I wonder why a review of ethics in practice is seen, by many health
disciplines, as less important than learning technical or
business-related concepts.
I wonder why a review of ethics in practice is seen, by many health disciplines, as less important than learning technical or business-related concepts. At a recent conference, I noticed that only about 40, out of hundreds of registrants, attended a class on ethics in practice. In fact, adherence to the ethical principles comprising respect for the individual, welfare of persons and justice should be considered vital in a clinical setting – to your patients, these principles are indispensable in achieving optimal outcomes and high-quality, holistic care; for your practice, they represent incident prevention and success through excellence.
In his lecture on ethics in chiropractic practice, Steve Savoie DC cited examples of doctors of all stripes neglecting these principles. He spoke of doctors not allowing patients time to expand on points within their history; register complaints; ask questions freely; or, God forbid, question any proposed strategy. Some, he said, create barriers to patient autonomy by failing to provide non-coercive, comprehensive – and comprehensible – informed consent; and failing to include, or tolerate, discussion of alternatives to the proposed care plan. He related examples of docs compromising the fiduciary relationship by performing procedures that may not be indicated. He warned against tendencies, across health care, not to provide necessary referrals. And he countered these with examples of outcomes achieved when practitioners adher to ethical principles. Not surprisingly, the rewards of doing so, to both patients and doctors, were incontestable by his (alarmingly small) audience.
Despite DCs’ commitment to, and reputation for, providing compassionate and holistic care, some members of the profession are guilty of infractions of ethical behaviour, as are some MDs and other health-care professionals. I am well aware your profession struggles with this and that you are working hard to prevent it amongst your ranks.
Preliminary solutions to this problem may revolve around giving priority to patient outcomes over patient visits.
This can involve the following actions: Take the time required with each patient on each visit – for a given patient, this may vary between visits. Let the patient and their family members talk and ask questions – it’s amazing what this might reveal. Understand your patient’s health goals and explain, without coercion, your preferred strategies and why you feel they will work – openly discuss alternatives. Then, without judgment, allow the patient to choose. Remember that informed consent is an ongoing process – continue to ensure your patient understands what is being done with, and to, them throughout their care. Don’t commit to a service or activity that you do not have time for, or are not adequately equipped, or trained, to provide – be honest and upfront. Refer out, if necessary. Offer, or agree to provide, letters/documents/referrals, and provide them in a timely and professionally relevant manner. Accept when a strategy, no matter how tried and true, may not work for a particular patient – this is not a sign of your technique’s weakness, but of your strength as a clinician. Finally, don’t shun opportunities to hone your knowledge and understanding of ethical concepts and how they can impact your practice.
Most importantly, don’t do all of this because it will ensure you’re “covered” and/or enhance your numbers. Do it, as Dr. Savoie so elegantly stated, because it’s the right thing to do. •
Bien à vous,
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