registered practitioners. However, the average number of guilty verdicts per practitioner remained statistically unchanged, indicating a persistent pattern of repeat offences. Notable shifts in transgression types included a decrease in fraudulent conduct and an increase in documentation-related negligence.
Conclusion. Although fewer practitioners were found guilty over the period of the present study, professional misconduct transgressions remained concentrated among repeat offenders. The study underscores the value of reinforcing the social contract in healthcare by recommending individualised ethics coaching for transgressors and revising current sanctioning practices to more effectively deter repeat misconduct.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJBL is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. Health Professions Council of South Africa. Health Professions Act, 1974 (Act No. 56 of 1974): Proposed Amendments to the Ethical Rules of Conduct for Practitioners Registered Under the Health Professions Act, 1974. Government Gazette No. 49720, 17 November 2023. Published under Government Notice R510. https:// www.gov.za/sites/default/files/gcis_document/202311/49720bn510.pdf (accessed 9 April 2026).
2. Rowe K, Moodley K. Patients as consumers of health care in South Africa: The ethical and legal implications. BMC Med Ethics 2013;14:15. https://doi. org/10.1186/1472-6939-14-15
3. Hoffmann WA, Nortjé N. Patterns of unprofessional conduct by medical practitioners in South Africa (2007 - 2013). S Afr Fam Pract 2016;58(3):108-113. https://doi.org/10.1080/20786190.2016.1186366
4. Rispel L. Analysing the progress and fault lines of health sector transformation in South Africa. S Afr Health Rev 2016;2016(1):17-23. https://hdl.handle.net/10520/ EJC189322 (accessed 9 April 2026).
5. Health Professions Council of South Africa. Judgements. Pretoria: HPCSA, 2025. https://www.hpcsa.co.za/page/judgements (accessed 24 September 2025).
6. Health Professions Council of South Africa. About us: History. Pretoria: HPCSA, 2025. https://www.hpcsa.co.za/about-us (accessed 24 September 2025).
7. South Africa. Health Professions Act 56 of 1974. https://www.gov.za/sites/ default/files/gcis_document/201505/act-56-1974.pdf (accessed 9 April 2026).
8. Health Professions Council of South Africa. Complaints process explained.
Pretoria: HPCSA, 2023. https://www.hpcsa-blogs.co.za/hpcsa-complaints-
process-explained/ (accessed 24 September 2025).
9. Starr P. The Social Transformation of American Medicine. New York: Basic Books,
1982:15.
10. Cruess RL, Cruess SR. Professionalism, communities of practice, and medicine’s
social contract. J Am Board Fam Med 2020;33(Suppl):S50-S56. https://doi.
org/10.3122/jabfm.2020.S1.190417
11. ABIM Foundation; ACP-ASIM Foundation; European Federation of Internal Medicine. Medical professionalism in the new millennium: A physician charter. J Am Coll Surg 2003;196(1):115-118. https://doi.org/10.1016/s1072- 7515(02)01617-4
12. London L, McCarthy G. Teaching medical students on the ethical dimensions of human rights: Meeting the challenge in South Africa. J Med Ethics 1998;24(4):257-262. https://doi.org/10.1136/jme.24.4.257
13. Musick DW. Teaching medical ethics: A review of the literature from North American medical schools with emphasis on education. Med Health Care Philos 1999;2(3):239-254. https://doi.org/10.1023/a:1009985413669
14. Behrens KG, Fellingham R. Great expectations: Teaching ethics to medical students in South Africa. Dev World Bioeth 2013;14(3):142-149. https://doi. org/10.1111/dewb.12017
15. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Acad Med 2014;89(11):1446-1451. https://doi.org/10.1097/ACM.0000000000000427
16. Hattab AS. Current trends in teaching ethics of healthcare practices. Dev World Bioeth 2004;4(2):160-172. https://doi.org/10.1111/j.1471-8731.2004.00091.x
17. DuBois, JM, Anderson EE, Chibnall JT, et al. Egregious ethical violations in medical
practice: Evidence-informed recommendations from a multidisciplinary working group. J Med Regul 2018;104(4):23-31. https://doi.org/10.30770/2572-1852- 104.4.23