Ethical Issues for Doctors Of Chiropractic Exclusive of (Sexual Misconduct)

Transcription

1 Ethical Issues for Doctors Of Chiropractic Exclusive of (Sexual Misconduct) Presented By: Joseph S. Ferezy, D.C. Objectives Sensitize the D.C. To issues relating to ethical dilemma that may arise in chiropractic practice Real or perceived Applies to patients and employees alike 1

2 Ethics A major branch of philosophy, encompasses right conduct and good living. It is significantly broader than the common conception of analyzing right and wrong A central aspect of ethics is "the good life", the life worth living or life that is satisfying, which is held by many philosophers to be more important than moral conduct. The major problem is the discovery of the summum bonum, the greatest good. The right act can be identified as the one causing the greatest good and the immoral act as the one impeding it. Morals Ethics and morals are respectively akin to theory and practice. Ethics denotes the theory of right action and the greater good Morals indicate their practice Moral has a dual meaning. The first indicates a person's comprehension of morality and his capacity to put it into practice. In this meaning, the antonym is "amoral", indicating an inability to distinguish between right and wrong. The second denotes the active practice of those values. In this sense, the contrary word is "immoral", referring to actions that violate ethical principles. Personal ethics signifies a moral code applicable to individuals, while social ethics means moral theory applied to groups. 2

3 Professional ethics Doing the right thing for a patient who has established a doctor/patient relationship Not determined by Law Scope of practice Determined by physician and patient The problem Real Patients are vulnerable When procedure is for gratification of doctor Do you practice for income or outcome Doctor may believe the unbelievable 3

4 The problem Perceived Patient may expect too much (excessive office time, sunday house calls, etc.) He grabbed me around the hips and pulled me toward him Specific patient related ethical issues Accepting a patient Responsibility to the patient Making a diagnosis Selecting therapy (do no harm) Sharing diagnosis/records Sharing responsibility to society (reporting child/dependant adult abuse, spousal abuse, suicidal/homicidal, etc.) Referral Over treatment & under-treatment Inappropriate patient behavior Patient billing issues Discharging a patient Responsibility to a former patient Treating an employee Treating immediate family Treating extended family 4

5 Accepting a patient Telephone contact do you do? Initial meeting Unrelated illness Bad vibe Responsibility to the patient Making a diagnosis Finding cancer Selecting therapy (do no harm) Subluxation v acute disc herniation Sharing diagnosis/records Best interest of patient Fees for records Patient Other physician Lawyer Insurance company 5

6 Responsibility to the patient Sharing responsibility to society (reporting child/dependant adult abuse, spousal abuse, suicidal/homicidal, etc.) Other physicians errors Malpractice Conspiracy of silence Referral To specialist From medical/osteopath Responsibility to the patient Do you practice for outcome or income? Over treatment If 100% chiropractic utilization Under treatment Follow-up on no-shows Patient characteristics and behavior Impaired Smells bad Dirty Off color comments 6

7 Patient billing issues Doctor v staff responsibility Not paying bills/making co-pays Bad checks/credit Charging for services Interference of managed care contracts Discharging a patient 7

8 Responsibility to a former patient Records requests Honoring past fees Treating an employee No different! Schedule time Keep records Fees 8

9 Treating immediate family At your own peril! Fees Treating extended family Ay your own peril! No different! Schedule time Keep records Fees? 9

10 Avoidance of ethical dilemma Have and enforce rules for your practice. Have a system to deal with issues (logs, meetings) Have communication (written and verbal) Keep good clinical records Recording an incident May keep separate file Use dating system if possible 10