When interviewing regulators and branch leaders about fraud, abuse and waste, we kept hearing the same two messages:
1. Things go wrong when people put their needs ahead of those of their patients
2. As a self-regulating profession, we have to call each other out for bad behaviour.
Physiotherapy (and health care in general) is an altruistic profession. Most of us go into physiotherapy to help people.
Of course, we need to be properly compensated for our knowledge, skills, time and education.
However, when getting remunerated becomes more important than what the patient in front of you needs, you are crossing an ethical line that could land you in hot water. Or worse.
By treating the insurance plan rather than the patient, a line is crossed.
The provider is putting their needs ahead of the patient’s. Treating the insurance plan rather than the patient can look like:
- Booking the patient in for the amount of appointments that their insurance will cover rather than what you predict will be needed to achieve therapeutic goals
- Using advertising strategies pointing out the expiration of health benefits as opposed to using health benefits for legitimate health care needs
- Cross-referring patients with benefits to all of the other health professionals in your clinic (e.g. RMT, chiro) regardless of patient need
So how do we make sure that we are behaving ethically?
Who decides what is right or wrong?
The first resource that I think of is “the College” (provincial regulatory body.) There are resources and the standards of practice on their website. Some of the larger colleges have practice advisors available to help work through challenging situations.
CPA’s Code of Ethics is another resource to help guide your practice. Take the time to review it, especially when you are faced with ethical dilemmas.
There are also rules to follow. If your practice includes publicly funded programs, extended health benefits, motor vehicle accident insurance, or worker’s compensation insurance; they each have their own rules to follow. Make sure that you know the rules and stay up to date on any changes.
Ignorance is not an excuse.
How can we stand by and watch colleagues behave unethically?
The Alliance announced the results of its investigation and sanctions against a candidate who forged his PCE exam results (May 19, 2016). That candidate will not be eligible to practice physiotherapy in Canada.
This is an extreme example. But what do we do when our employer, colleague or competitor behaves in unethical ways?
At some point, as self-regulating health professionals, we need to call each other out in order to maintain a positive reputation with Canadians. But that can be scary.
So how do you decide when to speak up and to whom?
Start with one of these:
- The Ethical Decision-Making Framework from the Winnipeg Health Authority
- The Ottawa Personal Decision Guide
- Speak to a trusted colleague or call the College to work through the problem and help figure out what options are available to you
Know your rights and responsibilities.
Follow your standards of practice.
If you are asked to do something that falls outside the line, listen to your gut.
Review the rules.
Your professional integrity and reputation are too important NOT to protect.
Further reading on whistleblowing
The Canadian Nurses Association has a good resource related to whistleblowing
Over to you
- Do you disagree with this stance on “making the call”? Why? Where is the line?
- What advice can you share to help others navigate this tricky area?
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